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1.
Article in English | WPRIM | ID: wpr-810984

ABSTRACT

OBJECTIVE: To evaluate the technical feasibility of intranodal lymphangiography and thoracic duct (TD) access in a canine model.MATERIALS AND METHODS: Five male mongrel dogs were studied. The dog was placed in the supine position, and the most prominent lymph node in the groin was accessed using a 26-gauge spinal needle under ultrasonography (US) guidance. If the cisterna chyli (CC) was not opacified by bilateral lymphangiography, the medial iliac lymph nodes were directly punctured and Lipiodol was injected. After opacification, the CC was directly punctured with a 22-gauge needle. A 0.018-in microguidewire was advanced through the CC and TD. A 4-Fr introducer and dilator were then advanced over the wire. The microguidewire was changed to a 0.035-in guidewire, and this was advanced into the left subclavian vein through the terminal valve of the TD. Retrograde TD access was performed using a snare kit.RESULTS: US-guided lymphangiography (including intranodal injection of Lipiodol [Guerbet]) was successful in all five dogs. However, in three of the five dogs (60%), the medial iliac lymph nodes were not fully opacified due to overt Lipiodol extravasation at the initial injection site. In these dogs, contralateral superficial inguinal intranodal injection was performed. However, two of these three dogs subsequently underwent direct medial iliac lymph node puncture under fluoroscopy guidance to deliver additional Lipiodol into the lymphatic system. Transabdominal CC puncture and cannulation with a 4-Fr introducer was successful in all five dogs. Transvenous retrograde catheterization of the TD (performed using a snare kit) was also successful in all five dogs.CONCLUSION: A canine model may be appropriate for intranodal lymphangiography and TD access. Most lymphatic intervention techniques can be performed in a canine using the same instruments that are employed in a clinical setting.


Subject(s)
Animals , Catheterization , Catheters , Dogs , Ethiodized Oil , Fluoroscopy , Groin , Humans , Lymph Nodes , Lymphatic System , Lymphography , Male , Needles , Punctures , SNARE Proteins , Subclavian Vein , Supine Position , Thoracic Duct , Ultrasonography
2.
Rev. chil. ortop. traumatol ; 60(2): 39-46, oct. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1095953

ABSTRACT

INTRODUCCIÓN: la lesión de los vasos subclavios durante la cirugía de clavícula es una situación rara, de suceder podría resultar incluso mortal; conocer su ubicación es indispensable para minimizar ese riesgo.OBJETIVO: determinar la ubicación y la distancia de la AS y VS respecto a la clavícula. Secundariamente, identificar las características particulares que influencien la ubicación y la distancia. MATERIALES Y MÉTODO: estudio retrospectivo, AngioTAC de tórax y cuello entre 2012 y 2017; se midió la longitud de la clavícula, distancia y dirección de los vasos subclavios en cada tercio de la clavícula, como también la angulación entre una horizontal y el centro de los vasos subclavios. Resultados: 39 AngioTC, 78 hombros. Distancia AS/clavícula tercio proximal, medio y distal 32,8mm (20,3-46,3), 15,4mm (6,8-28,0) y 62,7mm (37,0-115,4) respectivamente. La distancia VS/clavícula tercio proximal, medio y distal fue: 7,4mm (1,0-19,2), 16,2mm (6,7-34,7) y 67,1mm (29,7-117,0) respectivamente. La ubicación de AS y VS con respecto a la clavícula es posterosuperior en el tercio proximal, posteroinferior en el tercio medio e inferior en el tercio distal. CONCLUSIÓN: En el tercio proximal la vena puede estar solo a 1mm de la clavícula y la arteria a 6mm en dirección antero-posterior, resultando esa zona la más peligrosa. En el tercio medio la distancia es mayor, pudiendo estar arteria y vena a solo 6mm, la dirección de brocado más peligrosa es antero-inferior con una inclinación promedio de 45° caudal. El tercio distal es el más seguro, los vasos están al menos a 30mm de distancia hacia caudal. Nivel de evidencia III.


BACKGROUND: injury to the subclavian vessels during clavicle surgery is a rare situation, if it happens it could even be fatal; knowing their location is essential to minimize that risk. OBJECTIVE: determine location and distance of the AS and VS with respect to the clavicle. Secondarily identify particular characteristics that influence location and distance. MATERIAL AND METHODS: retrospective study, AngioTAC of thorax and neck between 2012 and 2017; it was measured the length of the clavicle, distance and direction of the subclavian vessels in each third of the clavicle and angulation between a horizontal and the center of the subclavian vessels were measured. Results: 39 AngioTC, 78 shoulders. AS / clavicle third proximal, middle and distal distance 32.8mm (20.3-46.3), 15.4mm (6.8-28.0) and 62.7mm (37.0-115.4) respectively. Distance VS / clavicle third proximal, middle and distal was: 7.4mm (1.0-19.2), 16.2mm (6.7-34.7) and 67.1mm (29.7-117.0) respectively. The location of AS and VS with respect to the clavicle is posterosuperior in the proximal third, posteroinferior in the middle third and inferior in the distal third. CONCLUSION: In the proximal third the vein can be only 1mm from the clavicle and the artery to 6mm in the anterior-posterior direction, this zone is the most dangerous. In the middle third the distance is greater, artery and vein can be only to 6mm, the most dangerous drilling direction is antero-inferior with an average inclination of 45° caudal. The distal third is the safest, the vessels are at least 30mm away from the vessels. Level of evidence III.


Subject(s)
Humans , Male , Female , Subclavian Artery/diagnostic imaging , Subclavian Vein/diagnostic imaging , Clavicle/blood supply , Subclavian Artery/anatomy & histology , Subclavian Vein/anatomy & histology , Sex Factors , Retrospective Studies , Computed Tomography Angiography
3.
Article in English | WPRIM | ID: wpr-765336

ABSTRACT

OBJECTIVE: Aberrant right subclavian artery (ARSA) is a rare anatomical variant of the origin of the right subclavian artery. ARSA is defined as the right subclavian artery originating as the final branch of the aortic arch. The purpose of this study is to determine the prevalence and the anatomy of ARSA evaluated with computed tomography (CT) angiography. METHODS: CT angiography was performed in 3460 patients between March 1, 2014 and November 30, 2015 and the results were analyzed. The origin of the ARSA, course of the vessel, possible inadvertent ARSA puncture site during subclavian vein catheterization, Kommerell diverticula, and associated vascular anomalies were evaluated. We used the literature to review the clinical importance of ARSA. RESULTS: Seventeen in 3460 patients had ARSA. All ARSAs in 17 patients originated from the posterior aspect of the aortic arch and traveled along a retroesophageal course to the right thoracic outlet. All 17 ARSAs were located in the anterior portion from first to fourth thoracic vertebral bodies and were located near the right subclavian vein at the medial third of the clavicle. Only one of 17 patients presented with dysphagia. CONCLUSION: It is important to be aware ARSA before surgical approaches to upper thoracic vertebrae in order to avoid complications and effect proper treatment. In patients with a known ARSA, a right transradial approach for aortography or cerebral angiography should be changed to a left radial artery or transfemoral approach.


Subject(s)
Angiography , Aorta, Thoracic , Aortography , Catheterization , Catheters , Cerebral Angiography , Clavicle , Deglutition Disorders , Diverticulum , Humans , Korea , Prevalence , Punctures , Radial Artery , Subclavian Artery , Subclavian Vein , Thoracic Vertebrae
4.
Article in English | WPRIM | ID: wpr-762708

ABSTRACT

The primary site for a hemodialysis catheter insertion is the right internal jugular vein (IJV) followed by the left IJV and subclavian vein. In cases when veins of the upper extremities are exhausted, femoral veins are an alternative insertion location. Femoral catheter insertions should only be used for short periods because of the increased risk of infection. There is a percutaneous technique to recanalize occluded central veins for hemodialysis catheter insertion. We experienced success with a cut-down method for permcath through a completely occluded IJV. We, therefore, find surgical recanalization to be better than percutaneous method in terms of cost and safety.


Subject(s)
Catheters , Femoral Vein , Humans , Jugular Veins , Methods , Renal Dialysis , Subclavian Vein , Upper Extremity , Veins
5.
Article in English | WPRIM | ID: wpr-788765

ABSTRACT

OBJECTIVE: Aberrant right subclavian artery (ARSA) is a rare anatomical variant of the origin of the right subclavian artery. ARSA is defined as the right subclavian artery originating as the final branch of the aortic arch. The purpose of this study is to determine the prevalence and the anatomy of ARSA evaluated with computed tomography (CT) angiography.METHODS: CT angiography was performed in 3460 patients between March 1, 2014 and November 30, 2015 and the results were analyzed. The origin of the ARSA, course of the vessel, possible inadvertent ARSA puncture site during subclavian vein catheterization, Kommerell diverticula, and associated vascular anomalies were evaluated. We used the literature to review the clinical importance of ARSA.RESULTS: Seventeen in 3460 patients had ARSA. All ARSAs in 17 patients originated from the posterior aspect of the aortic arch and traveled along a retroesophageal course to the right thoracic outlet. All 17 ARSAs were located in the anterior portion from first to fourth thoracic vertebral bodies and were located near the right subclavian vein at the medial third of the clavicle. Only one of 17 patients presented with dysphagia.CONCLUSION: It is important to be aware ARSA before surgical approaches to upper thoracic vertebrae in order to avoid complications and effect proper treatment. In patients with a known ARSA, a right transradial approach for aortography or cerebral angiography should be changed to a left radial artery or transfemoral approach.


Subject(s)
Angiography , Aorta, Thoracic , Aortography , Catheterization , Catheters , Cerebral Angiography , Clavicle , Deglutition Disorders , Diverticulum , Humans , Korea , Prevalence , Punctures , Radial Artery , Subclavian Artery , Subclavian Vein , Thoracic Vertebrae
6.
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 31(4): 156-159, out.-dez. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-999206

ABSTRACT

Introdução: A estimulação cardíaca temporária eventualmente é necessária por mais de 15 dias. Este contexto clínico está associado a complicações como o deslocamento de eletrodo e perfuração cardíaca, havendo a necessidade de reposicionamento ou troca de eletrodo. Além disto, os eletrodos e geradores convencionais para estimulação cardíaca temporária impõem ao paciente a restrição ao leito e suas consequências. Objetivo: avaliar um método previamente estudado de estimulação temporária relacionado à menor incidência de complicações e que permite a deambulação do paciente. Método: foram estudados 24 pacientes, entre janeiro de 2015 e dezembro de 2017, submetidos a implante de marcapasso provisório com o uso de eletrodo de fixação ativa. Resultados: a média de idade foi de 68,9 anos, e predominantemente do sexo masculino. O tempo médio de uso do marcapasso (MP) provisório foi de 9,7 dias, variando de dois a 28 dias. Durante um tempo total de 233 pacientes/ dia, não houve deslocamento de eletrodos, falhas de estimulação ou necessidade de revisão do sistema. Conclusão: a estimulação provisória utilizando eletrodos de MP definitivo de fixação ativa foi segura e impactou positivamente na qualidade de vida dos pacientes


Introduction: Temporary cardiac pacing is eventually required for more than 15 days. This clinical context is associated with complications such as electrode displacement and cardiac perforation, requiring repositioning or electrode replacement. In addition, conventional electrodes and generators for temporary cardiac stimulation force patients to stay in bed with its consequences. Objective: to evaluate a previously studied method of temporary stimulation related to a lower incidence of complications which allows patient to walk. Method: 24 patients were studied between January 2015 and December 2017, who underwent temporary PM implantation with the use of an active fixation electrode. Results: mean age was 68.9 years, and patients were predominantly male. The mean time of use of the temporary pacemaker (PM) was 9.7 days, ranging from two to 28 days. During a total time of 233 patients/ day, there was no electrode displacement, no stimulation failures or a need for system revision. Conclusion: Temporary stimulation using definitive PM fixation active electrodes was safe and had a positive impact on patients' quality of life


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pacemaker, Artificial , Cardiac Pacing, Artificial/methods , Electrodes , Prostheses and Implants , Subclavian Vein , Bradycardia/diagnosis , Retrospective Studies , Defibrillators, Implantable , Atrioventricular Block , Heart Atria , Heart Ventricles , Jugular Veins
7.
Medicina (B.Aires) ; 78(5): 372-375, oct. 2018. ilus
Article in Spanish | LILACS | ID: biblio-976128

ABSTRACT

La trombosis venosa profunda (TVP) del miembro superior es una entidad poco frecuente, se estima que representa el 10% de todos los casos de TVP. Clásicamente se clasifican en primarias (idiopáticas, por compresión de la vena subclavia o relacionadas con el ejercicio) y secundarias (cáncer, trombofilia, traumatismo, cirugía del hombro, asociadas a catéteres venosos o de causa hormonal). El síndrome de Paget- Schrötter es una trombosis primaria de la vena subclavia en la unión subclavio-axilar, ya sea por movimientos repetitivos o relacionada al ejercicio; llevando a microtrauma en el endotelio con la consiguiente activación de la cascada de coagulación. Clínicamente se presenta de forma brusca con dolor, edema y sensación de pesadez en el miembro afectado. El tratamiento varía desde trombolíticos y anticoagulación a la intervención quirúrgica, dependiendo del tiempo de evolución. Presentamos cuatro casos de trombosis de vena subclavia relacionada con el ejercicio.


Deep vein thrombosis (DVT) of the upper limb is a rare entity, estimated to account for 10% of all cases of DVT. Classically, they are classified into primary (idiopathic, due to subclavian vein compression or exercise related) and secondary (cancer, thrombophilia, trauma, shoulder surgery, associated to venous catheters or due to hormonal causes). The Paget- Schrötter syndrome is a primary thrombosis of the subclavian vein in the subclavian-axillary junction, related either to repetitive movements or to exercise; leading to microtrauma in the endothelium with consequent activation of the coagulation cascade. Clinically, it presents abruptly with pain, edema and feeling of heaviness in the affected limb. The treatment varies from thrombolytics and anticoagulation to surgical intervention, depending on the time of evolution. We present four cases of exercise-related subclavian vein thrombosis.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Subclavian Vein/pathology , Axillary Vein/pathology , Upper Extremity Deep Vein Thrombosis/pathology , Subclavian Vein/diagnostic imaging , Axillary Vein/diagnostic imaging , Phlebography , Ultrasonography, Doppler , Edema , Upper Extremity Deep Vein Thrombosis/diagnosis , Upper Extremity Deep Vein Thrombosis/drug therapy , Anticoagulants/therapeutic use
8.
J. vasc. bras ; 17(3)jul.-set. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-916052

ABSTRACT

policial masculino de 47 anos foi atendido em consultório com queixa de dispneia aos esforços, edema e dor importantes em braço direito. Relatou ferimento por arma de fogo infraclavicular direito 7 meses antes. Tomografia de tórax mostrou grande dilatação de veia subclávia, veias cervicais e de membro superior direito sem identificação da comunicação arteriovenosa. O paciente foi internado antes da data prevista para tratamento por piora clínica e foi submetido a implante de stent revestido Fluency 8x100 mm em artéria subclávia direita por técnica do varal. Angiografia de controle mostrou artéria subclávia pérvia e fechamento da fístula. Houve melhora dos sintomas em braço direito no primeiro dia após o procedimento. As lesões traumáticas da artéria subclávia são incomuns, porém podem evoluir com alto índice de morbimortalidade O trauma penetrante é o principal agente etiológico, e fístulas arteriovenosas devem ser pesquisadas durante o atendimento do paciente com lesões penetrantes em trajeto vascular


A 47-year-old male police officer presented at an outpatients consulting room complaining of exertional dyspnea and swelling and pain in the right arm. He had suffered a perforating gunshot wound of the right infraclavicular region 7 months previously. A chest tomography showed considerable dilatation of the subclavian and cervical veins and veins of the right upper limb, with no clear point of arteriovenous communication. His symptoms exacerbated and he was admitted to hospital before the date scheduled for treatment. He underwent endovascular treatment with an 8x100 mm Fluency covered stent that was placed in the right subclavian artery using the through-and-through technique. Control angiography showed that the fistulous defect had been completely sealed. There was significant relief of the symptoms on the first day after the operation. Traumatic lesions of the subclavian artery are rare, but can be associated with high morbidity and mortality rates. Penetrating trauma is the main cause and arteriovenous fistulas should be ruled out when evaluating penetrating injuries in vascular territorie


Subject(s)
Humans , Male , Adult , Arteriovenous Fistula , Endovascular Procedures/methods , Vascular System Injuries , Angiography/methods , Aspirin/therapeutic use , Stents , Subclavian Vein , Upper Extremity , Wounds and Injuries/complications , Wounds, Gunshot/complications
9.
Article in English | WPRIM | ID: wpr-715061

ABSTRACT

OBJECTIVE: To assess whether ultrasonographic examination compared to chest radiography (CXR) is effective for evaluating complications after central venous catheterization. METHODS: We performed a prospective observational study. Immediately after central venous catheter insertion, we asked the radiologic department to perform a portable CXR scan. A junior and senior medical resident each performed ultrasonographic evaluation of the position of the catheter tip and complications such as pneumothorax and pleural effusion (hemothorax). We estimated the time required for ultrasound (US) and CXR. RESULTS: Compared to CXR, US could equivalently identify the catheter tip in the internal jugular or subclavian veins (P=1.000). Compared with CXR, US examinations conducted by junior residents could equivalently evaluate pneumothorax (P=1.000), while US examinations conducted by senior residents could also equivalently evaluate pneumothorax (P=0.557) and pleural effusion (P=0.337). The required time for US was shorter than that for CXR (P < 0.001). CONCLUSION: Compared to CXR, US could equivalently and more quickly identify complications such as pneumothorax or pleural effusion.


Subject(s)
Catheterization, Central Venous , Catheters , Central Venous Catheters , Diagnostic Imaging , Observational Study , Pleural Effusion , Pneumothorax , Prospective Studies , Radiography , Subclavian Vein , Thorax , Ultrasonography
10.
Article in English | WPRIM | ID: wpr-787006

ABSTRACT

Baseline ¹⁸F-FDG PET was performed in a 74-year-old patient with relapsing upper mediastinum lymphoma. Left subclavian thrombosis was suspected on prior contrast-enhanced CT. Dynamic PET imaging was achieved during 3 min after IV injection of ¹⁸F-FDG to the left arm in order to further assess left subclavian vein permeability. The 20-s dynamic frame at 1 min after injection confirmed the absence of flow in the left subclavian vein and evidenced the derivation of ¹⁸F-FDG through left axillary, then superficial, then right internal mammary collaterals to the superior vena cava, hence confirming the subclavian thrombosis.


Subject(s)
Aged , Arm , Humans , Lymphoma , Mediastinum , Permeability , Subclavian Vein , Thrombosis , Tomography, X-Ray Computed , Vena Cava, Superior , Venous Thrombosis
11.
Article in English | WPRIM | ID: wpr-719092

ABSTRACT

OBJECTIVE: Central venous catheter (CVC) misplacement can result in incorrect readings of the central venous pressure, vascular erosion, and intravascular thrombosis. Several studies have examined the correlation between the guidewire J-tip direction and misplacement rate. This study examined whether the guidewire J-tip direction (cephalad vs. caudad) affects the misplacement rate in right subclavian venous catheterization. METHODS: This prospective randomized controlled study was conducted between February 2016 and February 2017. The subjects were divided into two groups (cephalad group vs. caudad group) and the misplacement rate was compared according to guidewire J-tip direction in each group. RESULTS: Of 100 patients, the cephalad and caudad groups contained 50 patients each. The age, sex, and operator experience were similar in the two groups. In the cephalad group, misplacement of CVC insertion into the ipsilateral internal jugular vein occurred in two cases. In the caudad group, misplacement of CVC insertion into the contralateral subclavian vein occurred in one case, with loop formation in the brachiocephalic trunk in one case. Guidewire J-tip direction showed no significant correlation with CVC misplacement. CONCLUSION: The guidewire J-tip direction does not influence the rate of misplacement.


Subject(s)
Brachiocephalic Trunk , Catheterization , Catheters , Central Venous Catheters , Central Venous Pressure , Humans , Jugular Veins , Prospective Studies , Reading , Subclavian Vein , Thrombosis
13.
Article in English | WPRIM | ID: wpr-102701

ABSTRACT

Lead insertion for cardiac implantable electronic devices requires venous access into the right side of the heart. The access route commonly used is from the axillary vein, through the subclavian vein and the superior vena cava. However, in patients with congenital heart malformations or those with vascular stenosis, and/or those who have undergone previous cardiac surgery, the passage of leads might be difficult, and the implantation procedure would show restricted scope. In such cases, insertion of leads through the hepatic vein is known to be a safe procedure. We report 2 cases of patients with limited vascular access who underwent lead implantation using the transhepatic approach—1 patient who underwent placement of an implantable cardioverter defibrillator and the other who underwent placement of a permanent pacemaker.


Subject(s)
Axillary Vein , Constriction, Pathologic , Defibrillators , Defibrillators, Implantable , Heart , Hepatic Veins , Humans , Subclavian Vein , Thoracic Surgery , Vena Cava, Superior
14.
Article in English | WPRIM | ID: wpr-67975

ABSTRACT

BACKGROUND: The current indications of cardiac implantable electronic devices (CIEDs) have expanded to include young patients with serious cardiac risk factors, but CIED placement has the disadvantage of involving unsightly scarring and bulging of the chest wall. A collaborative team of cardiologists and plastic surgeons developed a technique for the subpectoral placement of CIEDs in young female patients via a transaxillary approach. METHODS: From July 2012 to December 2015, subpectoral CIED placement via an axillary incision was performed in 10 young female patients, with a mean age of 25.9 years and mean body mass index of 20.1 kg/m². In the supine position, with the patient's shoulder abducted, an approximately 5-cm linear incision was made along one of the deepest axillary creases. The submuscular plane was identified at the lateral border of the pectoralis major, and the dissection continued over the clavipectoral fascia until the subpectoral pocket could securely receive a pulse generator. Slight upward dissection also exposed an entrance to the subclavian vein, allowing the cardiology team to gain access to the vein. One patient with dilated cardiomyopathy underwent augmentation mammoplasty and CIED insertion simultaneously. RESULTS: One case of late-onset device infection occurred. All patients were highly satisfied with the results and reported that they would recommend the procedure to others. CONCLUSIONS: With superior aesthetic outcomes compared to conventional methods, the subpectoral placement of CIEDs via a transaxillary approach is an effective, single-incision method to hide operative scarring and minimize bulging of the device, and is particularly beneficial for young female or lean patients.


Subject(s)
Body Mass Index , Cardiac Resynchronization Therapy , Cardiology , Cardiomyopathy, Dilated , Cicatrix , Defibrillators, Implantable , Fascia , Female , Humans , Mammaplasty , Methods , Pacemaker, Artificial , Plastics , Risk Factors , Shoulder , Subclavian Vein , Supine Position , Surgeons , Thoracic Wall , Veins
15.
Article in Korean | WPRIM | ID: wpr-17186

ABSTRACT

Central venous catheterization is a useful procedure for administrating fluids and drugs as well as monitoring central venous pressure in the operating room. The internal jugular vein and the subclavian vein are preferred as catheter insertion sites because of the low risk of infection and mechanical complications. However, the risk of venous malposition is higher in subclavian vein. The loop formation of the central venous catheter accompanied by its malposition increases the risk of thrombosis. If the procedure is to be performed with any difficulty, early radiologic examination should be required to detect and avoid complications. We report a case of malposition and loop formation of central venous catheter located in subclavian vein confirmed by chest X-ray after transferred to the intensive care unit.


Subject(s)
Catheterization, Central Venous , Catheters , Central Venous Catheters , Central Venous Pressure , Intensive Care Units , Jugular Veins , Operating Rooms , Subclavian Vein , Thorax , Thrombosis
16.
Einstein (Säo Paulo) ; 14(4): 561-566, Oct.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-840268

ABSTRACT

ABSTRACT Vascular punctures are often necessary in critically ill patients. They are secure, but not free of complications. Ultrasonography enhances safety of the procedure by decreasing puncture attempts, complications and costs. This study reviews important publications and the puncture technique using ultrasound, bringing part of the experience of the intensive care unit of the Hospital Israelita Albert Einstein, São Paulo (SP), Brazil, and discussing issues that should be considered in future studies.


RESUMO Punções vasculares são muitas vezes necessárias em pacientes gravemente enfermos. São seguras, mas não isentas de complicações. A ultrassonografia associada à técnica de punção gera diminuição do número de tentativas, de complicações e de custos. O presente artigo revisou importantes publicações sobre o tema, bem como técnicas de punções, trazendo parte da experiência do centro de terapia intensiva de adultos do Hospital Israelita Albert Einstein, em São Paulo (SP) e discutindo tópicos que devem ser melhor explorados em estudos futuros.


Subject(s)
Humans , Catheterization, Central Venous/methods , Punctures/methods , Ultrasonography, Interventional , Subclavian Vein , Axillary Vein , Catheterization, Central Venous/instrumentation , Punctures/instrumentation , Vascular Access Devices , Jugular Veins
17.
Article in English | WPRIM | ID: wpr-770915

ABSTRACT

A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.


Subject(s)
Anesthesia, General , Cardiopulmonary Resuscitation , Catheterization , Catheters , Central Venous Catheters , Child , Drug Therapy , Female , Hematopoietic Stem Cell Transplantation , Humans , Infant , Pediatrics , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Pulmonary Circulation , Pulmonary Embolism , Subclavian Vein , Thrombosis
18.
Chinese Medical Journal ; (24): 2647-2651, 2016.
Article in English | WPRIM | ID: wpr-230906

ABSTRACT

<p><b>BACKGROUND</b>The conventional venous access for cardiovascular implantable electronic device (CIED) is the subclavian vein, which is often accompanied by high complication rate. The aim of this study was to assess the efficacy and safety of optimized axillary vein technique.</p><p><b>METHODS</b>A total of 247 patients undergoing CIED implantation were included and assigned to the axillary vein group or the subclavian vein group randomly. Success rate of puncture and complications in the perioperative period and follow-ups were recorded.</p><p><b>RESULTS</b>The overall success rate (95.7% vs. 96.0%) and one-time success rate (68.4% vs. 66.1%) of punctures were similar between the two groups. In the subclavian vein group, pneumothorax occurred in three patients. The subclavian gaps of three patients were too tight to allow operation of the electrode lead. In contrast, there were no puncture-associated complications in the axillary vein group. In the patient follow-ups, two patients in the subclavian vein group had subclavian crush syndrome and both of them received lead replacement. The incidence of complications during the perioperative period and follow-ups of the axillary vein group and the subclavian vein group was 1.6% (2/125) and 8.2% (10/122), respectively (χ2 = 5.813, P = 0.016).</p><p><b>CONCLUSION</b>Optimized axillary vein technique may be superior to the conventional subclavian vein technique for CIED lead placement.</p><p><b>TRIAL REGISTRATION</b>www.clinicaltrials.gov, NCT02358551; https://clinicaltrials.gov/ct2/show/NCT02358551?term=NCT02358551& rank=1.</p>


Subject(s)
Aged , Axillary Vein , Defibrillators, Implantable , Electrodes, Implanted , Female , Humans , Male , Middle Aged , Pacemaker, Artificial , Perioperative Care , Pneumothorax , Diagnosis , Postoperative Complications , Prosthesis Implantation , Subclavian Vein
19.
Anatomy & Cell Biology ; : 210-212, 2016.
Article in English | WPRIM | ID: wpr-105515

ABSTRACT

Persistence of jugulocephalic vein is one of the extremely rare variations of the cephalic vein. Knowledge of such a variation is of utmost importance to orthopedic surgeons while treating the fractures of the clavicle, head and neck surgeons, during surgery of the lower part of neck, for cardiothoracic surgeons and radiologists during catheterization and cardiac device placement. We report the persistent jugulocephalic vein in an adult male cadaver, observed during the routine dissection classes. The right cephalic vein ascended upwards, superficial to the lateral part of the clavicle and terminated into the external jugular vein. It also gave a communicating branch to the axillary vein below the clavicle. We discuss the embryological and clinical importance of this rare variation.


Subject(s)
Adult , Axillary Vein , Cadaver , Catheterization , Catheters , Clavicle , Head , Humans , Jugular Veins , Male , Neck , Orthopedics , Subclavian Vein , Surgeons , Veins
20.
Article in English | WPRIM | ID: wpr-79145

ABSTRACT

A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.


Subject(s)
Anesthesia, General , Cardiopulmonary Resuscitation , Catheterization , Catheters , Central Venous Catheters , Child , Drug Therapy , Female , Hematopoietic Stem Cell Transplantation , Humans , Infant , Pediatrics , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Pulmonary Circulation , Pulmonary Embolism , Subclavian Vein , Thrombosis
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