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Soares Ferreira Júnior A, Boyle SH, Kuchibhatla M, Onwuemene OA. Central venous catheters are associated with thrombosis among adult inpatients undergoing therapeutic plasma exchange. J Clin Apher 2022; 37:340-347. [PMID: 35191546 DOI: 10.1002/jca.21975] [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: 11/12/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND For inpatients undergoing therapeutic plasma exchange (TPE) in the United States, the primary mode of venous access is the central venous catheter (CVC). To evaluate the impact of CVC on thrombosis outcomes of patients undergoing TPE, we analyzed the National Inpatient Sample (NIS) database. STUDY DESIGN AND METHODS In a cross-sectional analysis of the NIS, we identified hospital discharges of adult patients treated with TPE. Cases were classified into two groups based on CVC status. The primary outcome was thrombosis. Secondary outcomes were major bleeding, packed red blood cell (PRBC) transfusion, in-hospital mortality, hospital length of stay (LOS), and charges. RESULTS Among 9863 TPE-treated discharges, CVC was used in 5988 (60%). These numbers correspond to weighted national estimates of 49 315 and 29 940, respectively. There was a positive and significant association between CVC and thrombosis (OR = 1.23, 95% 1.04-1.46, P = 0.0174), PRBC transfusion (OR = 1.15, 95% 1.03-1.29, P = 0.0121), in-hospital mortality (OR = 1.36, 95% 1.10-1.68, P = 0.0043), hospital LOS (15.63 vs 12.45 days, P < 0.0001) and hospital charges ($166 387 vs. $132 655, P < 0.0001). CONCLUSION In hospitalized patients undergoing TPE, CVC use is associated with increased rates of thrombosis. Future studies are needed to investigate strategies to decrease CVC use and/or prevent CVC-associated complications in TPE-treated inpatients.
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Affiliation(s)
| | - Stephen H Boyle
- Duke University School of Medicine, Durham, North Carolina, USA.,Durham Veterans Administration Medical Center, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwatoyosi A Onwuemene
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Gómez-Arbeláez D, García-Gutiérrez A, González-Fajardo JA. Unilateral Proptosis (Exophthalmos) Caused by Axillary-Subclavian Venous Thrombosis in a Patient with Upper Extremity Arteriovenous Dialysis Fistula. Methodist Debakey Cardiovasc J 2021; 17:24-27. [PMID: 34824675 PMCID: PMC8588745 DOI: 10.14797/mdcvj.699] [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: 04/21/2021] [Accepted: 05/26/2021] [Indexed: 11/08/2022] Open
Abstract
Arterialization of orbital veins is most often due to dural arteriovenous malformations of the cavernous sinus area. We report an unusual case of unilateral proptosis (exophthalmos) caused by arterialized retrograde venous flow in the external jugular vein and cavernous sinus in a patient with an upper extremity hemodialysis fistula and ipsilateral acute central venous thrombosis. The patient’s symptoms improved after surgical closure of the hemodialysis fistula.
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Thrombotic superior vena cava syndrome: a national emergency department database study. J Thromb Thrombolysis 2021; 53:372-379. [PMID: 34342784 DOI: 10.1007/s11239-021-02548-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
Literature regarding etiology and trends of incidence of major thoracic vein thrombosis in the United States is limited. To study the causes, complications, in-hospital mortality rate, and trend in the incidence of major thoracic vein thrombosis which could have led to superior vena cava syndrome (SVCS) between 2010 and 2018. Data from the nationwide emergency department sample (NEDS) that constitutes 20% sample of hospital-owned emergency departments (ED) and in-patient sample in the United States were analyzed using diagnostic codes. A linear p-trend was used to assess the trends. Of the total 1082 million ED visits, 37,807 (3.5/100,000) (mean age 53.81 ± 18.07 years, 55% females) patients were recorded with major thoracic vein thrombosis in the ED encounters. Among these patients, 4070 (10.6%) patients had one or more cancers associated with thrombosis. Pacemaker/defibrillator-related thrombosis was recorded in 2820 (7.5%) patients, while intravascular catheter-induced thrombosis was recorded in 1755 (4.55%) patients. Half of the patients had associated complication of pulmonary embolism. A total of 59 (0.15%) patients died during these hospital encounters. The yearly trend for the thrombosis for every 100,000 ED encounters in the United States increased from 2.17/100,000 in 2010 to 5.98/100,000 in 2018 (liner p-trend < 0.001). Yearly trend for catheter/lead associated thrombosis was also up-trending (p-trend 0.015). SVCS is an uncommon medical emergency related to malignancy and indwelling venous devices. The increasing trend in SVCS incidence, predominantly catheter/lead induced, and the high rate of associated pulmonary embolism should prompt physicians to remain vigilant for appropriate evaluation.
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Klein-Weigel PF, Elitok S, Ruttloff A, Reinhold S, Nielitz J, Steindl J, Hillner B, Rehmenklau-Bremer L, Wrase C, Fuchs H, Herold T, Beyer L. Superior vena cava syndrome. VASA 2020; 49:437-448. [PMID: 33103626 DOI: 10.1024/0301-1526/a000908] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The superior vena cava syndrome (SVCS) is caused by compression, invasion, and/or thrombosis of the superior vena cava and/or the brachiocephalic veins. Benign SVCS is separated from malignant SVCS. SVCS comprises a broad clinical spectrum reaching from asymptomatic cases to rare life-threatening emergencies with upper airway obstruction and increased intracranial pressure. Symptoms are correlated to the acuity and extent of the venous obstruction and inversely correlated to the development of the venous collateral circuits. Imaging is necessary to determine the exact underlying cause and to guide further interventions. Interventional therapy has widely changed the therapeutic approach in symptomatic patients. This article provides an overview over this complex syndrome and focuses on interventional therapeutic methods and results.
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Affiliation(s)
- Peter Franz Klein-Weigel
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Saban Elitok
- Clinic for Nephrology, Endokrinology/Diabetology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Andreas Ruttloff
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Sabine Reinhold
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Jessika Nielitz
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Julia Steindl
- Clinic for Angiology, Interdisciplinary Center of Vascular Medecine, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | | | | | - Christian Wrase
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Heiko Fuchs
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
| | - Thomas Herold
- Radiology, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Lukas Beyer
- Diagnostic and Interventional Radiology, Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany
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5
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Central venous catheter-related thrombosis in children and adults. Thromb Res 2020; 187:103-112. [DOI: 10.1016/j.thromres.2020.01.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
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6
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Gluncic V, Lukić I, Bonasera L, Candido K. Upper extremity arteriovenous dialysis fistula causing arterialised blood flow in internal jugular vein in patients with brachiocephalic vein occlusion. Indian J Anaesth 2020; 64:915-917. [PMID: 33437089 PMCID: PMC7791415 DOI: 10.4103/ija.ija_378_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 11/08/2022] Open
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Endovascular port-a-cath rescue in acute thrombotic superior vena cava syndrome. J Vasc Surg Cases Innov Tech 2019; 5:169-173. [PMID: 31193522 PMCID: PMC6535642 DOI: 10.1016/j.jvscit.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/11/2019] [Indexed: 11/24/2022] Open
Abstract
Acute superior vena cava (SVC) syndrome is managed by endovascular recanalization, venoplasty with stenting, and anticoagulation. It is often associated with central venous catheters. We present a case of a 55-year-old woman with acute SVC syndrome due to port-a-cath-associated thrombosis of the SVC and the brachiocephalic and subclavian veins who was treated with catheter-based thrombectomy and local spray thrombolysis, venoplasty, and stent placement. Port-a-cath restoration was achieved in the same session by endovascular snaring and repositioning. This case demonstrates that reoperation with surgical catheter removal and reinsertion of central venous catheters with possible complications (eg, rethrombosis, bleeding) can be avoided by single-session endovascular management.
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8
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Premuzic V, Perkov D, Smiljanic R. The development of central venous thrombosis in hemodialyzed patients is associated with catheter tip depth and localization. Hemodial Int 2018; 22:454-462. [PMID: 29722112 DOI: 10.1111/hdi.12662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of our work was to analyze the incidence of tunneled hemodialysis catheters-related thrombosis in hemodialyzed patients depending on catheter tip depth and position and to evaluate the impact of other established risk factors responsible for development of central venous thrombosis. METHODS The presence of central vein thrombosis, location, and the depth of the catheter tip was reviewed by two experienced radiologists. All patients with suspected central venous thrombosis had factor V Leiden, lupus anticoagulant, and cardiolipin antibodies checked (acIgM and acIgG) and were evaluated with cat-scan venography. FINDINGS A total of 68 tunneled hemodialysis catheters were analyzed with CT venography for central venous thrombosis. There were no signs of central venous thrombosis when catheter tips were placed in the right atrium. There was significantly higher number of catheter tips located on the vein wall than located centrally in patients with central venous thrombosis. Higher percentage of central venous thrombosis, smaller number of tips placed in the right atrium, higher values of IgM cardiolipin antibodies, and higher number of patients with positive factor V Leiden mutation were found in group of patients with catheter tips located on vein wall. DISCUSSION Higher incidence of central venous thrombosis in patients with the catheter tip placed on the vein wall is a consequence of a catheter tip depth proximal of the right atrium. Increased factor V Leiden mutation and acIgM values in these patients should be observed as a result of the vein stasis caused by inappropriate catheter tip depth and localization.
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Affiliation(s)
- Vedran Premuzic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Drazen Perkov
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ranko Smiljanic
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia
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Sertic AJ, Connolly BL, Temple MJ, Parra DA, Amaral JG, Lee KS. Perforations associated with peripherally inserted central catheters in a neonatal population. Pediatr Radiol 2018; 48:109-119. [PMID: 28986615 DOI: 10.1007/s00247-017-3983-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/14/2017] [Accepted: 09/05/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are increasingly used in neonates but perforations can result in devastating complications such as pericardial and pleural effusions. Identifying risk factors may guide surveillance and reduce morbidity and mortality. OBJECTIVE To determine the risk factors for PICC perforation in neonates. MATERIALS AND METHODS Retrospective case:control (1:2) study of neonates admitted between 2004-2014. Charts and imaging were reviewed for clinical and therapeutic risk factors. RESULTS Among 3,454 PICCs, 15 cases of perforation (incidence 0.4%, 5 pericardial effusions, 10 pleural effusions) were matched to 30 controls, based on gestation and insertion date. Timing of perforations post-insertion was median 4 days for pericardial effusions and 21.5 days for pleural effusions. A risk factor for pericardial effusion was lower weight at PICC insertion compared with controls. There were no statistically significant differences between cases and controls in catheter material, insertion site, PICC size and lumen number. Among upper limb PICCs, pericardial effusions were associated with tip positions more proximal to the heart at insertion (P=0.005) and at perforation (P=0.008), compared with controls. Pleural effusions were associated with tip positions more distal from the heart at perforation (P=0.008). Within 48 h before perforation, high/medium risk infusions included total parenteral nutrition (100% cases vs. 56.7% controls, P=0.002) and vancomycin (60% cases vs. 23.3% controls, P=0.02). CONCLUSION PICC-associated pericardial effusions and pleural effusions are rare but inherent risks and can occur at any time after insertion. Risk factors and etiologies are multifactorial, but PICC tip position may be a modifiable risk factor. To mitigate this risk, we have developed and disseminated guidelines for target PICC positions and routinely do radiographs to monitor PICCs for migration and malposition in our NICU. The increased knowledge of risk profiles from this study has helped focus surveillance efforts and facilitate early recognition and treatment.
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Affiliation(s)
- Andrew J Sertic
- Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bairbre L Connolly
- Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael J Temple
- Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Dimitri A Parra
- Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joao G Amaral
- Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
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10
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Preoperative management of arteriovenous fistula (AVF) for hemodialysis. J Vasc Access 2017; 18:451-463. [PMID: 29027182 DOI: 10.5301/jva.5000771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 11/20/2022] Open
Abstract
Native arteriovenous fistula (AVF) is the favorite access for hemodialysis (HD). The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) recommends its creation in most patients with renal failure. Unfortunately, intensive efforts to promote native AVF in patients with marginal vessels have increased the rate of primary fistula failure. A non-functioning fistula prompts the use of central venous catheter (CVC) that, unlike AVF, has been associated with an increased risk of morbidity and mortality among patients receiving HD. We believe that successful and timely AVF placement relies on the development of a multidisciplinary integrated preoperative program divided into five stages: (i) management of patients with advanced chronic kidney disease (CKD), (ii) management of preoperative risk factors for AVF failure, (iii) planning of native AVF, (iv) assessment of patient eligibility and (v) preoperative vascular mapping. Focusing specifically on native AVF, we review scientific evidence regarding preoperative management of this vascular access in order to favor construction of long-term functioning fistula minimizing development of severe complications.
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11
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Superior vena cava syndrome complicated with acute pulmonary thromboembolism in a patient with lung cancer. J Cardiol Cases 2017; 17:9-11. [PMID: 30279843 DOI: 10.1016/j.jccase.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/11/2017] [Accepted: 08/14/2017] [Indexed: 11/22/2022] Open
Abstract
Thrombosis involving the subclavian vein and superior vena cava is relatively common, especially in cancer patients. Edema of the arms and head is a well-known clinical consequence of this thrombosis. The intrinsic risk of pulmonary embolism has not been reported previously. Herein, we describe the case of a 63-year-old male patient with extensive stage small cell lung cancer who developed superior vena cava syndrome. Pulmonary thromboembolism was complicated after receiving systemic chemotherapy and localized radiotherapy. <Learning objective: Superior vena cava (SVC) syndrome may pose a significant risk factor of pulmonary thromboembolism. Although SVC syndrome and pulmonary thromboembolism may have similar comorbidities, pulmonary thromboembolism might occur after treatment of SVC syndrome. Possible mechanisms may be related to tumor debris and hypercoagulable central vein thrombosis. Physicians must be vigilant with patients whom have dyspnea after treatment of SVC syndrome. Computed tomography angiography may help make an early diagnosis if clinical suspicion is made.>.
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Tromboembolia pulmonar asociada al síndrome de la vena cava superior de origen trombótico. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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Clark K, Chick JFB, Reddy SN, Shin BJ, Nadolski GJ, Clark TW, Trerotola SO. Concurrent Central Venous Stent and Central Venous Access Device Placement Does Not Compromise Stent Patency or Catheter Function in Patients with Malignant Central Venous Obstruction. J Vasc Interv Radiol 2017; 28:602-607. [PMID: 28238580 DOI: 10.1016/j.jvir.2016.12.1222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine if concurrent placement of a central venous stent (CVS) and central venous access device (CVAD) compromises stent patency or catheter function in patients with malignant central venous obstruction. MATERIALS AND METHODS CVS placement for symptomatic stenosis resulting from malignant compression was performed in 33 consecutive patients who were identified retrospectively over a 10-year period; 28 (85%) patients had superior vena cava syndrome, and 5 (15%) had arm swelling. Of patients, 11 (33%) underwent concurrent CVS and CVAD placement, exchange, or repositioning; 22 (67%) underwent CVS deployment alone and served as the control group. Types of CVADs ranged from 5-F to 9.5-F catheters. Endpoints were CVS patency as determined by clinical symptoms or CT and CVAD function, which was determined by clinical performance. RESULTS All procedures were technically successful. There was no difference between the 2 groups in clinically symptomatic CVS occlusion (P = .2) or asymptomatic in-stent stenosis detected on CT (P = .5). None of the patients in the CVS and CVAD group had recurrent clinical symptoms, but 3 (30%) of 10 patients with imaging follow-up had asymptomatic in-stent stenosis. In the control group, 3 (14%) patients had clinically symptomatic CVS occlusion and required stent revision, whereas 4 (21%) of 19 patients with imaging follow-up had asymptomatic in-stent stenosis. During the study, 2 (20%) functional but radiographically malpositioned catheters were identified (0.66 per 1,000 catheter days). CONCLUSIONS Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone.
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Affiliation(s)
- Katherine Clark
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Shilpa N Reddy
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Radiology Associates of the Main Line, Main Line Health System, Bryn Mawr Hospital, Bryn Mawr, Pennsylvania
| | - Benjamin J Shin
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Gregory J Nadolski
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Timothy W Clark
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
| | - Scott O Trerotola
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
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Oymak FS, Buyukoglan H, Tokgoz B, Ozkan M, Tasdemir K, Mavili E, Gulmez I, Demir R, Ozesmi M. Prevalence of Thromboembolic Disease IncludingSuperior Vena Cava and Brachiocephalic Veins. Clin Appl Thromb Hemost 2016; 11:183-9. [PMID: 15821824 DOI: 10.1177/107602960501100207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thrombosis of the brachiocephalic veins or superior vena cava (SVC) is rare. This study was conducted to determine the prevalence and characteristics of thrombosis of brachiocephalic veins and SVC, and its association with symptomatic pulmonary embolism (PE). The prevalence of thrombosis involving the brachiocephalic veins and SVC was evaluated retrospectively at a university hospital during the 3-year period. Patients were identified by hospital records and review of computer-generated lists of of all venograms, contrast-enhanced chest computed tomography, and magnetic resonance angiograms of the upper extremity and SVC. Thrombosis of the brachiocephalic veins and SVC was diagnosed in 33 (0.03%) of 100,942 patients of all ages [(32 of 70,751 adult patients≥ 20 years; 0.04%)]. Twenty-three (70%) patients initially had secondary thrombosis with multiple risk factors: associated with malignancy in 14 (42%) patients, chronic disorders in 13 (39%) patients, central venous lines (CVL) and peripheral venous lines (PVL) in 9 (27%) patients, and thrombophilia in 10 (38%) of 26 patients. Swelling of the arm, head, and neck was present in 32 (97%) patients. Symptomatic PE developed before thrombosis being treated in 12 (36%) patients. All patients except eight (three, thrombolytic; five, thrombectomy) received anticoagulant therapy. Thrombosis of the SVC and brachiocephalic veins is an uncommon but serious complication in patients with malignancy, chronic disorders, CVL, PVL, and thrombophilia. Because it is important clinical problem with frequent PE, the patients with appropriate clinical findings should be diagnosed early with imaging tests and treated with anticoagulant drugs.
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Affiliation(s)
- Fatma Sema Oymak
- Department of Chest Diseases, Erciyes University Medical School, 38039 Kayseri, Turkey.
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Morales García AI, Arenas Jiménez MD, Esteban de la Rosa RJ, Fernández-Castillo R. Oesophageal varices secondary to thrombosis of the superior vena cava due to jugular haemodialysis catheter. Nefrologia 2016; 36:458-9. [PMID: 26857202 DOI: 10.1016/j.nefro.2015.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022] Open
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16
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Takayoshi K, Ariyama H, Tamura S, Yoda S, Arita T, Yamaguchi T, Ozono K, Yamamoto H, Inadomi K, Kumagai H, Tanaka M, Okumura Y, Sagara K, Nio K, Nakano M, Arita S, Kusaba H, Odashiro K, Oda Y, Akashi K, Baba E. Intraluminal superior vena cava metastasis from adenosquamous carcinoma of the duodenum: A case report. Oncol Lett 2015; 11:605-609. [PMID: 26870254 PMCID: PMC4727094 DOI: 10.3892/ol.2015.3938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 10/09/2015] [Indexed: 11/05/2022] Open
Abstract
In 2013, a 76-year-old male with a cardiac pacemaker was diagnosed with adenosquamous carcinoma of the duodenum. Subsequently, a pancreatoduodenectomy and lymph node dissection were performed, and 12 cycles of adjuvant chemotherapy (modified FOLFOX6 regimen), which consisted of fluorouracil, leucovorin and oxaliplatin, were administered via a central venous catheter. At 5 months after the completion of adjuvant chemotherapy, the patient experienced the sudden onset of severe pain at the back right of the ear, edema of the right side of the face and right jugular vein dilatation. Computed tomography (CT) revealed filling defects in the superior vena cava (SVC) and right brachiocephalic vein, indicating catheter-induced venous thrombosis. Although the catheter was removed and anti-coagulation therapy, aspiration of the thrombosis and ballooning dilatation were performed immediately, the patient's symptoms were not ameliorated. Notably, histological examination following thrombus aspiration revealed metastatic cancer cells, and fluorodeoxyglucose-positron emission tomography/CT identified metabolically active nodules in the SVC at locations consistent with the initial duodenal tumors detected by CT and in the first thoracic vertebrae. The tumor thrombus rapidly increased in size and resulted in worsening dyspnea. Subsequently, radiotherapy was performed, followed by chemotherapy, which relieved the systemic symptoms and suppressed the tumor growth. Adenosquamous carcinoma of the duodenum is extremely rare, and to the best of our knowledge, intraluminal SVC metastasis as a result of adenosquamous carcinoma of the duodenum has not been reported previously. The placement of a cardiac pacemaker, central venous catheter and tumor cells possessing high metastatic potential are hypothesized to have contributed to this rare case of metastasis.
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Affiliation(s)
- Kotoe Takayoshi
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Hiroshi Ariyama
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Shingo Tamura
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan; Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Oita 874-0838, Japan
| | - Shunsuke Yoda
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Takeshi Arita
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Toshihiro Yamaguchi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka 812-8582, Japan
| | - Keigo Ozono
- Department of Anatomical Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka 812-8582, Japan
| | - Hidetaka Yamamoto
- Department of Anatomical Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka 812-8582, Japan
| | - Kyoko Inadomi
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Hozumi Kumagai
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Mamoru Tanaka
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Yuta Okumura
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Kosuke Sagara
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Kenta Nio
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Michitaka Nakano
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Shuji Arita
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan; Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Fukuoka 812-8582, Japan
| | - Hitoshi Kusaba
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Keita Odashiro
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomical Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka 812-8582, Japan
| | - Koichi Akashi
- Department of Hematology and Oncology, Kyushu University Hospital, Fukuoka, Fukuoka 812-8582, Japan
| | - Eishi Baba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Fukuoka 812-8582, Japan
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Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP). Ann Hematol 2015; 94:1765-76. [DOI: 10.1007/s00277-015-2481-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/17/2015] [Indexed: 01/06/2023]
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18
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Kiernan M, Bhogal M, Wong K, Sivaprakasam R, Ashman N, Ali N. Sight-threatening intraocular pressure due to an upper arm dialysis fistula. Lancet 2015; 386:101-2. [PMID: 26169868 DOI: 10.1016/s0140-6736(15)61003-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Ken Wong
- Royal London Hospital, London, UK
| | | | | | - Nadeem Ali
- Royal London Hospital, London, UK; Moorfields Eye Hospital, London, UK
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19
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Jouvenot M, Willoteaux S, Meslier N, Gagnadoux F. Worsening of Obstructive Sleep Apnea Associated with Catheter-Related Superior Vena Cava Syndrome. J Clin Sleep Med 2015; 11:681-2. [PMID: 25766698 DOI: 10.5664/jcsm.4784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/23/2015] [Indexed: 11/13/2022]
Abstract
ABSTRACT There is growing evidence that fluid accumulation in the neck contributes to the pathogenesis of obstructive sleep apnea (OSA). We describe a case of catheter-related superior v ena cava (SVC) thrombosis revealed by rapid onset of typical symptoms of OSA. A marked improvement in OSA severity was observed after central venous catheter removal, anticoagulant therapy, and SVC angioplasty.
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Affiliation(s)
- Marie Jouvenot
- Université d'Angers, Département de Pneumologie, CHU, Angers, France
| | - Serge Willoteaux
- Université d'Angers, Département de Radiologie, CHU, Angers, France
| | - Nicole Meslier
- Université d'Angers, Département de Pneumologie, CHU, Angers, France.,INSERM 1063, Angers, France
| | - Frédéric Gagnadoux
- Université d'Angers, Département de Pneumologie, CHU, Angers, France.,INSERM 1063, Angers, France
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20
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Yasar B, Abut E. A case of mediastinal fibrosis due to radiotherapy and 'downhill' esophageal varices: a rare cause of upper gastrointestinal bleeding. Clin J Gastroenterol 2015; 8:73-6. [PMID: 25708450 DOI: 10.1007/s12328-015-0555-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
'Downhill' varices are located in the proximal part of the esophagus. Their etiology differs from the distal types, with most of them usually being related to superior vena cava obstruction. Although bleeding due to 'downhill' varices is very rare, it can be life-threatening. Here, we present a case of upper gastrointestinal bleeding due to mediastinal fibrosis associated with chest radiotherapy for seminoma metastasis sixteen years previously, which was successfully treated conservatively.
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Affiliation(s)
- Bulent Yasar
- Department of Gastroenterohepatology, Camlica Erdem Hospital, Alemdag Yanyol Street, Uskudar, Istanbul, 34696, Turkey,
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21
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Espitia O, Guerin P, Néel A, Espitia-Thibault A, Pottier P, Planchon B, Pistorius MA. [Superior vena cava syndrome induced by pacemaker probes, 12 years after introduction]. JOURNAL DES MALADIES VASCULAIRES 2013; 38:193-197. [PMID: 23433510 DOI: 10.1016/j.jmv.2013.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 12/31/2012] [Indexed: 06/01/2023]
Abstract
Superior vena cava syndrome is a rare disease, most often found to result from a malignant process, which causes extrinsic compression of the superior vena cava. In recent years, there has been an increase of superior vena cava syndrome related to medical devices (implantable site, pacemaker [PM], central venous line for parenteral nutrition...). We report the case of a 37-year-old patient who developed a superior vena cava syndrome 12 years after implantation of a PM. The diagnosis was established on venography after two negative venous-CT focused on the superior vena cava. The superior vena cava syndrome improved immediately after angioplasty and stenting covering the PM probes at the superior vena cava/brachiocephalic venous trunk junction.
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Affiliation(s)
- O Espitia
- Service de Médecine Interne, Hôtel-Dieu, CHU de Nantes, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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22
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23
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Hagiya H, Hagioka S, Otsuka F. Ineffectiveness of daptomycin in the treatment of septic pulmonary emboli and persistent bacteremia caused by methicillin-resistant Staphylococcus aureus. Intern Med 2013; 52:2577-82. [PMID: 24240800 DOI: 10.2169/internalmedicine.52.0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 73-year-old man with long-term food deprivation and total parenteral nutrition was diagnosed with septic pulmonary emboli (SPE) and a persistent bacteremia caused by central line-associated blood stream methicillin-resistant Staphylococcus aureus (MRSA) infection. Although daptomycin (DAP) failed to treat the persistent bacteremia, linezolid successfully controlled it. DAP is inactivated by lung surfactant, and therefore, it should not be administered for lower respiratory infections. However, SPE caused by MRSA has been reported to be treatable with DAP since it is an infection of the lung parenchyma. We herein report the lack of effect of daptomycin in SPE treatment.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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24
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Koury JP, Burke CT. Endovascular management of acute upper extremity deep venous thrombosis and the use of superior vena cava filters. Semin Intervent Radiol 2012; 28:3-9. [PMID: 22379271 DOI: 10.1055/s-0031-1272975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Upper extremity deep venous thrombosis (UEDVT), though less common than lower extremity DVT, is a significant problem with several possible etiologies. The incidence of UEDVT is on the rise, primarily from the increasing use of central venous access devices. However, there are other causes of UEDVT, including primary venous thrombosis (Paget-Schroetter syndrome) and hypercoagulable states associated with underlying malignancy. The morbidity and mortality associated with UEDVT is largely from pulmonary embolism and the postphlebitic syndrome. Nevertheless, many UEDVTs are asymptomatic or patients may present with nonspecific clinical symptoms; therefore, a high index of suspicion is often necessary to make a correct diagnosis. Currently, there is no standard treatment algorithm for UEDVT. Treatment options may range from systemic anticoagulation to surgical correction depending on the etiology of the thrombus, as well as the patient's associated comorbidities, life expectancy and expected quality of life following treatment.
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Affiliation(s)
- Joseph P Koury
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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25
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Left Hemibody Swelling in an HIV-Positive Patient with Congenital Heart Disease. Case Rep Vasc Med 2012; 2012:569095. [PMID: 22934233 PMCID: PMC3420770 DOI: 10.1155/2012/569095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 03/04/2012] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 50-year-old HIV-positive woman with a congenital cyanotic heart disease who developed left axillary, subclavian, and brachiocephalic vein thrombosis and left lower aortopulmonary collateral arterial thrombosis, presenting as left hemibody swelling. We also briefly overview the literature regarding upper extremity deep vein thrombosis (UEDVT). Given the absence of other risk factors, it was our firm believe that our patient's UEDVT was due to a hypercoagulable state associated with congestive heart failure (CHF) and HIV infection.
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26
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Chen CF, Hsu SW, Ko SF, Chen KY. High-flow hemodialysis arteriovenous shunt with concurrent central vein stenosis masquerading as sigmoid sinus dural arteriovenous fistula. Clin Neuroradiol 2011; 23:59-62. [PMID: 22138853 DOI: 10.1007/s00062-011-0118-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 11/17/2011] [Indexed: 11/25/2022]
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27
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Sakai T, Matsusaki T, Abu-Elmagd K, Amesur N, Thaete FL, Zak MF, Aggarwal S. The role of ultrasonography in determining central venous patency in patients undergoing bowel transplantation. Clin Transplant 2011; 26:E78-83. [DOI: 10.1111/j.1399-0012.2011.01533.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Erharhaghen J, Bartz M, Di Giovanni S, Melms A, Haarmeier T, Sieverding L. An unusual location of deep venous thrombosis associated with ischemic stroke and persistent foramen ovale. Case Rep Neurol 2011; 3:160-4. [PMID: 21829401 PMCID: PMC3150870 DOI: 10.1159/000330376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Up to 40% of ischemic strokes have no known cause (cryptogenic). The prevalence of persistent foramen ovale (PFO) amongst patients with cryptogenic stroke (CS) is twice as high as that of the normal population, therefore suggesting a causal relationship between the two entities. However, PFO by itself is not sufficient to cause stroke, as an embolic source is needed. This source is often unknown, making the causal relationship between CS and PFO hard to demonstrate. The most frequent, although still seldom, identifiable cause of embolism in an otherwise cryptogenic stroke associated with PFO is a deep venous thrombosis (DVT) of the lower extremities. Here, we present a unique case of brachiocephalic venous DVT associated with PFO and ischemic stroke in a young patient. As the search for DVT in patients with PFO and stroke is often limited to the lower extremities, this case may suggest that an unspecified number of DVTs are overlooked. Our report lends support to paradoxical embolism as a mechanism of stroke in patients with PFO and does, at least in selected cases, suggest a more detailed search for DVT beyond the lower extremities.
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Affiliation(s)
- J Erharhaghen
- Department of Neurology, University of Tuebingen, Tuebingen, Germany
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29
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Linhart M, Schwab JO, Bellmann B, Schrickel JW, Kreuz J, Balta O, Naehle CP, Strach K, Schneider C, Esmailzadeh B, Fimmers R, Nickenig G, Lickfett LM. Prevalence of asymptomatic upper extremity venous obstruction in 302 patients undergoing first implantation of cardioverter defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:684-9. [PMID: 21303390 DOI: 10.1111/j.1540-8159.2011.03035.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Little is known about the prevalence of upper extremity vein obstruction or anomalies in patients before first implantation of implantable cardioverter defibrillator (ICD). It remains unclear in which patients contrast venography is warranted before implantation procedure. METHODS Results of clinical data and contrast venography of 302 consecutive patients scheduled for first ICD implantation were analyzed. RESULTS Prevalence of upper vein obstruction was 6.6% (20/302 patients) in a typical patient population undergoing first ICD implantation. Age, left ventricular ejection fraction, underlying heart disease, prior open-heart surgery, or cardiopulmonary resuscitation were not predictors of obstruction. Patients with previous cardiac pacemaker implantation had a higher rate of obstruction, though this was not statistically significant (20% vs 15.7%, P = 0.54). Persistent left vena cava was found in 0.7%. CONCLUSION There is no clinical parameter sufficient enough to predict upper extremity venous obstruction. Contrast venography may be considered in patients with previous pacemaker placement but should not be a routine diagnostic tool in unselected patients prior to first ICD-implantation procedure.
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Affiliation(s)
- Markus Linhart
- Medizinische Klinik und Poliklinik II, University of Bonn, Bonn, Germany.
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30
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Abstract
Upper extremity deep vein thrombosis (UEDVT) is associated with significant morbidity and mortality. The susceptible populations and risk factors for UEDVT are well-known. The presenting symptoms can be subtle, and therefore objective testing is necessary for diagnosis. The optimal diagnostic strategy has not been determined, and more than one test may be required to exclude the diagnosis. Proper treatment reduces the occurrence of complications, and treatment should include long-term anticoagulation if the patient has no contraindications. This article discusses the risk factors, pathogenesis, diagnosis, complications, and management of UEDVT.
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Affiliation(s)
- Peter S Marshall
- Pulmonary & Critical Care Section, Department of Internal Medicine, Yale School of Medicine 333 Cedar Street, LCI 105B, PO Box 208057, New Haven, CT 06520-8057, USA.
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31
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Emergency: Upper-extremity deep vein thrombosis. Am J Nurs 2010; 110:48-52. [PMID: 20520116 DOI: 10.1097/01.naj.0000372072.24134.a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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32
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Yardley AME, Sachdev N, Aburn NS. Unusual cause of presumed orbital cellulitis. Clin Exp Ophthalmol 2010; 38:321-2. [PMID: 20447132 DOI: 10.1111/j.1442-9071.2010.02243.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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33
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Garofalo R, Notarnicola A, Moretti L, Moretti B, Marini S, Castagna A. Deep vein thromboembolism after arthroscopy of the shoulder: two case reports and a review of the literature. BMC Musculoskelet Disord 2010; 11:65. [PMID: 20377851 PMCID: PMC2858720 DOI: 10.1186/1471-2474-11-65] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 04/08/2010] [Indexed: 11/30/2022] Open
Abstract
Background Deep vein thrombosis (DVT) has an incidence of 1 case per 1000 inhabitants in the general population and it is very rare after arthroscopy of the shoulder. Therefore, the current guidelines do not advise the administration of DVT prophylaxis in shoulder arthroscopy procedures. Cases presentation We describe two cases of thrombosis of the arm after shoulder arthroscopy on a total of 10.452 shoulder arthroscopies performed during a period of ten years. One of two patients was further complicated by a bilateral pulmonary microembolism. In these two clinical cases the complication developed despite the absence of risk factors such as a concomitant neoplasm, thrombophilia, smoking habit, or a long duration of the procedure. Conclusions The DVT after shoulder arthroscopy procedure remain a very rare complication. However, in view of the growing number of patients undergoing this procedure, this figure is expected to rise. The clinician surgeon should take in mind this possible complication that normally appears in the first 3 weeks after surgery, so to perform anti-coagulant treatment. Further clinical studies are therefore warranted to assess the true risk of VTE. In fact, the presence of "minor" predisposing factors that are not routinely studied, as well as the postoperative immobilization period, are potential risk factors that, associated with the invasiveness of the arthroscopy procedure, could trigger a thromboembolism.
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Affiliation(s)
- Raffaele Garofalo
- Department of Clinical Methodology and Surgical Techniques, University of Bari, Bari, Italy
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34
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Abstract
Oncologic emergencies represent a wide variety of conditions that can occur at any time during the course of a malignancy, from an initial presenting manifestation in someone with an undiagnosed cancer, to end-stage incurable metastatic disease. Emergent conditions can also arise after a malignancy has been in remission for many years, even decades, so clinicians must be aware of any prior history of cancer in patients. Oncologic emergencies include conditions caused by the cancer itself or side effects of therapy. Emergent conditions include metabolic, cardiac, neurologic, or infectious disorders. Many of these emergencies are imminently life-threatening, and can occur in patients with curable disease (such as lymphomas or leukemias); however, many also present in patients with incurable advanced disease. Prompt recognition and treatment of these conditions can lead to markedly improved quality and quantity of life.
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Affiliation(s)
- Deepti Behl
- Hematology and Oncology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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35
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Paoletti F, Pellegrino V, Antonelli M, Ripani U, Mosca S, Durì D, Galzerano A. Compensatory dilatation of the Azygos Venous system Secondary To Superior Vena Cava Occlusion. J Radiol Case Rep 2009; 3:49-55. [PMID: 22470636 DOI: 10.3941/jrcr.v3i12.215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Superior vena cava (SVC) occlusion can be clinically recognized in the acute setting when the stenosing process does not allow the development of collateral venous channels, which guarantee the venous drainage to the right heart. On the contrary, when the obstruction develops progressively, the diagnosis of SVC obstruction may remain undiagnosed. In the present case, the presence of SVC thrombosis was purely coincidental. In fact, the obstruction was first noticed on diagnostic tests performed because of the malfunction of a totally implantable Porth a Cath placed into the superior vena cava (through right subclavian access), five years before, in a patient suffering from non-Hodgkin disease. Venography is the most appropriate diagnostic methodology which reveals the presence of a dilated azygos vein as a compensatory mechanism. Comparison with computed tomography allows to confirm the diagnosis and to identify the possible causes. Dilatation of the azygos vein, secondary to superior vena cava thrombosis, although a rare event, should be taken into consideration in those patients with CVC and who present with frequent episodes of deep venous thrombosis.
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Affiliation(s)
- Francesco Paoletti
- Anaesthesiology and Resuscitation Department, Santa Maria della Misericordia Hospital, Perugia, Italy
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36
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Nortley M, Brett A, Fossati N, Chemla ES. Retroesophageal internal jugular-to-internal jugular vein bypass for venous occlusion in a patient with complex hemodialysis access. J Vasc Surg 2009; 50:1490-2. [DOI: 10.1016/j.jvs.2009.07.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
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37
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Atici AG, Findik S, Light RW, Ozkaya S, Erkan L, Akan H. Vena caval thromboses. J Crit Care 2009; 25:336-42. [PMID: 19914035 DOI: 10.1016/j.jcrc.2009.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 09/26/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with vena caval (VC) thrombosis have been reported with a variety of clinical presentations, which may create a diagnostic challenge for physicians. OBJECTIVE The objective of the study was to evaluate the clinical characteristics of patients with VC thrombosis. PATIENTS AND METHODS Files and all imaging methods of consecutive patients with superior or inferior VC thrombosis with or without pulmonary embolism (PE) between January 26, 2001, and May 12, 2006, were retrospectively studied in detail. RESULTS In our series, VC thromboses within the inferior and superior VC were detected in 28 patients, mostly by combined computed tomographic venography and spiral computed tomographic pulmonary angiography. Nine of these 28 patients (32.1%) had VC thromboses without PE (7 patients with isolated and 2 patients with nonisolated VC thrombosis). Key symptoms and findings in the 9 patients without PE were unexplained dyspnea and tachypnea, respectively. CONCLUSIONS Many patients with VC thrombosis do not have peripheral vein thrombosis. Moreover, nearly one third of patients with VC thrombosis have negative pulmonary angiograms but do have dyspnea and tachypnea.
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Affiliation(s)
- Atilla G Atici
- Department of Pulmonary Medicine, Ondokuz Mayis University Hospital 55139 Kurupelit, Samsun, Turkey.
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38
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Shivakumar SP, Anderson DR, Couban S. Catheter-associated thrombosis in patients with malignancy. J Clin Oncol 2009; 27:4858-64. [PMID: 19738117 DOI: 10.1200/jco.2009.22.6126] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Central venous catheters are widely used in the care of patients with cancer. Indwelling catheters are associated with upper extremity deep venous thrombosis in some patients, and recognition of this entity is an important aspect of treating patients with malignancies. This article will review the incidence, pathogenesis, clinical presentation, diagnosis, treatment, and prophylaxis of catheter-associated thrombosis in patients with malignancy. The care of pediatric patients with malignancy and catheter-associated thrombosis will also be addressed.
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Affiliation(s)
- Sudeep P Shivakumar
- Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax, Nova Scotia, Canada
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39
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Huang TC, Hsu HH, Hsu YM, Yao NS. Mediastinitis and mediastinitis-like symptoms associated with mal-positioning of a Port-A catheter. Eur J Cancer Care (Engl) 2009; 18:645-9. [PMID: 19473373 DOI: 10.1111/j.1365-2354.2007.00895.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mediastinitis is a life-threatening condition and would appear to have been rarely reported as arising as a central-venous catheter-associated complication. Here we report on one cancer patient featuring a Port-A catheter tip positioned within the innominate vein, who developed mediastinitis and mediastinitis-like symptoms subsequent to chemotherapeutic-agent infusion through this catheter. The relevant literature pertaining to this condition was reviewed, and the possible pathophysiology of the condition was discussed.
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Affiliation(s)
- T-C Huang
- Division of Hematology/Oncology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
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40
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Foley PWX, Ratib K, Leyva F. Extensive venous thrombosis and cardiomyopathy demonstrated with cardiovascular magnetic resonance. J Cardiovasc Med (Hagerstown) 2008; 9:1075-7. [PMID: 18799976 DOI: 10.2459/jcm.0b013e328308ba7a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a patient who presented with typical symptoms of submassive pulmonary embolism associated with newly diagnosed cardiomyopathy. Contrast enhanced computed tomography demonstrated extensive venous thrombosis, and late enhancement cardiovascular magnetic resonance imaging was consistent with dilated cardiomyopathy with midwall fibrosis. We discuss the images and aetiology of the cardiomyopathy.
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Affiliation(s)
- Paul W X Foley
- Department of Cardiology, University of Birmingham, Good Hope Hospital, Heart of England NHS Trust, Sutton Coldfield, West Midlands, B75 7RR, UK.
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42
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Lénárd L, Szabados S, Imre J, Pintér O, Fazekas A, Tornai Z, Déczy K, Várady E, Papp L. [Vena cava superior syndrome: surgical treatment of the thrombosis of the superior vena cava after implantation of a hemodialysis catheter--a case report and review of the literature]. Orv Hetil 2008; 149:29-34. [PMID: 18089480 DOI: 10.1556/oh.2008.28207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
One of the rare reasons of the non malignant superior vena cava syndrome is the thrombosis of superior vena cava. Obstruction or occlusion of central veins is one of the many complications of the more and more frequently used central venous catheters and pacemaker electrodes. The authors report a case of superior vena cava thrombosis resulting in dialysis catheter insufficiency in case of a young, uraemic, female patient wit Tesio catheter and the surgical treatment of it with the use of cardiopulmonary bypass during the operation. Apropos of this case, the authors outline the causes of malignant, non-malignant and iatrogenic superior vena cava syndrome, furthermore the conservative, surgical and catheter therapy of the syndrome.
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Affiliation(s)
- László Lénárd
- Pécsi Tudományegyetem, Altalános Orvostudományi Kar, Szívgyógyászati Klinika, Pécs.
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Takeda T, Saitoh M, Takeda S. Superior vena cava syndrome caused by an intravascular thrombosis due to underlying prostate carcinoma. Intern Med 2008; 47:2007-9. [PMID: 19015618 DOI: 10.2169/internalmedicine.47.1428] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Superior vena cava (SVC) syndrome is usually caused by malignant tumors or their lymph node metastases oppressing a SVC. However, we encountered a case of SVC syndrome that was caused by a thrombus in the SVC, which we considered as a manifestation of Trousseau's syndrome triggered by underlying prostate cancer. A 60-year-old man patient complained of facial swelling. Physical examinations suggested SVC syndrome; enhanced CT and MRI demonstrated the presence of thrombus in the SVC accompanied by multiple mediastinal and axillary lymph node swelling. Histological examination of both percutaneous transluminally aspirated thrombus via a catheter through jugular vein and the axillary lymph nodes included metastatic prostate cancer. Although the ultrasonic and MR images were not compatible with the prostate cancer, needle biopsies from the prostate established the diagnosis. The SVC syndrome as an initial manifestation of underlying unknown malignancy and also due to intravascular thrombosis caused by cancer metastasis to the vascular wall is extremely uncommon.
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Affiliation(s)
- Takayuki Takeda
- Department of Internal Medicine, Division of Respiratory Medicine, Uji Tokusyukai Hospital, Uji.
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Superior Vena Cava Syndrome. Oncology 2007. [DOI: 10.1007/0-387-31056-8_70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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45
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Abstract
A review of 50 years of research on catheter tip placement indicates an overwhelming preference for the lower third of the superior vena cava as the appropriate tip location. Despite this evidence, there are still practitioners, physicians, and nurses who advocate tip placement within the axillo-subclavian-innominate vein (also referred to as the midclavicular). This article looks at the arguments presented by practitioners who support midclavicular tip placement. It also reviews some of the research from which the recommendations for superior vena cava placement are derived.
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Affiliation(s)
- Lynda S Cook
- CuraScript Infusion Pharmacy, Greensboro, NC 27455, USA.
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Watson RR, Russo C. Upper extremity arteriovenous dialysis fistula resulting in cavernous sinus arterialized blood flow. AJNR Am J Neuroradiol 2007; 28:1155-6. [PMID: 17569977 PMCID: PMC8134150 DOI: 10.3174/ajnr.a0504] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Arterialized blood flow in the cavernous sinus may result from carotid-cavernous fistula or dural venous fistula. We encountered an unusual case of arterialized blood flow in the cavernous sinus on MR angiography resulting from arterialized retrograde venous flow in the internal jugular vein. This abnormal flow originated from an upper extremity dialysis arteriovenous fistula in the presence of central venous occlusion. The patient's symptoms of visual disturbance resolved after the central venous occlusion was treated with stent placement.
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Affiliation(s)
- R R Watson
- Southern Illinois University School of Medicine, Department of Radiology, Memorial Medical Center, Springfield, IL 62781, USA.
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47
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48
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Abstract
Thrombosis of the internal jugular vein is a rare form of deep vein thrombosis with potentially life threatening complications. We report on a 46-year-old male presenting with dysphagia and neck swelling. An extensive thrombosis of the internal jugular vein was found on ultrasound of the neck. An interdisciplinary workup revealed an occult gastric carcinoma. This case demonstrates that concomitant malignancies may contribute to a thrombosis of the internal jugular vein, which is then the primary symptom presented by the patient.
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Affiliation(s)
- J Stern-Sträter
- Universitäts-Hals-Nasen-Ohren-Klinik Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Deutschland.
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Marcy PY, Magné N, Castadot P, Italiano A, Amoretti N, Bailet C, Bentolila F, Gallard JC. Is radiologic placement of an arm port mandatory in oncology patients? Cancer 2007; 110:2331-8. [PMID: 17886248 DOI: 10.1002/cncr.23040] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of the current study was 2-fold: to evaluate a radiologically placed percutaneous arm port device (PRAPD) in a large series of 1000 consecutive cancer patients undergoing chemotherapy (in terms of safety, efficacy, complications, and quality of life [QoL]) and to propose future recommendations. METHODS From 1998 to August 2002, all patients who had cancer required chemotherapy underwent insertion of a PRAPD and were prospectively included. All patients were followed for technical feasibility, overall device-related complications, and QoL. RESULTS Technical failures (6.3%) were caused by the inability to perform an arm venogram in 22 patients or to catheterize the brachial vein in 41 patients. Septic complications (3.2%) included septicemia (n = 7 patients), catheter sepsis (n = 9 patients), and febrile neutropenia (n = 16 patients). Mechanical complications (4%) included a twisted port (n = 2 patients), extravasation (n = 7 patients), catheter leaks (n = 7 patients), port obstruction (n = 7 patients), skin dehiscence of the port (n = 11 patients), catheter rupture and occlusion (n = 5 patients), and median nerve compression (n = 1 patient). Central venous thrombosis occurred in 12 patients (1.2%), and arm phlebitis occurred in 7 patients (0.7%). Procedure-related death occurred in 0.4%. Early port removal was performed in 5.3% of patients. Good QoL was reported at port removal. CONCLUSIONS The PRAPD was found to be safe, effective, and well tolerated in oncology patients. PRAPD could be recommended in selected patients instead of a surgical port device.
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Abstract
Patients with malignancies are subject to developing a unique set of complications that require emergent evaluation and treatment. With the increasing incidence of cancer in the general population and improved survival, these emergencies will be more frequently encountered. Physicians must be able to recognize these conditions and institute appropriate therapy after a focused initial evaluation. The approach to definitive therapy is commonly multidisciplinary, involving surgeons, radiation oncologists, medical oncologists, and other medical specialists. Prompt interventions can be lifesaving and may spare patients considerable morbidity and pain. In this review, we discuss the diagnosis of and initial therapy for common emergencies in hematology and oncology.
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