CANNULATION of the cervical thoracic duct and external lymphatic drainage has been observed, by Dumont,1 to lead to a reduction in portal pressure and ascites in the cirrhotic patient. The physiological basis for this response has not been clarified.
A functional resistance at the venolymphatic area is an attractive concept which has received some support from previous investigation. Zemel and Gutelius2 have observed a valve structure at the junction that might limit a potential increase in lymphatic flow. The reduction in ascites following thoracic duct-esophageal shunting of lymph also supports the presence of a significant resistance at the junction.3 If a mechanical factor limiting flow at the lymphatic venous junction can be confirmed, a permanent reduction of portal pressure might result from thoracic duct venous anastomosis.4 Therefore, the present study was undertaken to evaluate resistance at the lymphatic venous junction at normal and elevated flow rates.
GUTELIUS JR, SHIZGAL HM. Resistance at the Thoracic Duct Subclavian Vein Junction. Arch Surg. 1966;93(5):755-758. doi:10.1001/archsurg.1966.01330050059008