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Soejima K, Hilpisch K, Samec ML, Temple RL, Bonner MD. Jugular Approach for the Transcatheter Pacemaker Implant - Better Access for Smaller Hearts? Circ J 2024; 88:1127-1134. [PMID: 38658350 DOI: 10.1253/circj.cj-24-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND The Micra leadless pacemaker was developed to fit inside the right ventricle, thereby reducing overall complications by 48% compared with a historical control group. The current labeling restricts implants to the femoral approach. In this article we used 3-dimensional computer models of human hearts to demonstrate why implants can be difficult in small patients and how using the jugular approach reduces these difficulties. METHODS AND RESULTS Cardiac computed tomography scans were made of 45 pacemaker patients, 26 in the US and 19 from a single center in Japan. Dimensional measurements were taken in all 45 hearts, and these dimensions were compared between patient cohorts and between the Micra delivery tool dimension and patient heart dimensions. Hearts were smaller among patients in the Japanese than US cohort. In addition, the tool dimension exceeded heart dimensions in a larger percentage of hearts from Japanese patients. Three dimensions were identified that most likely limit navigating across the tricuspid valve to the right ventricle in smaller hearts and for which the jugular approach improved navigation. CONCLUSIONS Although the femoral procedure today maintains an excellent safety profile and procedure experience for most global implants, this study provides the rationale as to why the jugular approach may improve the ease of the Micra implant in small hearts, namely by reducing the tortuosity of the navigation across the tricuspid valve.
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Affiliation(s)
- Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital
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Abdalkader M, Miller MI, Klein P, Hui FK, Siracuse JJ, Mian AZ, Sakai O, Nguyen TN, Setty BN. Differential Assessment of Internal Jugular Vein Stenosis in Patients Undergoing CT and MRI with Contrast. Tomography 2024; 10:266-276. [PMID: 38393289 PMCID: PMC10893318 DOI: 10.3390/tomography10020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE Internal Jugular Vein Stenosis (IJVS) is hypothesized to play a role in the pathogenesis of diverse neurological diseases. We sought to evaluate differences in IJVS assessment between CT and MRI in a retrospective patient cohort. METHODS We included consecutive patients who had both MRI of the brain and CT of the head and neck with contrast from 1 June 2021 to 30 June 2022 within the same admission. The degree of IJVS was categorized into five grades (0-IV). RESULTS A total of 35 patients with a total of 70 internal jugular (IJ) veins were included in our analysis. There was fair intermodality agreement in stenosis grades (κ = 0.220, 95% C.I. = [0.029, 0.410]), though categorical stenosis grades were significantly discordant between imaging modalities, with higher grades more frequent in MRI (χ2 = 27.378, p = 0.002). On CT-based imaging, Grade III or IV stenoses were noted in 17/70 (24.2%) IJs, whereas on MRI-based imaging, Grade III or IV stenoses were found in 40/70 (57.1%) IJs. Among veins with Grade I-IV IJVS, MRI stenosis estimates were significantly higher than CT stenosis estimates (77.0%, 95% C.I. [35.9-55.2%] vs. 45.6%, 95% C.I. [35.9-55.2%], p < 0.001). CONCLUSION MRI with contrast overestimates the degree of IJVS compared to CT with contrast. Consideration of this discrepancy should be considered in diagnosis and treatment planning in patients with potential IJVS-related symptoms.
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Affiliation(s)
- Mohamad Abdalkader
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
| | - Matthew I. Miller
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA 02139, USA;
| | - Piers Klein
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
| | - Ferdinand K. Hui
- Neuroscience Institute, The Queen’s Medical Center, Honolulu, HI 96813, USA;
- Department of Radiology, University of Hawaii, Honolulu, HI 96813, USA
| | | | - Asim Z. Mian
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
| | - Osamu Sakai
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
| | - Thanh N. Nguyen
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
| | - Bindu N. Setty
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
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Monroe EJ, Woods MA, Shin DS, Reis J, Swietlik J, Eifler A, Pinchot JW, Chick JFB. Percutaneous treatment of symptomatic deep vein thrombosis in adolescents using large-bore thrombectomy systems. Pediatr Radiol 2023; 53:2692-2698. [PMID: 37819408 DOI: 10.1007/s00247-023-05785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND While large-bore mechanical thrombectomy provides effective venous thrombus removal, often with avoidance of thrombolytics, literature surrounding the application of these devices in pediatric patients is sparse. OBJECTIVE To report technical success and outcomes following large-bore thrombectomy systems in adolescent patients with deep venous thrombosis. MATERIALS AND METHODS A retrospective review identified all patients less than 18 years of age undergoing mechanical venous thrombectomy at a single institution between 2018 and 2022. No patients were excluded. Technical success was defined as extraction of thrombus sufficient to restore unimpeded flow in affected segments. Clinical success was defined as resolution of presenting symptoms. RESULTS Nine consecutive patients (6 females, 3 males; age range 15-17 years) underwent 10 thrombectomy procedures using ClotTriever (n=6; 60%), FlowTriever (n=2; 20%), or both (n=2; 20%). Chronicity of thrombus was categorized as acute (<2 weeks) in 6 (60%), subacute (2-6 weeks) in 1 (10%), and chronic (>6 weeks) in 3 (30%). Distribution of thrombus was lower extremity and/or inferior vena cava (IVC) in 9 (90%) and unilateral axillo-subclavian in 1 (10%). Technical success was achieved in 9 interventions (90%). Clinical success was achieved in 8 patients (88.9%). No patients received thrombolytics. There were no intraprocedural adverse events (AE). Minor complications (Society of Interventional Radiology mild adverse events) were observed in a delayed fashion following 2 interventions (20%). CONCLUSIONS This preliminary experience demonstrated high rates of technical and clinical success with large-bore deep venous thrombectomy in adolescent patients across a range of thrombus chronicity and locations.
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Affiliation(s)
- Eric J Monroe
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Michael A Woods
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA
| | - David S Shin
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, USA
| | - Joseph Reis
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, USA
| | - John Swietlik
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Aaron Eifler
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Jason W Pinchot
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Jeffrey Forris Beecham Chick
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, USA
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Yang W, Sam K, Qiao Y, Huang Z, Steinman DA, Wasserman BA. A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro-Occipital Venous Plexus. J Am Heart Assoc 2023; 12:e031832. [PMID: 37830353 PMCID: PMC10757507 DOI: 10.1161/jaha.123.031832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
Background Adaptive arterial remodeling caused by flow reduction from downstream stenosis has been demonstrated in animal studies. The authors sought to determine whether inward remodeling from downstream stenosis also occurs in humans and is detectable by ex vacuo expansion of the Rektorzik venous plexus (RVP) surrounding the petrous internal carotid artery. Methods and Results The authors analyzed 214 intracranial magnetic resonance imaging examinations that included contrast-enhanced vessel wall imaging. RVP symmetry was qualitatively assessed on vessel wall imaging. RVP thickness (RVPT) was measured on the thicker side if asymmetric or randomly assigned side if symmetric. Maximum stenosis (M1 or intracranial internal carotid artery) was measured. Posterior communicating artery and A1 diameters (>1.0 mm and 1.5 mm, respectively) defined adequate collateral outflow when proximal to the stenosis. Seventy-two patients had stenosis downstream from RVPT measurements. For those without adequate outflow (38 of 72), 95.0% with RVPT ≥1.0 mm had ≥50% stenosis compared with only 5.6% with RVPT <1.0 mm. For these 72 patients, higher RVPT (RVPT ≥1.0 mm versus <1.0 mm) and absent adequate outflow were associated with greater downstream stenosis (P<0.001) using multivariate regression. For patients with downstream stenosis without adequate outflow, asymmetric RVP thickening was associated with greater ipsilateral stenosis (P<0.001, all had ≥46% stenosis) when stenosis was unilateral and greater differences in stenosis between sides (P=0.005) when stenosis was bilateral. Conclusions Inward internal carotid artery remodeling measured by RVPT or RVP asymmetry occurs as downstream stenosis approaches 50%, unless flow is preserved through a sufficiently sized posterior communicating artery or A1, and may serve as a functional measure of substantial flow reduction from downstream stenosis.
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Affiliation(s)
- Wenjie Yang
- Department of Diagnostic Radiology & Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | - Kevin Sam
- Department of Diagnostic Radiology & Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | - Ye Qiao
- Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins School of MedicineBaltimoreMD
| | - Zhongqing Huang
- Department of Diagnostic Radiology & Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreMD
| | - David A. Steinman
- Department of Mechanical & Industrial EngineeringUniversity of TorontoCanada
| | - Bruce A. Wasserman
- Department of Diagnostic Radiology & Nuclear MedicineUniversity of Maryland School of MedicineBaltimoreMD
- Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins School of MedicineBaltimoreMD
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Schiefer J, Lichtenegger P, Zimpfer D, Hutschala D, Kuessel L, Felli A, Hornykewycz S, Faybik P, Base E. Performing central venous catheters in neonates and small infants undergoing cardiac surgery using a wireless transducer for ultrasound guidance: a prospective, observational pilot study. BMC Pediatr 2021; 21:341. [PMID: 34389009 PMCID: PMC8360777 DOI: 10.1186/s12887-021-02822-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Neonates and small infants with congenital cardiac disease undergoing cardiac surgery represent major challenges facing paediatric anaesthesia and perioperative medicine. Aims. We here aimed to investigate the success rates in performing ultrasound (US) guided central venous catheter insertion (CVC) in neonates and small infants undergoing cardiac surgery, and to evaluate the practicability and feasibility of thereby using a novel wireless US transducer (WUST). Methods Thirty neonates and small infants with a maximum body weight of 10 kg and need for CVC before cardiac surgery were included in this observational trial and were subdivided into two groups according to their weight: < 5 kg and ≥ 5 kg. Cannulation success, failure rate, essential procedure related time periods, and complications were recorded and the clinical utility of the WUST was assessed by a 5-point Likert scale. Results In total, CVC-insertion was successful in 27 (90%) of the patients and the first attempt was successful in 24 (78%) of patients. Success rates of CVC were 80% < 5 kg and 100% ≥5 kg. Comparing the two groups we found a clear trend towards longer needle insertion time in patients weighing < 5 kg (33 [28–69] vs. 24 [15–37]s, P = .07), whereas, the total time for catheter insertion and the duration of the whole procedure were similar in both groups (199 [167–228] vs. 178 [138–234] and 720[538–818] vs. 660 [562–833]s. In total, we report 3 (10%) cases of local hematoma as procedure-related complications. Assessments of the WUST revealed very good survey results for all parameters of practicability and handling (all ratings between 4.5 and 5.0). Conclusion Although difficulties in CVC-placement seem to relate to vessel size and patient’s weight, US guided CVC-insertion represents a valuable, fast, and safe intervention in neonates and small children undergoing cardiac surgery. Using the WUST is feasible for this clinical application and may aid in efforts aiming to optimize perioperative care. Trial registration Wireless US-guided CVC placement in infants; Clinicaltrials.gov: NCT04597021; Date of Registration: 21October, 2020; retrospectively registered.
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Affiliation(s)
- Judith Schiefer
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Division of Anesthesia and General Intensive Care Medicine, Medical University of Vienna, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Paul Lichtenegger
- Division of Anesthesia and General Intensive Care Medicine, Medical University of Vienna, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Doris Hutschala
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lorenz Kuessel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alessia Felli
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Division of Anesthesia and General Intensive Care Medicine, Medical University of Vienna, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephan Hornykewycz
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Peter Faybik
- Division of Anesthesia and General Intensive Care Medicine, Medical University of Vienna, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eva Base
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Aslan S, Guillot M, Ross-Ascuitto N, Ascuitto R. Hemodynamics in a bidirectional Glenn Shunt supplemented with a modified Blalock-Taussig shunt: Computational fluid dynamics assessment. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2020.101256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Uzumcugil F, Ekinci S. Ultrasound-guided anatomical evaluation of right internal jugular vein in children aged 0-2 years: A prospective observational study. Paediatr Anaesth 2020; 30:934-940. [PMID: 32618403 DOI: 10.1111/pan.13961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/10/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The right internal jugular vein is commonly preferred for central venous cannulation, and ultrasonographic assessment and guidance is the recommended technique for this procedure. Despite the safety and reliability of this technique, it requires specific training and experience as well as thorough knowledge of anatomy. AIM The position of the right internal jugular vein with respect to carotid artery and its transverse diameter free from overlap with the carotid artery were evaluated using ultrasound in patients aged 0-2 years. METHODS This single-center, prospective, observational study included patients aged 0-2 years who underwent elective surgery between July 2018 and July 2019. The diameters and anatomical position were evaluated using ultrasound. All parameters were compared between groups classified according to postmenstrual ages. The correlations of these parameters with weight and postmenstrual ages were analyzed. RESULTS A total of 156 patients were included. The diameters (P < .001) and depth (P = .012) were smaller in patients with postmenstrual age <45 weeks. The anteroposterior diameter was significantly correlated with weight in patients with postmenstrual age <45 weeks, but not in older patients. Right internal jugular vein was lateral and anterolateral with respect to carotid artery in 51.3% and 42.9% of patients, respectively, and >80% of the transverse diameter was free from overlap with the carotid artery. CONCLUSION Our results support the current data for the high anatomical variability of the right internal jugular vein, highlighting the recommendation of the Rapid Central Vein Assessment (RaCeVA) protocol prior to and ultrasound guidance during catheterization of central veins.
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Affiliation(s)
- Filiz Uzumcugil
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Saniye Ekinci
- Department of Pediatric Surgery, Hacettepe University School of Medicine, Ankara, Turkey
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Stevens KE, Price JE, Marko J, Kaler SG. Neck masses due to internal jugular vein phlebectasia: Frequency in Menkes disease and literature review of 85 pediatric subjects. Am J Med Genet A 2020; 182:1364-1377. [PMID: 32293788 DOI: 10.1002/ajmg.a.61572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/31/2020] [Accepted: 02/24/2020] [Indexed: 11/06/2022]
Abstract
Classic Menkes disease is a rare X-linked recessive disorder of copper metabolism caused by pathogenic variants in the copper transporter gene, ATP7A. Untreated affected individuals suffer failure to thrive and neurodevelopmental delays that begin at 6-8 weeks of age and progress inexorably to death, often within 3 years. Subcutaneous injections of Copper Histidinate (US Food and Drug Administration IND #34,166, Orphan product designation #12-3663) are associated with improved survival and neurological outcomes, especially when commenced within a month of birth. We previously identified internal jugular vein phlebectasia (IJP) in four Menkes disease subjects. This feature and other connective tissue abnormalities appear to be consequences of deficient activity of lysyl oxidase, a copper-dependent enzyme. Here, we report results from a prospective study of IJP based on 178 neck ultrasounds in 66 Menkes subjects obtained between November 2007 and March 2018. Nine patients met the criterion for IJP (one or more cross-sectional area measurements exceeding 2.2 cm2 ) and five subjects had clinically apparent neck masses that enlarged over time. Our prospective results suggest that IJP occurs in approximately 14% (9/66) of Menkes disease patients and appears to be clinically benign with no specific medical or surgical actionability. We surveyed the medical literature for prior reports of IJP in pediatric subjects and identified 85 individuals and reviewed the distribution of this abnormality by gender, sidedness, and underlying etiology. Taken together, Menkes disease accounts for 16% (15/94) of all reported IJP individuals. Neck masses from IJP represent underappreciated abnormalities in Menkes disease.
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Affiliation(s)
- Kristen E Stevens
- Section on Translational Neuroscience, Molecular Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.,George Washington University School of Nursing, Washington, District of Columbia, USA
| | - Julienne E Price
- Section on Translational Neuroscience, Molecular Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Jamie Marko
- Department of Diagnostic Imaging, NIH Clinical Center, Bethesda, Maryland, USA
| | - Stephen G Kaler
- Section on Translational Neuroscience, Molecular Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.,Center for Gene Therapy, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
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Pulsatile Tinnitus Caused by Internal Jugular Phlebectasia in an Adult. J Craniofac Surg 2020; 31:e161-e163. [PMID: 31934968 DOI: 10.1097/scs.0000000000006123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Internal jugular phlebectasia is a rare condition. Children with internal jugular phlebectasia are often discovered by their parents when they notice a soft mass in the neck that appears when the child cries, coughs, or breathes deeply. Most internal jugular vein dilatations occur unilaterally on the right side according to the literature reports. To our knowledge, no other internal jugular phlebectasia patients reported pulsatile tinnitus as the major complaint without a soft mass in the neck. The authors reported a female adult patient with left-side internal jugular phlebectasia with pulsatile tinnitus as the major complaint without a soft mass in the neck. Internal jugular phlebectasia was diagnosed by color ultrasound of the internal jugular vein. Pure-tone audiometry, tympanometry, hemoglobin, thyroid function, and magnetic resonance imaging were made to differentiate other diseases that can cause the pulsatile tinnitus. Conservative treatment is recommended in this report. The possibility of internal jugular vein dilatation should be considered when differentiate the possible diseases that caused pulsatile tinnitus.
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Pasolini MP, Spinella G, Del Prete C, Valentini S, Coluccia P, Auletta L, Greco M, Meomartino L. Ultrasonographic assessment of normal jugular veins in Standardbred horses. BMC Vet Res 2019; 15:343. [PMID: 31619232 PMCID: PMC6794831 DOI: 10.1186/s12917-019-2104-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
Abstract
Background Ultrasonography (US) is the recommended imaging technique to evaluate jugular veins. This prospective randomized clinical study was designed to collect a series of B-mode US measurements of manually distended jugular veins in healthy Italian Standardbreds and to find possible correlations between ultrasound measurements and animal morphometric characteristics. Forty-two horses, eight males and 34 females (range 3–22 years; bodyweight 494.4 ± 41.7 kg), were included in the study. The diameters and wall thicknesses of both jugular veins were measured at three different sites of the neck. The differences in ultrasound measurements based on scans, age, gender, side, and site of the neck were evaluated by ANOVA or by the Kruskal-Wallis test. The effects of the morphometric measures on each ultrasound parameter were evaluated by MANOVA (P < 0.05). Results The ultrasound measurements did not differ significantly between the three different sites or between genders; hence, they were pooled together in the results. On the transverse scan, the mean dorsoventral and lateromedial diameters were 1.58 ± 0.23 and 2.20 ± 0.25 cm, respectively; the mean superficial and deep wall thicknesses (SWT and DWT) were 0.07 ± 0.01 and 0.08 ± 0.01 cm, respectively. On the longitudinal scan, the mean dorsoventral diameter was 1.59 ± 0.26 cm, and the SWT and DWT were both 0.08 ± 0.01 cm. Neck length, from the caudal edge of the mandible to the thoracic inlet, was related to the dorsoventral diameter in both longitudinal and transverse scan and to the SWT and DWT in transverse scan, whereas height at the withers (measured with tape) and estimated weight were related to the wall thickness. Dividing the subjects into groups by age in years (“young” 3–7, “mature” 8–14, “old” > 14), differences were found for the lateromedial diameter in the transverse scan and the SWT on the longitudinal scan. The main limitation of this study was that only one operator performed the measurements. Conclusion The US measurements of the jugular veins and their relationship with morphometric measures reported in this manuscript might be considered as guidelines both for early diagnosis and monitoring jugular vein abnormalities in healthy Italian Standardbred horses.
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Affiliation(s)
- Maria Pia Pasolini
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via a Federico Delpino, 1, 80137, Naples, Italy
| | - Giuseppe Spinella
- Department of Veterinary Medical Sciences, University Alma Mater of Bologna, via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, BO, Italy
| | - Chiara Del Prete
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via a Federico Delpino, 1, 80137, Naples, Italy.
| | - Simona Valentini
- Department of Veterinary Medical Sciences, University Alma Mater of Bologna, via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, BO, Italy
| | - Pierpaolo Coluccia
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Via a Federico Delpino, 1, 80137, Naples, Italy
| | - Luigi Auletta
- IRCCS SDN, via E. Gianturco 113, 80143, Naples, Italy
| | - Michele Greco
- Clevedale Veterinary Practice, Home Farm, Redcar, UK
| | - Leonardo Meomartino
- Interdepartmental Radiology Centre, University of Naples Federico II, Via Federico Delpino 1, 80137, Naples, Italy
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Educational Effectiveness of an Easily Made New Simulator Model for Ultrasound-Guided Vascular Access and Foreign Body Management Procedures on Pediatric Patients. Pediatr Emerg Care 2019; 35:407-411. [PMID: 29461427 DOI: 10.1097/pec.0000000000001410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to introduce an easily made chicken breast simulator for ultrasound (US)-guided vascular access, foreign body (FB) detection, and hydrodissection in pediatric patients and to validate the effectiveness for training using this phantom tissue model. METHODS The authors made the tissue phantom simulator using a chicken breast and rubber tourniquet for vascular access and fragments of a tongue blade and steel clip for FB detection and hydrodissection using a very simple method. We provided training on US-guided vascular access (following the tip [FTT] method), FB detection, and hydrodissection using this model for novice physicians to learn US-guided procedures for pediatric patients. In addition, we provided a questionnaire to solicit their thoughts on their knowledge and confidence to perform these procedures before and after training and to learn their thoughts on the similarity to actual patients and usefulness of this model on a 10-point Likert scale. RESULTS A total of 16 emergency residents participated in this study. We obtained US images during vascular access (FTT) and FB detection/ hydrodissection procedures using this phantom tissue model. Residents' knowledge of and confidence to perform US-guided FTT method and FB detection/hydrodissection procedures after training increased to a statistically significant degree (P < 0.001 in all items). The median Likert scores regarding the similarity to actual patients and usefulness of this model were 8.5 (interquartile range, 7.5-9) and 10 (interquartile range, 8-10), respectively. CONCLUSIONS The model for US-guided procedures used in this study can be constructed by simple and easy methods, presents realistic procedural images, and was useful for training novice physicians to conduct US-guided procedures on pediatric patients.
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Álvarez JML, Quevedo OP, Cabrera LS, Escot CR, Lorenzo TR, Cañal JML, Ferrer JFL. Vascular ultrasound in pediatrics: utility and application of location and measurement of jugular and femoral vessels. J Med Ultrason (2001) 2017; 45:469-477. [PMID: 29256187 DOI: 10.1007/s10396-017-0853-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To measure the depth (D p) and diameter (D m) of the internal jugular vein (IJV), femoral vein (FV), and femoral artery (FA) in pediatric patients to evaluate the clinical implications. METHODS This study included 125 pediatric patients. All of them underwent bilateral ultrasound study of vessels and were classified into three groups based on anthropometric and demographic parameters. RESULTS Measured mean D p values were: 0.72 (0.34) cm for the FA, 0.79 (0.35) cm for the FV, and 0.77 (0.24) cm for the IJV. Mean antero-posterior D m values were: 0.37 (0.17) cm for the FA, 0.42 (0.22) cm for the FV, and 0.59 (0.23) cm for the IJV. D p and D m increased with age (A), weight (W), height (H), and body surface area (BSA). In the lower ranges of these variables, D p was similar for all three studied vessels (0.6-0.7 cm). In the higher ranges, femoral vessel D p values (1.1-1.2 cm) were larger than jugular ones (0.9 cm). Additionally, in these low ranges, IJV D m values were larger than femoral ones (0.45-0.50 vs. 0.25 cm). In the higher ranges, diameter values were similar (0.6-0.7 cm). CONCLUSIONS In pediatric patients, major vessels can be located and their depth and diameter measured by vascular ultrasound. In younger patients, jugular and femoral vessels had similar depth values; in older ones, they had similar diameters. Ultrasound measurements in pediatric patients could facilitate the choice of the vessel to be cannulated, the catheter diameter, and the length of the needle to be used. Vascular canalization of IJV may be recommended as the first choice because of its low depth and large diameter.
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Affiliation(s)
- J M López Álvarez
- Unit of Intensive Pediatric Medicine, Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (Mother and Child University Hospital of Canarias), Las Palmas, Gran Canaria, Spain.
| | - O Pérez Quevedo
- Unit of Intensive Pediatric Medicine, Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (Mother and Child University Hospital of Canarias), Las Palmas, Gran Canaria, Spain
| | - L Santana Cabrera
- Service of Intensive Medicine, Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (Mother and Child University Hospital of Canarias), Las Palmas, Gran Canaria, Spain
| | - C Rodríguez Escot
- Service of Intensive Medicine, Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (Mother and Child University Hospital of Canarias), Las Palmas, Gran Canaria, Spain
| | - T Ramírez Lorenzo
- Unit for Support of Research, Department of Biostatistics, University of Las Palmas de GC, Las Palmas, Gran Canaria, Spain
| | - J M Limiñana Cañal
- Unit for Support of Research, Department of Biostatistics, University of Las Palmas de GC, Las Palmas, Gran Canaria, Spain
| | - J F Loro Ferrer
- Department of Clinical Sciences, University of Las Palmas de GC, Las Palmas, Gran Canaria, Spain
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López Álvarez JM, Pérez Quevedo O, Santana Cabrera L, Escot CR, Loro Ferrer JF, Lorenzo TR, Limiñana Cañal JM. Vascular ultrasound in pediatrics: estimation of depth and diameter of jugular and femoral vessels. J Ultrasound 2017; 20:285-292. [PMID: 29204232 DOI: 10.1007/s40477-017-0272-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022] Open
Abstract
Objectives To estimate, on the basis of anthropometric and demographic variables, the depth (Dp) and diameter (Dm) of femoral and jugular vessels, which have been located and measured by ultrasound, in pediatric patients. Method 750 measurements of Dp and Dm of the femoral vein (FV), femoral artery (FA) and internal jugular vein (IJV) were made in 125 pediatric patients. The values were correlated with patients' sex, weight, age, size and body surface area (BSA). Results Mean Dp values were 0.72 (0.34) cm for FA, 0.79 (0.35) cm for FV and 0.77 (0.24) cm for IJV. Mean antero-posterior Dm values were 0.37 (0.17) cm for FA, 0.42 (0.22) cm for FV and 0.59 (0.23) cm for IJV. In the studied pediatric patients, femoral and jugular vessels depth correlated with age, size, weight and BSA (R = 0.46-0.60); vascular depth could be estimated from patients' weight and size (FA-Dp: R = 0.71; FV-Dp: R = 0.72; IJV-Dp: R = 0.53). Correlation with diameter was better for FA and FV (R = 0.81-0.89) than for IJV (R = 0.42-0.51); vascular diameter could be estimated from patient's size (FA-Dm: R = 0.89; FV-Dm: R = 0.86; IJV-Dm: R = 0.52). Conclusions FV, FA and IJV depth and diameter correlated with weight, size, age and body surface area in the studied pediatric patients. Correlation was better for femoral than for jugular vessels. Depth could be estimated from patients' weight and size, while diameter could be estimated from the size. Such estimations may facilitate the choice of vessels to be cannulated, length and diameter of cannulation needles and the diameter of catheters to be used in pediatric patients.
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Affiliation(s)
- J M López Álvarez
- Unit of Intensive Pediatric Medicine, Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (Mother and Child University Hospital of Canarias), Las Palmas, Spain
| | - O Pérez Quevedo
- Unit of Intensive Pediatric Medicine, Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (Mother and Child University Hospital of Canarias), Las Palmas, Spain
| | - L Santana Cabrera
- Service of Intensive Medicine, Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (Mother and Child University Hospital of Canarias), Las Palmas, Spain
| | - C Rodríguez Escot
- Service of Intensive Medicine, Complejo Hospitalario Universitario Insular Materno-Infantil de Canarias (Mother and Child University Hospital of Canarias), Las Palmas, Spain
| | - J F Loro Ferrer
- Department of Clinical Sciences, University of Las Palmas de GC, Las Palmas, Spain
| | - T Ramírez Lorenzo
- Department of Biostatistics. Unit for Support of Research, University of Las Palmas de GC, Las Palmas, Spain
| | - J M Limiñana Cañal
- Department of Biostatistics. Unit for Support of Research, University of Las Palmas de GC, Las Palmas, Spain
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Eksioglu AS. Response regarding our article, "sonographic measurement criteria for the diagnosis of internal jugular phlebectasia in children". JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:48-49. [PMID: 25200764 DOI: 10.1002/jcu.22236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/14/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Ayse Secil Eksioglu
- Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Department of Radiology, Ankara, Turkey
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Kayashima K. Diagnostic criteria of pediatric internal jugular phlebectasia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:47. [PMID: 25179586 DOI: 10.1002/jcu.22237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/14/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Kenji Kayashima
- Department of Anesthesia, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu, 806-8501, Fukuoka, Japan
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Lee JG, Park HB, Shin HY, Kim JD, Yu SB, Kim DS, Ryu SJ, Kim GH. Effect of Trendelenburg position on right and left internal jugular vein cross-sectional area. Korean J Anesthesiol 2014; 67:305-9. [PMID: 25473458 PMCID: PMC4252341 DOI: 10.4097/kjae.2014.67.5.305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/24/2014] [Accepted: 08/08/2014] [Indexed: 11/14/2022] Open
Abstract
Background Unlike the right internal jugular vein (RIJV), there is a paucity of data regarding the effect of the Trendelenburg position on the left internal jugular vein (LIJV). The purpose of this study is to investigate the cross-sectional area (CSA) of the LIJV and RIJV and their response to the Trendelenburg position using two-dimensional ultrasound in adult subjects. Methods This study enrolled fifty-eight patients with American Society of Anesthesiologists physical status class I-II who were undergoing general anesthesia. CSAs of both the RIJV and LIJV were measured with a two-dimensional ultrasound in the supine position and then in a 10° Trendelenburg position. Results In the supine position, the transverse diameter, anteroposterior diameter, and CSA of the RIJV were significantly larger than those of the LIJV (P < 0.001). Of 58 patients, the RIJV CSA was larger than the LIJV CSA in 43 patients (74.1%), and the LIJV CSA was larger than the RIJV CSA in 15 patients (25.9%). In the Trendelenburg position, CSAs of the RIJV and LIJV increased 39.4 and 25.5%, respectively, compared with the supine position. However, RIJV changed at a rate that was significantly greater than that of the LIJV (P < 0.05). Of 58 patients, the RIJV CSA was larger than the LIJV CSA in 48 patients (82.8%), and the LIJV CSA was larger than the RIJV CSA in 10 patients (17.2%). Conclusions In supine position, the RIJV CSA was larger than the LIJV CSA. The increased CSA in the Trendelenburg position was greater in the RIJV than the LIJV.
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Affiliation(s)
- Jeong Gil Lee
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hee Bin Park
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hye Young Shin
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ju Deok Kim
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Soo Bong Yu
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Doo Sik Kim
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sie Jeong Ryu
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Gyeong Han Kim
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
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