Innominate vein compression syndrome

Flowreversal in the left internal jugular vein due to a prominent brachiocephalic trunk: A case report

Reversal of blood flow has only been reported in the left internal jugular vein following interventions such as central venous catheter, dialysis shunt placement, or external compression from a tumor. We describe a rare case of chronic headache and hearing loss due to flow reversal in the left internal jugular vein and compensatory massive dilation of the right internal jugular vein. Flow reversal was caused by a prominent brachiocephalic trunk with subseqent compression of the vena brachiocephalica sinistra. Vascular anomalies and associated venous bypass circulation may be considered as a rare cause of non-specific malaise. Restoration of the physiological direction of blood flow should be discussed on an interdisciplinary basis given the unpredictable haemodynamic consequences.

Stenting of innominate vein compression syndrome

We report the case of a 60-year-old woman who sought medical attention for left cervical and supraclavicular pain and swelling. Previous computed tomography, intravascular ultrasound, and venography studies were reviewed, confirming extrinsic compression of the left innominate vein by the left common carotid artery against the left clavicle head. Stenting of the lesion was performed, with good mid-term symptom relief and patency. It is, to the best of our knowledge, the first case study in the literature to report endovascular treatment of this syndrome.

Aortosternal Venous Compression: A Review of Two Cases

Aortosternal venous compression (AVC) is a rare venous compression syndrome that involves brachiocephalic venous compression due to its positioning between the sternum and the aorta. One of the features of AVC involves compression of the left innominate vein with variability in luminal caliber on inspiration and expiration. Imaging modalities such as computed tomography (CT) examination can aid in initial diagnosis; however, venography can be utilized for confirmatory diagnosis due to its higher specificity during the inspiratory and expiratory phases. Through findings demonstrated during venography, we herein present two cases of confirmed AVC secondary to an aberrant right subclavian artery. Characteristic imaging features in the diagnosis of AVC and its etiology are discussed.

Factors causing loss of normal Doppler waveform of the left internal jugular vein: evaluation on chest computed tomography

PURPOSE

To evaluate the presence and causes of left brachiocephalic vein (LBCV) steno-occlusive lesions in patients with loss of normal waveform in Doppler ultrasound of the left internal jugular vein (LIJV).

MATERIALS AND METHODS

We performed Doppler ultrasound of both internal jugular veins in 1912 patients who received an implantable venous access port from August 2013 to January 2016. Among them, 106 patients showed loss of normal Doppler waveforms of the LIJV (56 men and 50 women; mean age, 61.4 ± 11.6 years). We retrospectively analyzed the presence and causes of the LBCV steno-occlusive lesions on contrast-enhanced chest computed tomography (CT) images.

RESULTS

LBCV steno-occlusive lesions were present in 82 patients (77.4%). The causes of these lesions were anatomic structures (n = 70, 85.4%), tumorous lesions (n = 11, 13.4%), and thrombus (n = 1, 1.2%). The anterior anatomic structures to the LBCV causing stenosis were bony structures (n = 50), right upper lobe (n = 11), and mediastinal fat (n = 9). The posterior anatomic structures to the LBCV resulting in stenosis were right brachiocephalic artery (n = 58), left common carotid artery (n = 7), and aortic arch (n = 5). The tumorous lesions resulting in stenosis were mediastinal lymph node (n = 5), thymic lesions (n = 3), lymphoma (n = 1), lung cancer (n = 1), and bone tumor (n = 1).

CONCLUSIONS

It is necessary to suspect steno-occlusive lesion of the LBCV from various causes and to use caution when performing central venous catheterization in cases with loss of a normal Doppler waveform.

Venous stenosis in chronic dialysis patients with a well-functioning arteriovenous fistula

Purpose

It is not clear whether patient who is dialyzing with a well-functioning vascular access may appear venous stenosis. The aim is to see the prevalence of central or other vein stenoses/occlusions in patients with asymptomatic, normal functioning fistulas.

Methods

A total of 54 patients met the inclusion criteria. We performed angiography examinations for these patients and reviewed venography of the superficial and deep venous systems.

Results

Among these patients, 21 (39%) were detected positive cases by the angiography, the remainder was negative cases. Thirteen of 54 (24%) had mild central venous stenosis (stenosis <50% diameter with or without collateral branch), 7/54 (13%) had upper arm vein system occlusion or stenosis, another one had anastomotic stenosis. There were no differences in fistula flow dynamics between those with venous abnormalities and those without such as blood flow rate, venous pressures, brachial arterial velocity, and brachial arterial flow rate. We also observed no significant differences in other variables between these two groups (including BMI, hemoglobin, albumin, gender, primary disease, URR, spKt/V P > 0.05).

Conclusion

The frequency of venous lesion is not low in hemodialysis patients with a well-functioning AVF. To value the impact of these abnormalities on access, prognosis needs longer time follow-up.

An unusual cause of venous hypertension after dialysis access creation

Venous hypertension after creation of arteriovenous fistula or arteriovenous shunt occurs in approximately 10-15% of patients (Kojecky et al., Biomed Papers, 2002;146:77-79; Criado et al., Ann Vasc Surg 1994;8:530-535). Its etiology is commonly stenosis and/or thrombosis of the central venous system secondary to previous catheterization with subsequent development of venous hypertension after the arteriovenous connection is made. Treatment strategies often involve venography to determine the site of venous stenosis and/or occlusion centrally and subsequent endovascular recanalization of the stenotic or occluded veins. In this article, we report a case of venous hypertension in a 76-year-old man who presented with a swollen arm after placement of an arteriovenous fistula. In this circumstance, venography revealed extrinsic compression of the subclavian vein at the level of the first rib, the anatomic abnormality seen in venous thoracic outlet syndrome. In this report, we describe surgical and endovascular management of this patient, and review the literature on the causes of central vein stenosis discovered after creation of dialysis access.

Extrinsic Compression of the Left Innominate Vein in Hemodialysis Patients

PURPOSE

Central venous stenosis is a common problem in hemodialysis patients. The most well known cause is intrinsic stenosis, usually a result of subclavian vein catheterization. A lesser-known cause is extrinsic compression of the left innominate vein. This study investigates the prevalence of this phenomenon in a series of patients undergoing diagnostic fistulography.

MATERIALS AND METHODS

One hundred six fistulograms of 48 patients were reviewed retrospectively. In reviewing the fistulograms, attention was paid to the central veins, which were graded for extrinsic compression of the left innominate vein. Presence of collaterals was noted, as well as the presence of any intrinsic stenosis of the left innominate or subclavian veins. Medical records were reviewed for a history of catheterization of the left-side venous system for hemodialysis or any other reason. The type of vascular access (native fistula, synthetic graft) and indication for the fistulogram were recorded.

RESULTS

Some degree of extrinsic compression was observed in 21 of 48 of patients (44%). Twelve of 48 patients (25%) had mild, six of 48 patients (13%) had moderate and three of 48 patients had (6%) severe compression. Among patients with any degree of extrinsic compression only four of 21 patients (19%) had previous left subclavian or jugular catheterization. Intrinsic stenosis was observed in 11 of 48 patients (23%). All but two of them had undergone previous left subclavian or jugular catheterization and two had concomitant extrinsic compression. Collaterals were seen in 21 of 48 patients (44%). Eleven of 21 patients (52%) with extrinsic compression showed collateral veins. Ten of 11 patients (91%) with intrinsic stenosis had collateral veins. All three patients with severe extrinsic compression were symptomatic and were treated with stent placement after angioplasty failed because of elastic recoil.

CONCLUSION

Extrinsic compression is a common finding on diagnostic hemodialysis fistulography and may be hemodynamically significant. Unlike intrinsic stenosis, it is unrelated to previous central catheterization. Angioplasty alone may not be adequate for treatment and stent placement may be required.

Left innominate vein compression by a brachiocephalic artery anomaly

An unique case of left innominate vein compression by a leftward origin of a brachiocephalic artery in conjunction with an aberrant right subclavian artery anomaly occurred in a young patient. Aortography and magnetic resonance imaging were invaluable in arriving at a diagnosis.