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Sternbach S, Taggert J, Raible W, Sternbach Y, Ozsvath K. Venous pseudoaneurysm in a dialysis patient. J Vasc Surg Cases Innov Tech 2024; 10:101548. [PMID: 39069992 PMCID: PMC11277363 DOI: 10.1016/j.jvscit.2024.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/16/2024] [Indexed: 07/30/2024] Open
Abstract
We present a case of embolization for post-angioplasty pseudoaneurysm of the internal mammary vein. A 62-year-old male presented to the emergency department with right upper extremity edema. One month prior, he underwent angioplasty of right cephalic, subclavian, and innominate veins for similar symptoms but felt they had worsened. Computed tomography with intravenous contrast revealed pseudoaneurysm of the right internal mammary vein, and the patient was taken emergently to the operating room where embolization was successfully performed. Central venous pseudoaneurysm is a rare complication of angioplasty and the unique considerations of the anatomic region necessitate discussion of the optimal treatment modality.
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Affiliation(s)
- Sarah Sternbach
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - John Taggert
- Division of Vascular Surgery, Department of Surgery, St Peter’s Health Partners, Troy, NY
| | - William Raible
- Division of Vascular Surgery, Department of Surgery, St Peter’s Health Partners, Troy, NY
| | - Yaron Sternbach
- Division of Vascular Surgery, Department of Surgery, St Peter’s Health Partners, Troy, NY
| | - Kathleen Ozsvath
- Division of Vascular Surgery, Department of Surgery, St Peter’s Health Partners, Troy, NY
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Davies MG, Hart JP. Endovascular management of acute and subacute venous thoracic outlet syndrome. Front Surg 2024; 11:1302568. [PMID: 38440414 PMCID: PMC10909919 DOI: 10.3389/fsurg.2024.1302568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Approximately 3% of all patients presenting with Thoracic Outlet Syndrome have a venous etiology (vTOS), which is considered "effort thrombosis". These patients will present with symptomatic deep venous thrombosis or focal subclavian vein (SCV) stenosis. Endovascular management of vTOS occurs in several phases: diagnostic, preoperative therapeutic intervention before decompression, postoperative interventions after decompression, and delayed interventions in the follow-up after decompression. In the diagnostic phase, dynamic SCV venography can establish functional vTOS. Approximately 4,000 patients have been treated for vTOS and reported in the literature since 1970. Declotting of the SCV was followed by surgical decompression in 53% of patients, while in the remainder, surgical decompression alone (18%), endovascular intervention alone (15%), or conservative therapy with anticoagulation (15%) was performed. The initial intervention was predominantly catheter-directed thrombolysis, with <10% of cases undergoing concomitant balloon angioplasty. 93% of cases were successful. In the postoperative phase, balloon angioplasty was performed to correct residual intrinsic SCV disease after vTOS decompression in under 15% of cases. Stents were rarely deployed. Symptom relief was reported as 94 ± 12% (mean ± SD) and 90 ± 23%, respectively for declotting with decompression and declotting alone. In the delayed phase, balloon angioplasty was performed in under 15% of cases to re-establish patency.
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Affiliation(s)
- Mark G. Davies
- Department of Cardiovascular Outcomes, Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases, Houston, TX, United States
| | - Joseph P. Hart
- Division of Vascular and Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
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Zhang R, Zhang J, Xue X, Sun Z, Du N, Chen N, Dong F, Wang X, Tian Q. Comparison of Lower and Upper Extremity Arteriovenous Graft: A Retrospective Clinical Analysis with 5-Year Follow-Up. Ann Vasc Surg 2024; 98:235-243. [PMID: 37392856 DOI: 10.1016/j.avsg.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND For patients in whom an upper extremity (UE) vascular access cannot be established, the lower extremity (LE) arteriovenous graft (AVG) could be selected. However, the application of LE AVG is limited owing to its high infection rate, uncertain patency time, and technical difficulties. This study aimed to compare the long-term patency rates and the incidence of vascular access complications of AVG in the LE and UE to provide a reference for the applications of AVG, especially in the LEs. METHODS This was a retrospective analysis of patients who successfully underwent LE or UE AVG placement from March 2016 to October 2021. Patient characteristics were collected and compared using parameter or nonparameter tests according to data type. Postoperative patency was evaluated using Kaplan-Meier test. Postoperative complication incidence density and intergroup comparison were estimated using the Poisson distribution. RESULTS Twenty-two patients with LE AVG and 120 patients with UE AVG were included. The 1-year primary patency rate was 67.4% (±11.0% standard error [SE]) in the LE group and 30.1% (±4.5% SE) in the UE group (P = 0.031). The assisted primary patency rate at postoperative months 12, 24, and 36 was respectively 78.6% (±9.6% SE), 65.5% (±14.4% SE), and 49.1% (±17.8% SE) in the LE group and 63.3% (±4.6% SE), 47.5% (±5.4% SE), and 30.4% (±6.1% SE) in the UE group (P = 0.137). The secondary patency rate at postoperative months 12, 24, and 36 remains 95.5% (±4.4% SE) in the LE group and 89.3% (±2.9% SE), 83.7% (±3.9% SE), and 73.0% (±6.2% SE), respectively, in the UE group (P = 0.200). Postoperative complications included stenosis, occlusion/thrombosis, infection, steal syndrome, pseudoaneurysm, severe postoperative serum swelling, and AVG exposure. The total incidence rates of postoperative complications were 0.87 (95% confidence interval [CI] 0.59-1.23) versus 1.61 (95% CI 1.45-1.79) (P = 0.001) cases/person-year, the incidence rates of stenosis were 0.45 (95% CI 0.26-0.73) versus 0.92 (95% CI 0.80-1.06) (P = 0.005) cases/person-year and the incidence rates of occlusion/thrombosis were 0.34 (95% CI 0.17-0.59) versus 0.62 (95% CI 0.52-0.74) cases/person-year in the LE group compared to those in the UE group (P = 0.041). CONCLUSIONS LE AVG had higher primary patency rate and lower postoperative complication incidence than UE AVG. With the development of interventional technology, both LE AVG and UE AVG exhibited high secondary patency rates. LE AVG can be a reliable and long-term alternative for appropriately selected patients with unusable UE vessels.
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Affiliation(s)
- Ruibin Zhang
- Department of Nephrology, Blood Purification Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jing Zhang
- Department of Nephrology, Heze Municipal Hospital, Heze, Shandong, China
| | - Xia Xue
- Department of General Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhenfu Sun
- Department of Nephrology, Heze Municipal Hospital, Heze, Shandong, China
| | - Nannan Du
- Department of Nephrology, Blood Purification Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Nan Chen
- Department of Nephrology, Heze Municipal Hospital, Heze, Shandong, China
| | - Fangfang Dong
- Department of Nephrology, Gaomi People's Hospital, Gaomi, Shandong, China
| | - Xiaoping Wang
- Department of Nephrology, Blood Purification Center, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - Qiuju Tian
- Department of Nephrology, Heze Municipal Hospital, Heze, Shandong, China.
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Cochran RL, Ghoshhajra BB, Hedgire SS. Body and Extremity MR Venography: Technique, Clinical Applications, and Advances. Magn Reson Imaging Clin N Am 2023; 31:413-431. [PMID: 37414469 DOI: 10.1016/j.mric.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Magnetic resonance venography (MRV) represents a distinct imaging approach that may be used to evaluate a wide spectrum of venous pathology. Despite duplex ultrasound and computed tomography venography representing the dominant imaging modalities in investigating suspected venous disease, MRV is increasingly used due to its lack of ionizing radiation, unique ability to be performed without administration of intravenous contrast, and recent technical improvements resulting in improved sensitivity, image quality, and faster acquisition times. In this review, the authors discuss commonly used body and extremity MRV techniques, different clinical applications, and future directions.
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Affiliation(s)
- Rory L Cochran
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Brian B Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Li X, Liu S. Who's to blame for central venous stenosis. Pak J Med Sci 2023; 39:1216. [PMID: 37492289 PMCID: PMC10364258 DOI: 10.12669/pjms.39.4.7559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/06/2023] [Indexed: 07/27/2023] Open
Abstract
doi: https://doi.org/10.12669/pjms.39.4.7559
How to cite this: Li X, Liu S. Who’s to blame for central venous stenosis. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7559
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Affiliation(s)
- Xiaodong Li
- Xiaodong Li, Department of Nephrology, Baoding No. 1 Central Hospital of Hebei Medical University, Baoding, Hebei, China
| | - Shuangyan Liu
- Shuangyan Liu, Graduate School of Hebei Medical University, Shijiazhuang 050017, Hebei, China
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Bissacco D, Mandigers TJ, Romagnoli S, Aprea T, Lomazzi C, D'Alessio I, Ascenti V, Ierardi AM, Domanin M, Tolva VS, Carrafiello G, Trimarchi S. Acute venous problems: Integrating medical, surgical, and interventional treatments. Semin Vasc Surg 2023; 36:307-318. [PMID: 37330243 DOI: 10.1053/j.semvascsurg.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
"Acute venous problems" refers to a group of disorders that affect the veins and result in sudden and severe symptoms. They can be classified based on the pathological triggering mechanisms, such as thrombosis and/or mechanical compression, and their consequences, including symptoms, signs, and complications. The management and therapeutic approach depend on the severity of the disease, the location, and the involvement of the vein segment. Although summarizing these conditions can be challenging, the objective of this narrative review was to provide an overview of the most common acute venous problems. This will include an exhaustive yet concise and practical description of each condition. The multidisciplinary approach remains one of the major advantages in dealing with these conditions, maximizing the results and the prevention of complications.
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Affiliation(s)
- Daniele Bissacco
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy.
| | - Tim J Mandigers
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Romagnoli
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Aprea
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilenia D'Alessio
- Vascular Surgery Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Velio Ascenti
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Radiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy; Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Gianpaolo Carrafiello
- Radiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy
| | - Santi Trimarchi
- Department of Clinical and Community Sciences, University of Milan, Via Sforza 35, 20122, Milan, Italy; Vascular Surgery Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
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Tabriz DM, Arslan B. HeRO Graft: Indications, Technique, Outcomes, and Secondary Intervention. Semin Intervent Radiol 2022; 39:82-89. [PMID: 35210737 PMCID: PMC8856774 DOI: 10.1055/s-0042-1742391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Hemodialysis Reliable Outflow (HeRO) graft is a nontraditional, surgical, and endovascularly placed access that offers options in failing arteriovenous fistula/arteriovenous graft or catheter-dependent patients. The HeRO graft provides a unique option and is specifically referred to in the 2019 Kidney Disease Outcomes Quality Initiative (KDOQI) vascular access update. The interventional radiologist has a role and opportunity to work collaboratively with surgeons in assisting with (1) the identification, selection, preparation for, and placement of HeRO grafts and (2) providing post-placement maintenance to ensure long-term patency.
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Affiliation(s)
- David M. Tabriz
- Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Bulent Arslan
- Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois,Address for correspondence Bulent Arslan, MD, FSIR Department of Vascular and Interventional Radiology, Rush University Medical Center1750 W. Harrison St. (Jelke), Suite 164, Chicago, IL 60612
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