Subject(s)
Cardiology , Education, Medical , Cardiology/education , Curriculum , Faculty, Medical/education , Humans , TeachingABSTRACT
OBJECTIVE: To describe and increase understanding of the brachial-basilic vein anatomy that could impact planning of long-term hemodialysis access procedures. METHODS: Preoperative vein mapping was conducted in a cross-sectional, observational study in end-stage renal disease patients from August 2005 to May 2010. "Traditional" anatomic description with basilic-brachial junction at the axillary level with paired brachial veins was classified as "Type 1." Junctions observed at the mid or lower portions of the upper arm with duplication of the brachial vein above that level were classified as "Type 2." Junctions at the mid and lower portions of the upper arm with no duplication of the brachial vein above that level were classified as "Type 3." RESULTS: Two hundred ninety patients (mean age, 56 ± 17 years; 52% men) were observed and 426 arms mapped (221 right, 205 left). The prevalence of variations in venous arm anatomy was as follows: Type 1: 66%; Type 2: 17%; and Type 3: 17%. CONCLUSIONS: This study underscores the need for heightened awareness of upper arm venous variations and advocates the regular use of preoperative ultrasound imaging. We propose that recognition of Type 3 anatomy may have implications in access algorithm and planning.
Subject(s)
Arteriovenous Shunt, Surgical , Brachiocephalic Veins/abnormalities , Renal Dialysis , Upper Extremity/blood supply , Vascular Malformations/epidemiology , Adult , Aged , Algorithms , Brachiocephalic Veins/diagnostic imaging , Chi-Square Distribution , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Patient Selection , Prevalence , Prospective Studies , Retrospective Studies , Terminology as Topic , Texas , Ultrasonography, Doppler, Duplex , Vascular Malformations/classification , Vascular Malformations/diagnostic imagingABSTRACT
Superior vena cava (SVC) hemorrhage due to iatrogenic injury is an infrequent but important event. We report the case of a 56-year-old woman with a history of right pneumonectomy for lung cancer with iatrogenic SVC injury and hemorrhage. After unsuccessful attempts at suture repair of the defect, an endovascular approach using a stent graft succeeded in controlling hemorrhage while maintaining vessel patency. To our knowledge, this is the third report of SVC hemorrhage control using this technique, and it supports the experience of other authors that endovascular stenting is an effective means of treating emergent venous hemorrhage.
Subject(s)
Blood Vessel Prosthesis Implantation , Hemorrhage/surgery , Iatrogenic Disease , Vascular Surgical Procedures/adverse effects , Vena Cava, Superior/injuries , Vena Cava, Superior/surgery , Angioplasty, Balloon , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Bronchial Fistula/etiology , Bronchial Fistula/surgery , Carcinoma, Squamous Cell/surgery , Fatal Outcome , Female , Hemorrhage/diagnostic imaging , Hemorrhage/etiology , Hemothorax/etiology , Hemothorax/surgery , Humans , Lung Neoplasms/surgery , Middle Aged , Phlebography , Pneumonectomy/adverse effects , Stents , Treatment Outcome , Vena Cava, Superior/diagnostic imagingABSTRACT
UNLABELLED: CONTEX: Most cases of pancreatoblastoma, a rare tumor of neuroendocrine origin, are seen in the pediatric population. To date, at least sixteen case reports have been described of pancreatoblastoma in patients 19-year old or older. Surgical resection is the mainstay of curative treatment. Even patients with liver metastasis can have long-term disease-free survival. CASE REPORT: One recent example is a 33-year-old male who presented to us for a right hepatic lobectomy for removal of the presumed primary tumor - later discovered to be a metastasis - followed by pancreaticoduodenectomy for resection of the true primary lesion. Five years after resection, this patient is the longest disease-free survivor of metastatic adult pancreatoblastoma. CONCLUSION: We review the literature and propose that resection of pancreatoblastoma can offer long-term disease-free survival even with liver metastasis and microscopically-positive surgical margins.
