Ultrasound-guided left internal jugular vein cannulation: Advantages of a lateral oblique axis approach.

INTRODUCTION: Retrospective observational study to evaluate the technique of cannulation guided by ultrasound of the left internal jugular vein (LIJV) using a lateral oblique axis (LOAX) approach with variable angulation in the placement of tunneled central venous catheters (CVC) for hemodialysis. METHODS: Seventy-one patients with 77 LIJV vascular accesses aged 16 or older who needed CVC for hemodialysis were evaluated. The catheters were inserted, guided by LOAX ultrasound with variable angulation, depending on the angulation of the left brachiocephalic trunk. The success rate, additional instrumentation needs, and number of immediate and late complications were analyzed. FINDINGS: Central venous catheters placement was possible in all cases and none of the peelable introducers folded. A placement guide was needed in only eight patients, whose brachiocephalic trunk elongation and angulation was 90°. We found no major complications, and only five cases of minor complications (6.5%): four periprocedural and one displacement of the catheter a week after placement. DISCUSSION: Tunneled CVC percutaneous cannulation in LIJV guided by ultrasound with the LOAX approach with variable angulation provides very good results, allows visualization of the needle and the vascular structures at the same time, and reduces the number of manoeuvers required for placement and complications that might arise.

Recanalización del uréter seccionado: a propósito de dos casos / Recanalization of a dissected ureter: report of two cases

Objetivos: Describir la técnica utilizada para la recanalización de los extremos ureterales y restablecimiento de su integridad en uréteres seccionados con fístula asociada. Material y métodos: Presentamos dos pacientes con solución de continuidad ureteral y fístula asociada secundarios a cirugía abdominopélvica por carcinoma rectal y carcinoma de ano. En el momento del procedimiento ambos pacientes se encontraban libres de enfermedad y existía una moderada cantidad de tejido fibroso posquirúrgico periureteral en los estudio de tomografía computarizada (TC). En ambos pacientes se realizó un doble abordaje ureteral: por nefrostomía percutánea para cateterizar el extremo proximal y mediante cistoscopia el segmento distal. En el procedimiento se utilizaron guías hidrofílicas para sobrepasar los segmentos seccionados del uréter y lazos de recuperación para establecer la comunicación entre ambos. Resultados: En ambos casos se consiguió restablecer la integridad ureteral y se dejaron colocados catéteres ureterales tipo doble pigtail y se realizaron dilataciones de la estenosis resultante en el área de unión de ambos fragmentos, coincidentes con las áreas de fibrosis. Se observó un cierre inmediato de las fístulas ureterales. Conclusiones: La pérdida de la solución de continuidad ureteral hace necesario un doble abordaje y la captura mediante lazo de recuperación de la guía hidrofílica introducida por el otro extremo ureteral. Un abordaje multidisciplinario, necesario para la cateterización del extremo ureteral distal, resulta deseable en el tratamiento de este tipo de lesiones

Objectives: To describe the technique used for recanalization of the two ends of a dissected ureter to reestablish its integrity in two cases with associated fistula. Materials and methods: We present two patients with ureteral discontinuity and associated fistula secondary to abdominopelvic surgery to treat rectal carcinoma and anal carcinoma. Both patients were disease-free at the time of the procedure with a moderate amount of postsurgical periureteral fibrous tissue seen at CT. A double ureteral approach was used in both patients: percutaneous nephrostomy to catheterize the proximal tip and cystoscopy for the distal segment. Hydrophilic guides were used to extend the catheters beyond the sectioned segments and lassos were used to establish the communication between them. Results: Ureteral integrity was reestablished in both cases; double pigtail catheters were left in place and the stenotic segment at the junction of the two fragments coinciding with the areas of fibrosis was dilated. The immediate closure of the ureteral fistulas was observed. Conclusions: Loss of ureteral patency makes it necessary to use a double approach and lasso capture of the hydrophilic guidewire introduced through the other end of the ureter. A multidisciplinary approach is necessary for the catheterization of the distal tip of the ureter and is desirable for this type of lesion