The new surface landmarks for blind axillary vein puncture

Abstract Objective: To compare the efficacy of blind axillary vein puncture utilizing the new surface landmarks for the subclavian method. Methods: This prospective and randomized study was performed at two cardiology medical centers in East China. Five hundred thirty-eight patients indicated to undergo left-sided pacemaker or implantable cardioverter defibrillator implantation were enrolled, 272 patients under the axillary access and 266 patients under the subclavian approach. A new superficial landmark was used for the axillary venous approach, whereas conventional landmarks were used for the subclavian venous approach. We measured lead placement time and X-ray time from vein puncture until all leads were placed in superior vena cava. Meanwhile, the rate of success of lead placement and the type and incidence of complications were compared between the two groups. Results: There were no significant differences between the two groups in baseline characteristics or number of leads implanted. There were high success rates for both strategies (98.6% [494/501] vs. 98.4% [479/487], P=0.752) and similar complication rates (14% [38/272] vs. 15% [40/266], P=0.702). Six cases in the control group developed subclavian venous crush syndrome and five had pneumothorax, while neither pneumothorax nor subclavian venous crush syndrome was observed in the experimental group. Conclusion: We have developed a new blind approach to cannulate the axillary vein, which is as effective as the subclavian access, safer than that, and also allows to get this vein without the guidance of fluoroscopy, contrast, or echography.

El ganglio centinela en el cáncer de mama precoz / Sentinel node in early breast cancer

Presentar nuestra experiencia en utilización del ganglio centinela en cáncer de mama precoz. Entre mayo 1998 y julio 1999 realizamos la identificación del ganglio centinela utilizando azul de isosulfán en 40 pacientes con carcinoma mamario, todos ganglios clínicamente negativos. El ganglio centinela fue determinado en 28 casos (70%), siendo positivo en 8 (36,4%). Desde agosto1999 - abril 2011, realizamos determinación del ganglio centinela mediante técnica combinada Linfazurín® 1% y/oazul patente 3% + 99m Tc (1 500 mCi 12 horas antes de la intervención 733/726 pacientes, todos axila clínicamente negativa. 5 falsos negativos (22,7%).Últimos 15 casos porcentaje de detección subió 73,3% falsos negativos solo 9,1%. La identificación fue posible solo con azul en 702/733 (95,67%) y solo con 99mTc en720 (98,22%) y en 728/733 (99,32%) al combinarlos. En cinco (0,68%) no fue posible localizar el ganglio centinela por ninguno de los dos métodos. Axila fue positiva en 175/733 casos (23,87%), siendo el centinela el único ganglio positivo en 84 (48%), micro-metástasis 42/175 casos (24%). 10 falsos negativos en 175 axilas positivas (5,71%). Sensibilidad del procedimiento combinado es 92,3% con especificidad 100%. Valor predictivo positivo 100% negativo 97,05%. Factores pronósticos más importantes para ganglio positivo fueron grado nuclear, invasión linfovascular. La combinación de azul con 99m Tc es idónea con alta sensibilidad y especificidad del procedimiento

Present our experience in utilization of sentinel lymph node in early breast cancer. We realized identification of sentinel lymph node utilized isosulfan blue in 40 patients with breast cancer, all of them with nodes clinical negative between May of 1998 to July1999. The sentinel lymph node was determinate in 28 cases (70%) it was positive 8 (36.4%). Until August 1999 - April 2011 realized the sentinel lymph node determination with combined technique Linfazurin 1% blue patent 3% + 99mTc(1500 mCi 12 hours before intervention. 733/726 patients with clinical negative axillaries. 5 negative false (22.7%). Last 15 cases percentile of detection was increased 73.3% negative false only 9.1%. Identification were possible only with blue 702/733 cases (95.67%) only with 99m Tc in 720 (98.22%) in 728/733 when combined both. Five (0.68%) was not possible localization of sentinel forany of two methods. The axils were positive 175/733 cases (23.87%) only positive node was the sentinel in 84 (48%), micro metastases 42/175 s (24%). 10 negative falser 175 positives axillaries (5.71%). The sensitive of combined procedure was 92.3% with specificity 100%. Predictive positive value was 100% negative 97.05%. Prognostic factors more important positive nodule were nuclear grade, and lymphatic vascular invasion. The combination of blue with 99m Tc is a procedure with high sensitive and specificity

Aneurisma venoso no pé: relato de casos e revisão da literatura / Venous aneurysm of the foot: case reports and review of the literature

Este relato descreve dois casos de aneurisma venoso no pé, apresentados sob a forma de tumoração indolor e não-pulsátil no dorso do pé e sem história de trauma. O ultra-som Doppler evidenciou formação ovalada, anecóica, em comunicação com a veia e com sinal Doppler venoso, sugestiva de aneurisma venoso. O diagnóstico foi confirmado pelo exame histopatológico, com dilatação aneurismática constituída pelos três componentes da parede da veia. O tratamento consistiu na ligadura e ressecção cirúrgica. Os aneurismas venosos são relativamente raros, havendo relato de sua presença em várias localizações, principalmente nos membros inferiores. Na revisão da literatura, não foram encontrados relatos de aneurismas venosos no pé.

We report two cases of venous aneurysms of the foot, presented as a nonpulsatile, painless mass on the back of the foot, with no history of trauma. Doppler ultrasonography showed an anechoic, oval mass communicating with the vein and venous signal suggestive of venous aneurysm. The diagnosis was confirmed by histopathologic analysis, with aneurysmal dilatation involving the three layers of the venous wall. The treatment consisted of ligation and surgical excision. Venous aneurysms are relatively rare, and their presence has been reported in many locations, particularly in the lower limbs. Any venous aneurysms of the foot were found in the review of the literature.

Brachio-infraclavicular axillary interposition graft as a successful tertiary vascular access procedure for hemodialysis

This study describes experience with brachio-axillary interposition graft for hemodialysis as a successful tertiary vascular access procedure. The purpose of the study is to assess the role of this procedure in the dialysis access algorithm. Between May [1995] and March [2000], fourteen grafts were placed in 14 patients, with exhausted venous arm sites. No significant post-operative complications occurred, the secondary patency rate after 1 and 2 years was 85.7% and 77% respectively, which were much better than conventional arm bridge fistula 50-70% after one year, Really, this procedure opened the closed doors infront of those miserable patients with chronic renal failure and exhausted all venous arm sites and good enough that the proposed two main problems with this procedure which were heart failure and steal phenomena did not occur with a significant importance. No single case of heart failure occurred in this series also, steal phenomena occurred only in one case with mild degree that there was no need for intervention, So, it might prove reasonable to use this graft earlier in an effort to eliminate the painful, costly and inconvenient multiple revisions frequently required with more conventional grafts

Cateterizaçäo percutânea da veia axilar: Uma alternativa de acesso venoso central-estudo prospectivo de 23 pacientes / Percutaneous catheterization of the axilary vein: An alternnative pathway to the central venous system Prospective study of 23 patients

Os autores estudam a cateterizaçäo percutânea da veia axiliar prospectiva, consecutivamente em 23 pacientes, obtendo sucesso da punçäo em 22(95,7por cento) sendo em 19(82,6por cento) deles na primeria tentativa. O tempo médio gasto no cateterismo foi de quatro minutos. A veia era visível em sete(30,4por cento), palpável em catorze (60,8por cento), e em dois (8,7por cento), a punçäo foi guiada pela pulsaçäo da artéria umeral. Realizou-se controle radiológico em 19(86,4por cento)pacientes e, em 1(5,3por cento), a extremidade do cateter ocupava uma lozalizaçäo anômala(V.jugular interna), taxa comparável às técnicas usuais de cateterismo. Baixa atividade enzimática e plaquetonia näo foram associados a nenhum tipo de complicaçäo hemorrágica. seis (27,3por cento) pacientes apresentaram complicaçöes: incômodo local (5-22,7por cento), infecçäo cutânea no local de punçäo (4-18,2por cento), troboflebite (1-4,5por cento), e edema do membro superior (1-4,5por cento). todas as complicaçSes foram correlacionadas à percutânea prologada do cateter (=>8dias - P<0.05), tendo todas regredidas após a retirada do cateter. Näo houve sepse relacionada ao cateter. O tempo médio de permanência foi 6,7 dias(1-14). a punçäo da via axiliar é um bom método alternativo para o acesso venoso central, com baixa morbidade, fácil e rápida execuçäo, sendo boa a sua aceitaçäo pelos pacientes. Há neste procedimento, ausência de riscos de danos mecânicos graves que comprometam a vida destes, até mesmo nos que se encomtram agitados e em ventilaçäo mecânica. Constitui-se no entanto, em uma via que deve ser utilizada emcateterizaçöes de curta permanência(8

Evaluación de la punción venosa axilar como vía de abordaje venoso central / Evaluation of axillary venous puncture as central venous boarding technique

Se evaluó prospectivamente la efectividad de la punción venosa axilar como técnica de abordaje venoso central, durante el período comprendido entre agosto de 1988 y agosto de 1990. Se realizaron un total de 216 punciones, de las cuales el 85,2% resultaron exitosas. El tiempo promedio de abordaje fue de 6,8 minutos, siendo realizados el 79,4% de las punciones en menos de 6 minutos. Hubo un total de 28 complicaciones, y la más frecuente fue la punción de la arteria axilar (42,6%). En seis pacientes se formaron hematomas sin ninguna consecuencia para ellos. En un solo caso se evidenció infección del catéter y tres pacientes sufrieron de tromboflebitis. se demostró que la punción venosa axilar es un procedimiento seguro, facil de realizar con un alto porcentaje de éxito y con ventajas ante otras técnicas, por lo cual se aconseja como una alternativa, en el abordaje venoso central

Fístula arteriovenosa axilo-axilar: um método alternativo de acesso vascular para hemodiálise

Os autores relatam sua experiência com a criaçäo cirúrgica de fístula arteriovenosa entre os vasos axilares em sete pacientes renais crônicos, visando obter acesso vascular nestes indivíduos näo candidatos a transplante e dependentes de hemodiálise. Tal procedimento é recomendado quando outros meios de acesso já foram esgotados. Uma prótese tubular, aloplástica, em posiçäo pré-esternal, subcutânea, sem formar alça, conecta os vasos axilares. O método é de fácil realizaçäo cirúrgica e permite a obtençäo de um acesso vascular seguro, durável, bem tolerado, com morbidade desprezível e mortalidade nula

Evaluación flujométrica de puentes axilofemorales y femoropoplíteos ante la compresión externa y la flexión / Flow evaluation of axillary femoral and femoropopliteal bypasses in external compression and flexion

Se evalúan los efectos que tienen las compresiones externas (peso corporal, cinturones, flexión de la pierna) sobre el comportamiento del flujo distal en un "bypass" axilofemoral o femoropoplíteo. Se estudiaron 10 puentes axilofemorales y 15 femoropolíteos (con diferentes materiales protésicos) no observándose variaciones estadísticamente significativas antes y después de las compresiones, concluyendose que la presión externa habitual no determina caída del flujo