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Marshall-Goebel K, Lee SMC, Lytle JR, Martin DS, Miller CA, Young M, Laurie SS, Macias BR. Jugular venous flow dynamics during acute weightlessness. J Appl Physiol (1985) 2024; 136:1105-1112. [PMID: 38482574 DOI: 10.1152/japplphysiol.00384.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 04/30/2024] Open
Abstract
During spaceflight, fluids shift headward, causing internal jugular vein (IJV) distension and altered hemodynamics, including stasis and retrograde flow, that may increase the risk of thrombosis. This study's purpose was to determine the effects of acute exposure to weightlessness (0-G) on IJV dimensions and flow dynamics. We used two-dimensional (2-D) ultrasound to measure IJV cross-sectional area (CSA) and Doppler ultrasound to characterize venous blood flow patterns in the right and left IJV in 13 healthy participants (6 females) while 1) seated and supine on the ground, 2) supine during 0-G parabolic flight, and 3) supine during level flight (at 1-G). On Earth, in 1-G, moving from seated to supine posture increased CSA in both left (+62 [95% CI: +42 to 81] mm2, P < 0.0001) and right (+86 [95% CI: +58 to 113] mm2, P < 0.00012) IJV. Entry into 0-G further increased IJV CSA in both left (+27 [95% CI: +5 to 48] mm2, P = 0.02) and right (+30 [95% CI: +0.3 to 61] mm2, P = 0.02) relative to supine in 1-G. We observed stagnant flow in the left IJV of one participant during 0-G parabolic flight that remained during level flight but was not present during any imaging during preflight measures in the seated or supine postures; normal venous flow patterns were observed in the right IJV during all conditions in all participants. Alterations to cerebral outflow dynamics in the left IJV can occur during acute exposure to weightlessness and thus, may increase the risk of venous thrombosis during any duration of spaceflight.NEW & NOTEWORTHY The absence of hydrostatic pressure gradients in the vascular system and loss of tissue weight during weightlessness results in altered flow dynamics in the left internal jugular vein in some astronauts that may contribute to an increased risk of thromboembolism during spaceflight. Here, we report that the internal jugular veins distend bilaterally in healthy participants and that flow stasis can occur in the left internal jugular vein during acute weightlessness produced by parabolic flight.
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Guarino P, Tesauro P, Giordano L, Caporale CD, Presutti L, Mattioli F. Surgical and radiological perspectives for the spinal accessory nerve passing through a fenestrated internal jugular vein: case series and literature review. J Surg Case Rep 2024; 2024:rjae099. [PMID: 38617811 PMCID: PMC11014881 DOI: 10.1093/jscr/rjae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 04/16/2024] Open
Abstract
The preservation of the spinal accessory nerve represents a key goal in head and neck oncologic surgery during selective neck dissection. This study aims to illustrate the anatomical variants of the XI cranial nerve, delving into the relationship between the spinal nerve and the internal jugular vein, as well as the surgical implications. Two cases of patients who underwent oncologic surgery with neck dissection are described. Both cases found the spinal accessory nerve passing through the fenestration of the internal jugular vein. Alongside this case series, an independent literature review was conducted using the Medline and PubMed databases. In the majority of cases (67% - 96%), the spinal accessory nerve traces a lateral course to the internal jugular vein. Less frequently, the XI cranial nerve courses medial to the internal jugular vein. More rarely, as described in this case series, the nerve crosses through the fenestration of the vein (0.48% - 3.3%).
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Affiliation(s)
- Pierre Guarino
- U.O.C di Otorinolaringoaitra e Chirurgia Cervico-Facciale, Azienda USL di Pescara, 65124 Pescara, Italy
| | - Paolo Tesauro
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Leone Giordano
- Otolaryngology and Audiology Unit, IRCCS Ospedale San Raffaele, 20132 Milano, Italy
| | - Claudio Donadio Caporale
- U.O.C di Otorinolaringoaitra e Chirurgia Cervico-Facciale, Azienda USL di Pescara, 65124 Pescara, Italy
| | - Livio Presutti
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Francesco Mattioli
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
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Ängeby E, Adrian M, Bozovic G, Borgquist O, Kander T. Central venous catheter tip misplacement: A multicentre cohort study of 8556 thoracocervical central venous catheterisations. Acta Anaesthesiol Scand 2024; 68:520-529. [PMID: 38351546 DOI: 10.1111/aas.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND There is a paucity of data on the incidence of central venous catheter tip misplacements after the implementation of ultrasound guidance during insertion. The aims of the present study were to determine the incidence of tip misplacements and to identify independent variables associated with tip misplacement. METHODS All jugular and subclavian central venous catheter insertions in patients ≥16 years with a post-procedural chest radiography at four hospitals were included. Each case was reviewed for relevant catheter data and radiologic evaluations of chest radiographies. Tip misplacements were classified as 'any tip misplacement', 'minor tip misplacement' or 'major tip misplacement'. Multivariable logistic regression analyses were used to investigate associations between predefined independent variables and tip misplacements. RESULTS A total of 8556 central venous catheter insertions in 5587 patients were included. Real-time ultrasound guidance was used in 91% of all insertions. Any tip misplacement occurred (95% confidence interval) in 3.7 (3.3-4.1)% of the catheterisations, and 2.1 (1.8-2.4)% were classified as major tip misplacements. The multivariable logistic regression analyses showed that female patient gender, subclavian vein insertions, number of skin punctures and limited operator experience were associated with a higher risk of major tip misplacement, whereas increasing age and height were associated with a lower risk. CONCLUSIONS In this large prospective multicentre cohort study, performed in the ultrasound-guided era, we demonstrated the incidence of tip misplacements to be 3.7 (3.3-4.1)%. Right internal jugular vein catheterisation had the lowest incidence of both minor and major tip misplacement.
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Affiliation(s)
- Emilia Ängeby
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
| | - Maria Adrian
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Gracijela Bozovic
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Medical Imaging and Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Ola Borgquist
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital, Lund, Sweden
| | - Thomas Kander
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
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Oshima T, Yamagata K, Shimizu Y, Koizumi S, Fujiu K, Komuro I. Iatrogenic vertebral artery injury during catheter ablation treated using coil embolization. Pacing Clin Electrophysiol 2024. [PMID: 38525529 DOI: 10.1111/pace.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
The internal jugular vein (IJV) is occasionally used for blood access during catheter ablation. Additionally, accidental injury of the vertebral artery during an IJV puncture is a rare complication that can result in catastrophic events, such as death. However, vascular access complications cannot be completely prevented despite the introduction of ultrasound-guided punctures. Here, we present a case of a patient with symptomatic paroxysmal atrial fibrillation that required catheter ablation.
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Affiliation(s)
- Tsukasa Oshima
- Department of Cardiovascular Medicine, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yu Shimizu
- Department of Cardiovascular Medicine, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, the University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Heo Y, Lee SJ, Kim TS. Delayed Pulsatile Tinnitus by an Ascending Pharyngeal Artery- Internal Jugular Vein Fistula Caused by Blunt Trauma: A Case Report and Review of the Literature. Ear Nose Throat J 2024:1455613241229974. [PMID: 38304932 DOI: 10.1177/01455613241229974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Head and neck trauma-induced pulsatile tinnitus (PT) should be approached with caution, as it can rarely be attributed to an arteriovenous fistula (AVF). We present a 26-year-old male with a history of blunt trauma who presented delayed PT with direct AVF between the ascending pharyngeal artery (APA) and the internal jugular vein (IJV). The patient underwent occlusion of the fistula with transarterial embolization using coils and PT was completely resolved, confirming successful treatment. The delayed manifestation of PT in the APA-IJV fistula is probably due to the gradual formation of a pseudoaneurysm and subsequent AVF. This case highlights the importance of investigating PT in head trauma patients, as it can be a sign of AVF and possible complications. Overall, this case contributes to understanding delayed PT with AVF and emphasizes the importance of prompt diagnosis and treatment of AVF in patients with head and neck trauma.
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Affiliation(s)
- Yoon Heo
- Department of Otolaryngology, Kangwon National University Hospital, Chuncheon, Korea
| | - Seung Jin Lee
- Department of Neurosurgery, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Tae Su Kim
- Department of Otolaryngology, School of Medicine, Kangwon National University, Chuncheon, Korea
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Bekyarova AI, Velikova AV, Atanasova NV, Zhelezov MD. A Rare Anastomosis Between the Internal and the External Jugular Veins: A Case Report. Cureus 2024; 16:e55212. [PMID: 38558638 PMCID: PMC10981499 DOI: 10.7759/cureus.55212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Usually, the external jugular vein (EJV) is located superficially over the sternocleidomastoid muscle and joins the subclavian vein or the venous angle. The internal jugular vein (IJV) lies deeply in close relation with the common carotid artery and vagus nerve, enveloped by the carotid sheath. Normally, there is no direct connection between those vessels. During a routine neck dissection, we found a rare anastomosis between IJV and EJV. The anastomosis was localized on the level of the cricoid cartilage. It was approximately 1 cm long, with the diameter of the lumen being 0.3 cm. There was no obstruction along the length of the vessel. The direction was oblique and followed the blood flow from IJV to EJV. The observed variation has high clinical importance related to numerous procedures executed in the neck region, such as placement of hemodialysis catheter in patients with renal failure, insertion of central venous line in the care of critically ill patients, and radical neck dissections.
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Affiliation(s)
| | - Adelina V Velikova
- Department of Anatomy and Cell Biology, Medical University of Varna, Varna, BGR
| | - Nikol V Atanasova
- Department of Anatomy and Cell Biology, Medical University of Varna, Varna, BGR
| | - Marin D Zhelezov
- Department of Anatomy and Cell Biology, Medical University of Varna, Varna, BGR
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Xiong X, Zhang H. A rare hemodialysis vascular access complication- Internal jugular vein reflux. J Clin Ultrasound 2024. [PMID: 38169054 DOI: 10.1002/jcu.23633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
Hemodialysis (HD) arteriovenous fistulas commonly present with late vascular access complications, but are rarely in association with internal jugular vein (IJV) reflux. We reported two patients who had severe and mild IJV reflux, respectively. Case 1 was a 48-year-old male with end-stage renal disease (ESRD) who had been treated with HD for 5 years. He presented with persistent headaches, nausea, and vomiting. Combined with all the examinations, it was revealed severe IJV reflux, brachiocephalic vein stenosis, high-flow vascular access, and IJV valve dysfunction. Case 2 was a 59-year-old female with ESRD who had constructed an AVF for 4 months and had been on HD for only 1 day. She presented with dizziness and nausea after the first hemodialysis and duplex ultrasonography showed slightly continuous IJV reflux, high-flow vascular access, and IJV valve dysfunction. Furthermore, we reviewed 16 case reports to identify the characteristics of IJV reflux in HD patients. IJV reflux in HD patients may be caused by high-flow access, central venous stenosis or occlusion, and valve dysfunction. Severe IJV reflux can develop neurological symptoms secondary to intracranial venous reflux in this article. Etiological treatment is helpful for these patients, but there is a risk of recurrence.
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Affiliation(s)
- Xiaowei Xiong
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People's Republic of China
- Department of Ultrasound, Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Hongxia Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Cho KH, Honkura Y, Kim JH, Hayashi S, Kitamura K, Murakami G, Rodríguez-Vázquez JF. Topohistology of the cranial nerves IX-XII at the cranial base and upper parapharyngeal space: A histological study using human fetuses. Anat Rec (Hoboken) 2023. [PMID: 38009864 DOI: 10.1002/ar.25355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/17/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
The topographical relationships among the lower cranial nerves, internal carotid artery (ICA), and internal jugular vein (IJV) in the upper parapharyngeal neurovascular bundle remain obscure. Thus, details of the anatomy were examined in human fetus histology. We observed the horizontal histological sections from 20 midterm (9-18 weeks) and 12 near-term (28-40 weeks) fetuses. At the external skull base, the glossopharyngeal nerve crosses the anterior aspect of the IJV to reach the medially located Hyrtl's fissure in the petrous temporal bone. The nerve crossed the anterior aspect of the ICA medially near or below the first cervical nerve root. Below the hypoglossal nerve canal, the accessory nerve crosses the anterior or posterior aspects of the IJV and moves laterally. During the half-spiral course, the hypoglossal nerve was tightly attached to the posterolateral-anterior aspects of the vagus nerve and surrounded by a common nerve sheath. The glossopharyngeal ganglia sometimes extended inferiorly to the level of the hypoglossal nerve canal but were absent along the inferior course. The inferior vagal ganglion rarely extends above the occipital condyle. The superior cervical sympathetic ganglion occasionally extends above the first cervical nerve root. The IJV (or ICA) descends to the lateral (or medial) margins of the parapharyngeal neurovascular bundle. The glossopharyngeal (or accessory) nerve crosses the ICA (or IJV) to exit the bundle at the base of the skull (or below the hypoglossal nerve canal). The glossopharyngeal and vagus inferior ganglia differ at each site.
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Affiliation(s)
- Kwang Ho Cho
- Department of Neurology, Wonkwang University School of Medicine and Hospital, Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Yohei Honkura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Shogo Hayashi
- Department of Anatomy, Division of Basic Medical Science, Tokai University School of Medicine, Tokyo, Japan
| | - Kei Kitamura
- Department of Histology and Embryology, Tokyo Dental College, Tokyo, Japan
| | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
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Luo N, Liang XY, Li L, Zhang X, Zang CM, Liu X, Fan XZ. Foreign body accompanied with thrombosis in the right internal jugular vein: A case report. Clin Hemorheol Microcirc 2023:CH231988. [PMID: 38007641 DOI: 10.3233/ch-231988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
A rare foreign body accompanied by thrombosis in the right internal jugular vein was accidentally observed. We collected the medical history of this special patient, analyzed the causes and characteristics of the foreign body and thrombosis formation, and subsequently observed the changes in thrombosis. Finally, we discussed the diagnostic value of ultrasound for such rare intravascular lesions.
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Affiliation(s)
- Nan Luo
- Department of Ultrasound, Air Force Medical Center, Air Force Medical University, Beijing, China
- Anhui Medical University Fifth Clinical Medical College, Anhui, China
| | - Xiao-Yu Liang
- Department of Ultrasound, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Lu Li
- Department of Outpatients, the 26th Rest Center for Retired Cadres, Beijing Garrison Region, Beijing, China
| | - Xiao Zhang
- Department of Ultrasound, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Chun-Mei Zang
- Department of Ultrasound, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Xi Liu
- Department of Ultrasound, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Xiao-Zhou Fan
- Department of Ultrasound, Air Force Medical Center, Air Force Medical University, Beijing, China
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Greiner B, Kaiser U, Maurer K, Stroszczynski C, Jung EM. Wireless handheld ultrasound for internal jugular vein assessment in pediatric patients. Clin Hemorheol Microcirc 2023:CH231981. [PMID: 37980654 DOI: 10.3233/ch-231981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Rapid evolution of ultrasound technology has allowed widespread use of handheld ultrasound devices (HHUDs) for many possible applications. Along with the adult population, the use of HHUDs for Point of Care Ultrasound (POCUS) in pediatric medicine has been increasing over the last few years. However, pediatric-specific literature is still scarce on mobile vascular ultrasound. OBJECTIVE To evaluate diagnostic capabilities of Vscan Air™ in comparison with high-end ultrasound for the assessment of the internal jugular vein in children and adolescents. METHODS 42 Internal Jugular Veins (IJVs) of 21 pediatric patients were scanned by an experienced examiner using a WLAN-supported handheld ultrasound device (Vscan Air™) and high-end cart-based ultrasound (LOGIQ E9) as reference. B-Mode and Color-coded Doppler (CCDS) were performed and compared. Image quality was assessed using a score of 0 to 5 and statistically analyzed. Results were interpreted independently by two readers in consensus. RESULTS 21 patients (2-17 years; mean 11,00±4,5 years; female n = 11, male n = 10) were examined. The rating score never dropped below 3 for both devices. The median score evaluation of B-Mode and CCDS for the high-end device was 5.00, of Vscan Air™ 5.00 for B-Mode and 4.00 for CCDS. A significant difference was shown between the two devices in the evaluation of CCDS. CONCLUSIONS Vscan Air™ ultrasound device allows sufficient assessability of the IJV in pediatric patients, opening up new possibilities for fast and mobile POCUS of cervical veins and potential guidance of central venous catheter placement.
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Affiliation(s)
- Barbara Greiner
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Kaiser
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Katharina Maurer
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Christian Stroszczynski
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Institute of Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
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Mishra A, Kumar M, Kumar N, Goyal K, Soni KD, Yadav A. Short-axis versus long-axis approach for ultrasound-guided vascular access: An updated systematic review and meta-analysis of randomised controlled trials. Indian J Anaesth 2023; 67:S208-S217. [PMID: 38187975 PMCID: PMC10768910 DOI: 10.4103/ija.ija_965_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims There are two approaches for ultrasound (US)-guided vessel cannulation: the short axis (SA) approach and the long axis (LA) approach. However, it remains to be seen which approach is better. Therefore, we performed the present updated systematic review and meta-analysis to assess the effectiveness and safety of US-guided vascular cannulation between the SA and LA techniques. Methods We performed a comprehensive electronic database search in PubMed, Embase, Cochrane Library and Web of Science for the relevant studies from inception to June 2022. Randomised controlled trials comparing the SA approach and the LA approach for US-guided vascular access were incorporated in this updated meta-analysis. The first-attempt success rate was the primary outcome. The secondary outcomes were the overall success rate, cannulation time, number of attempts and the incidence of complications. The statistical analysis was conducted using RevMan software (version 5.4; the Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark). The Cochrane risk of bias tool was used to evaluate each study's potential risk for bias. Results In total, 16 studies consisting of 1885 participants were incorporated in this updated meta-analysis. No statistically significant difference was found between the SA and LA vascular access techniques for first-pass success rate (risk ratio = 1.07, 95% confidence interval: 0.94-1.22). The overall cannulation success rate, complication rate, average cannulation time and average number of attempts were not significantly different between the SA and LA groups. Conclusion This updated meta-analysis demonstrated that the SA and LA approaches of US-guided vessel cannulation are similar regarding first-pass success, overall cannulation success rate, total complication rate, cannulation time and the number of attempts.
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Affiliation(s)
- Aparna Mishra
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mohan Kumar
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Kumar
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Keshav Goyal
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anuradha Yadav
- Department of Oral Medicine and Radiology, I.T.S College, C.D.S.R, Ghaziabad, Uttar Pradesh, India
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Zeng X, Zeng X, Zeng Q, Wu Y, Zhang S, Yang Y, Zhu X, Zhang W, Xu Y, Min X, Chen W, Zhou W, Qiu J. The external jugular vein is a feasible and safe alternative access for retrieval of inferior vena cava filter. J Vasc Access 2023; 24:1489-1494. [PMID: 35168443 DOI: 10.1177/11297298211064467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose is to analyze whether the external jugular vein (EJV) is a feasible and safe alternative access for the retrieval IVCFs designed for the jugular approach. METHODS This study was designed as a nonrandomized, controlled study. The patients were divided into two groups: the IJV or EJV access groups. All operations were performed by the vascular surgery team. The main outcome was the technical success rate. The secondary outcomes included (1) the IVCF retrieval rate; (2) the time required to puncture the access vein (min); (3) the number of punctures required for access, and other aspects. RESULTS A total of 119 patients were recruited for IVCF retrieval. Seventeen patients refused to join this trial, leaving 58 patients in the IJV group and 44 patients in the EJV group. In the IJV group, technical success was not achieved in one patient who started in the EJV group and was transferred to the IJV group. There was no significant difference in age, comorbidities, or technical success rate between the two groups. Significant differences were observed in puncture time (min), number of punctures, and inadvertent puncture of the carotid artery. All of the patients were discharged 1 or 2 days after the operation. CONCLUSION EJV is safe and feasible alternative access for the retrieval of IVCFs that are designed for jugular approaches.
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Affiliation(s)
- Xiong Zeng
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiande Zeng
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qingfu Zeng
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuewu Wu
- Department of Cardiovascular Surgery, First People's Hospital of Fuzhou, Fuzhou, Jiangxi, China
| | - Shanzhong Zhang
- Department of Vascular Surgery, First People's Hospital of Jingdezhen, Jingdezhen, Jiangxi, China
| | - Yujin Yang
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xianhua Zhu
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wenwen Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yingqi Xu
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xixi Min
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weimin Zhou
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiehua Qiu
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Cardiovascular Surgery, First People's Hospital of Fuzhou, Fuzhou, Jiangxi, China
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13
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Li L, Li P, London NR, Xu H, Chen X, Carrau RL. Relevance of the Internal Jugular Vein for Surgery in the Upper Parapharyngeal Space. Ear Nose Throat J 2023:1455613231197730. [PMID: 37786236 DOI: 10.1177/01455613231197730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Objective: Tumors arising from the upper parapharyngeal space (UPPS) may have intimate relationships with the internal carotid artery (ICA) and the internal jugular vein (IJV). The significance of the ICA in UPPS has been sufficiently articulated, whereas the relevance of the IJV has not been addressed. This study aimed to assess the anatomical variations of the IJV within the UPPS, and to explore its implications for surgical procedures. Methods: An endoscopic dissection of the IJV was performed on 10 cadaveric specimens. In addition, 30 patients who underwent transoral or transcervical resection of UPPS tumors were retrospectively reviewed to characterize the IJV and its relation to the tumor. Results: On the cadaveric specimens, the IJV was located at the posteromedial and posterolateral aspects of the styloid process in 13 (65%) and 7 (35%) sides, respectively. In our clinical series, the IJV was not encountered in 18 patients with pre-styloid tumors. In 12 patients harboring retro-styloid tumors, the IJV was partially (n = 5) or completely (n = 7) compressed and was displaced into the posterolateral aspect of the tumor. The IJV was injured intraoperatively in 1 patient, requiring an immediate conversion to an open transcervical corridor that allowed its exposure and ligation without difficulty. Conclusion: This study characterizes the IJV and its relationship with adjacent neurovascular structures in the UPPS, which may provide further safeguards during transoral and transcervical procedures in the UPPS.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH, USA
| | - Pingdong Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nyall R London
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH, USA
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hongbo Xu
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, OH, USA
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14
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Ip JE. Leadless Pacemaker Implantation Using a Superior Approach When a Conventional, Femoral Implant Fails. JACC Clin Electrophysiol 2023; 9:1838-1839. [PMID: 37480868 DOI: 10.1016/j.jacep.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 07/24/2023]
Affiliation(s)
- James E Ip
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA.
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15
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Govender I, Okonta HI, Adeleke O, Rangiah S. Central venous pressure line insertion for the primary health care physician. S Afr Fam Pract (2004) 2023; 65:e1-e8. [PMID: 37427779 DOI: 10.4102/safp.v65i1.5740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 07/11/2023] Open
Abstract
Central venous access is an important procedure to understand and perform not only in the emergency unit but also for prolonged reliable venous access. All clinicians must be familiar and confident with this procedure. This paper will focus on applied anatomy in respect of common anatomical sites for venous access, the indications, the contraindications, the technique and complications that may arise following the procedure. This article is part of a series on vascular access. We have previously written on the intra osseous procedure and an article on umbilical vein catheterisation will follow.
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Affiliation(s)
- Indiran Govender
- Department of Family Medicine and Primary Health Care, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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16
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Madoure A, Penubarthi LK, Kushwaha A, Alexander A. Unilateral Fenestration of Internal Jugular Vein With a Radiological Clue: A Rare Case Report and Literature Review. Cureus 2023; 15:e39863. [PMID: 37404430 PMCID: PMC10315060 DOI: 10.7759/cureus.39863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
The intricacies of human anatomy continue to astound, as underscored by this unusual case of a 45-year-old female patient who presented to our esteemed otolaryngology department with T3N1MO squamous cell carcinoma of the lip. The preoperative diagnostic imaging of this patient divulged an enigmatic venous anomaly involving the internal jugular vein (IJV). Our team meticulously orchestrated a wide local excision of the primary tumor and modified radical neck dissection with Abbe Estlander flap reconstruction. Identification of the anomaly during the preoperative phase helped in meticulous planning and preparation. Thus, the surgical team was well-prepared for neck dissection and successfully navigated the rare IJV fenestration without incurring nerve or vascular injuries. This remarkable case accentuates the importance of maintaining a profound understanding of potential anatomical aberrations while performing intricate surgical procedures such as neck dissections. Heightened awareness can circumvent inadvertent damage to critical structures, ultimately safeguarding patient well-being. In this captivating report, we explain the preoperative suspicion, intraoperative identification, and subsequent outcome of a rare fenestration of the IJV encountered during a challenging neck dissection.
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Affiliation(s)
- Anbarasi Madoure
- Otolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Lokesh Kumar Penubarthi
- Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Akshat Kushwaha
- Otolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Arun Alexander
- Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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17
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Sugiyama T, Fujimura M. Preservation of Enlarged Mastoid Emissary Vein during Microvascular Decompression for Trigeminal Neuralgia Accompanied by Abnormal Venous Drainage: A Technical Case Report. NMC Case Rep J 2023; 10:139-143. [PMID: 37293198 PMCID: PMC10247221 DOI: 10.2176/jns-nmc.2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/13/2023] [Indexed: 06/10/2023] Open
Abstract
During microvascular decompression (MVD) for trigeminal neuralgia (TGN), the mastoid emissary veins (MEV) are routinely sacrificed using the suboccipital retrosigmoid approach. The technical nuances when the MEV is an important collateral venous pathway for the obstructive internal jugular vein (IJV) have not been described thus far. Herein, we demonstrate for the first time a modified surgical technique for MVD to preserve the MEV. A 62-year-old man with a 10-year history of TGN refractory to carbamazepine was referred to our hospital for MVD. Preoperative imaging revealed that the superior cerebellar artery was the offending vessel. Computed tomography angiography also revealed that his contralateral IJV pathway was hypoplastic, and the ipsilateral pathway was severely stenosed by the external compression of the elongated styloid process and the transverse process of the first cervical vertebra. The ipsilateral MEV and the connecting occipital veins were enlarged as the sole collateral pathways of intracranial venous drainage. A modified MVD technique, including an upside-down L-shaped skin incision, layer-by-layer dissection of the occipital muscles, and denuding of the intraosseous part of the MEV, was used to cure the TGN with the preservation of the venous pathway. After surgery, the pain completely diminished without any complications. In conclusion, such technical modifications would be applicable in cases where the MEV needs to be preserved during posterior fossa surgery. Preoperative screening of the venous system is also recommended.
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Affiliation(s)
- Taku Sugiyama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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18
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Yang B, Li M, Liang J, Tang X, Chen Q. Effect of internal jugular vein catheterization on intracranial pressure and postoperative cognitive function in patients undergoing robot-assisted laparoscopic surgery. Front Med (Lausanne) 2023; 10:1199931. [PMID: 37215728 PMCID: PMC10192865 DOI: 10.3389/fmed.2023.1199931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
Background We aimed to evaluate the effects of internal jugular vein (IJV) catheterization on intracranial pressure (ICP) and postoperative delirium (POD) during robot-assisted laparoscopic surgery by measuring the optic nerve sheath diameter (ONSD). Methods Data from a prospective single-center cohort study, conducted from October 2021 to February 2022, were used. Forty out of 80 patients scheduled for laparoscopic radical hysterectomy or prostatectomy were assigned to the group receiving IJV catheterization (Group I), and the other 40 only received peripheral venous cannulation (Group C) according to clinical need of patients. Ultrasonography of ONSDs, the proportion of regurgitation time in a cardiac cycle, and hemodynamic parameters were measured at four time points: immediately after induction of anesthesia in the supine position (T0), 30 min (T1), 60 min (T2) after orienting to the Trendelenburg position, and before returning to the supine position at the end of surgery (T3). Time to eye opening and emergence stay, POD, and QoR-15 were compared. Results The ONSDs increase gradually as the surgery progressed. Group I showed a higher value of ONSD at T1 (4.72 ± 0.29 mm vs. 4.5 ± 0.33 mm, p = 0.0057) and T3 (5.65 ± 0.33 mm vs. 5.26 ± 0.31 mm, p < 0.0001). The proportions of the regurgitation time of IJVV were greater in Group I than those in Group C at T1 (14.95, 8.5%-18.9% vs. 9.6%, 0%-17.2%, p < 0.0001) and T3 (14.3, 10.6%-18.5% vs. 10.4%, 0%-16.5%, p = 0.0003). Group I had a delayed time to eye opening (10.7 ± 1.72 min vs. 13.3 ± 2.35 min, p < 0.0001) and emergence stay (32.2 ± 5.62 min vs. 39.9 ± 6.7 min, p < 0.0001). There were no significant differences in POD and QoR-15 between the two groups on day three. Conclusion IJV cannulation may not be the preferred approach in robot-assisted laparoscopic surgery as it was risk factor for IJVV regurgitation, ICP elevation, emergence delayed.
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Affiliation(s)
- Bin Yang
- School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Min Li
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jingqiu Liang
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Xixi Tang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qi Chen
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
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19
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N P, Sinha M, Kumar M, Ramchandani S, Khetrapal M, Karoo K, Mesa BK. Role of Internal Jugular Vein Collapsibility Index in Predicting Post-spinal Hypotension in Pregnant Women Undergoing Cesarean Section: A Prospective Observational Study. Cureus 2023; 15:e39389. [PMID: 37362461 PMCID: PMC10286763 DOI: 10.7759/cureus.39389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Post-spinal hypotension (PSH) frequently occurs in women undergoing cesarean section. In recent studies, Ultrasound-guided measurements of the internal jugular vein (IJV) have been reported to predict fluid responsiveness. We planned to evaluate the correlation between the internal jugular vein collapsibility index (IJVCI) and PSH in cesarean section patients. Methods Ninety-one parturients who underwent elective lower segment cesarean section with a singleton pregnancy were recruited. Preoperatively, patients were placed in a supine position with a 15-degree left lateral tilt. Maximum (at the end of expiration) and minimum (at the end of inspiration) IJV diameters (mm) and IJVCI were assessed using M-mode imaging during spontaneous and deep breathing. Spinal anaesthesia was performed at the L3-4 or L4-5 level. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, and SpO2 were recorded from baseline till the delivery of the baby. Results Among 91 patients, 40 (45.5%) patients had at least one episode of hypotension. Demographic variables and baseline vitals were comparable between the hypotensive and normotensive groups (p>0.05). In spontaneous and deep breathing, IJV diameter at the end-expiration (IJVdmax), end-inspiration (IJVdmin), and IJVCI amongst both hypotensive and non-hypotensive pregnant women were statistically similar. Receiver Operating Characteristic (ROC) curve analysis showed that during spontaneous breathing, using a cut-off point of 29.5%, IJVCI had a sensitivity and specificity of 70% and 23%, respectively, for predicting PSH; whereas during deep breathing, IJVCI had a sensitivity and specificity of 77% and 27%, respectively, for predicting the same using a cut-off value of 37.5%. Conclusion We conclude that internal jugular vein parameters such as maximum diameter, minimum diameter, and IJVCI during spontaneous and deep breathing cannot be used as reliable predictors of post-spinal hypotension in pregnant patients undergoing elective cesarean section.
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Affiliation(s)
- Pharanitharan N
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Mamta Sinha
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Mayank Kumar
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Sarita Ramchandani
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Monica Khetrapal
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Khushbu Karoo
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Bharath K Mesa
- Anaesthesiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
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20
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Kenny JES, Yang Z, Clarke G, Elfarnawany M, Munding CE, Eibl AM, Eibl JK, Taylor JL, Kim CH, Johnson BD. A Novel Spectral Index for Tracking Preload Change from a Wireless, Wearable Doppler Ultrasound. Diagnostics (Basel) 2023; 13:diagnostics13091590. [PMID: 37174981 PMCID: PMC10178522 DOI: 10.3390/diagnostics13091590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
A wireless, wearable Doppler ultrasound offers a new paradigm for linking physiology to resuscitation medicine. To this end, the image analysis of simultaneously-acquired venous and arterial Doppler spectrograms attained by wearable ultrasound represents a new source of hemodynamic data. Previous investigators have reported a direct relationship between the central venous pressure (CVP) and the ratio of the internal jugular-to-common carotid artery diameters. Because Doppler power is directly related to the number of red cell scatterers within a vessel, we hypothesized that (1) the ratio of internal jugular-to-carotid artery Doppler power (V/APOWER) would be a surrogate for the ratio of the vascular areas of these two vessels and (2) the V/APOWER would track the anticipated CVP change during simulated hemorrhage and resuscitation. To illustrate this proof-of-principle, we compared the change in V/APOWER obtained via a wireless, wearable Doppler ultrasound to B-mode ultrasound images during a head-down tilt. Additionally, we elucidated the change in the V/APOWER during simulated hemorrhage and transfusion via lower body negative pressure (LBNP) and release. With these Interesting Images, we show that the Doppler V/APOWER ratio qualitatively tracks anticipated changes in CVP (e.g., cardiac preload) which is promising for both diagnosis and management of hemodynamic unrest.
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Affiliation(s)
- Jon-Emile S Kenny
- Health Sciences North Research Institute, Sudbury, ON P3E 2H3, Canada
- Flosonics Medical, Toronto, ON P3C 1R7, Canada
| | - Zhen Yang
- Flosonics Medical, Toronto, ON P3C 1R7, Canada
| | - Geoffrey Clarke
- Health Sciences North Research Institute, Sudbury, ON P3E 2H3, Canada
- Flosonics Medical, Toronto, ON P3C 1R7, Canada
| | | | | | - Andrew M Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H3, Canada
- Flosonics Medical, Toronto, ON P3C 1R7, Canada
| | - Joseph K Eibl
- Health Sciences North Research Institute, Sudbury, ON P3E 2H3, Canada
- Flosonics Medical, Toronto, ON P3C 1R7, Canada
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
| | - Jenna L Taylor
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Chul-Ho Kim
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Bruce D Johnson
- Human Integrative and Environmental Physiology Laboratory, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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21
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Tucci M, Chaiyamoon A, Suwannakhan A, Cardona JJ, Comert A, Iwanaga J, Dumont AS, Tubbs RS. A novel direct pathway of dural venous outflow from the basilar venous plexus via the diploic space of the clivus. World Neurosurg 2023:S1878-8750(23)00578-8. [PMID: 37121502 DOI: 10.1016/j.wneu.2023.04.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION The internal jugular vein is the preeminent outflow of the dural venous sinuses in the supine position, while the vertebral venous plexus dominates venous outflow in the upright position. Emissary veins can also be an accessory pathway for this venous egress. To our knowledge, alternative dural venous sinus directly drainage via the diploic space has not been previously reported in the literature. MATERIALS AND METHODS Ten fresh frozen adult cadavers underwent exposure of the basilar venous plexus. The entire plexus, still adhered to the underlying clivus, was removed with its underlying bone and submitted for histological examination following decalcification (Masson Trichrome, 5μm slices). RESULTS All specimens were found to have direct communications between the basilar venous plexus and underlying diploic space of the clivus i.e., no intermediate clival emissary vein. These were concentrated near the midline and were more numerous over the clivus near the junction of the occipital and sphenoid bones. The endothelium of the venous sinus was continuous at the opening into the diploic space and these openings ranged in size from 500 to 750 μm (mean 650 μm). CONCLUSION An improved understanding of cerebral venous drainage can assist clinicians and surgeons in recognizing normal, pathologic, and variant anatomy in this region. Based on our study, direct venous sinus to diploic space drainage offers an additional pathway for venous egress from the intracranium. Therefore, removal of the dura over the clivus during various skull base procedures might be associated with increased venous bleeding from the basilar venous plexus on its deep surface where it interfaces with the clivus.
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Affiliation(s)
- Marissa Tucci
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen, Thailand.
| | - Athikhun Suwannakhan
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand; In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand
| | - Juan J Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ayhan Comert
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; University of Queensland, Brisbane, Australia
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22
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Gong TS, Li TS. Resectable fusiform internal jugular vein aneurysm with vascular excision and bypass with an 8 mm Maquet graft: A case report. Medicine (Baltimore) 2023; 102:e33582. [PMID: 37083804 PMCID: PMC10118334 DOI: 10.1097/md.0000000000033582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
RATIONALE Venous aneurysm is a rare vascular disease. Studies reveal that patients with fusiform internal jugular vein aneurysms are not suitable for embolization. PATIENT CONCERNS Two treatment options are considered, either bypass the aneurysm via stenting or excision of the lesion site and anastomosis using an artificial graft. The advantages of excision bypass include the absence of endoleak and stent migration; however, a larger wound and longer operation time are required for it. DIAGNOSES Physical examination revealed a swelling in the right neck area. Head and neck computed tomography was performed for the survey. It revealed a 27.22 × 25.07 × 58.17 mm internal jugular fusiform aneurysm. INTERVENTIONS Vein excision was performed while using hemoclamps to control inflow and outflow, and a graft was anastomosed for bypass using an 8 mm Maquet graft. OUTCOMES The wound recovery was favorable, with no signs of infection, and the pain was under control. LESSONS The patient had a contrast-enhanced head and neck computed tomography, and the images efficiently diagnosed a venous aneurysm. This patient had refractory pain, which was a significant indication of the operation. We decided by ourselves on the duration of the interval of following up. We used excision and bypassing with graft, and the result was beneficial.
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Affiliation(s)
- Ting-Sheng Gong
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, Changhua, Taiwan
| | - Tzong-Shiun Li
- Division of Cardiovascular Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, Changhua, Taiwan
- College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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23
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Salazar-Orellana JLI, Aceytuno RD, Vásquez-Cortez NA, Umaña-Cerros JR, Medrano-Machado EY. Pourfour Du Petit Syndrome Due to Ipsilateral Internal Jugular Vein Distention. Cureus 2023; 15:e37853. [PMID: 37214050 PMCID: PMC10198767 DOI: 10.7759/cureus.37853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/23/2023] Open
Abstract
Pourfour du Petit Syndrome (PdPS) is characterized by signs of oculosympathetic hyperactivity caused by irritation in the oculosympathetic pathway and shares etiologies with Horner Syndrome. We present the case of a 64-year-old woman with Pourfour du Petit syndrome due to compression of the second-order cervical sympathetic chain neuron from a dominant and prominent right internal jugular vein compensatory for contralateral agenesis. Internal jugular vein agenesis is a rare developmental vascular anomaly and is asymptomatic in the majority of patients with this condition.
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Affiliation(s)
| | - R Daniel Aceytuno
- Department of Family Medicine, Northern Ontario School of Medicine, Sudbury, CAN
| | | | - Juan R Umaña-Cerros
- Department of Internal Medicine, Instituto Salvadoreño del Seguro Social, San Salvador, SLV
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24
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Iankovitch A, Ledley JS, Almabrouk T, Al-Jaberi N, Coey J. Anatomical variations of the internal jugular vein in the context of central line placement: A visual approach to data processing. Clin Anat 2023; 36:172-177. [PMID: 35869858 DOI: 10.1002/ca.23939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
Central line placement in the internal jugular vein (IJV) can result in complications. Previous studies that examined variations in geometric anatomical parameters in pediatric populations have reduced these risks in children. The aim of this study was to establish possible anatomical variations to improve central line placement in the adult population and demonstrate the use of a correlation heatmap in processing large amounts of data. Twenty-seven volunteers were imaged using ultrasound at three different neck levels on right and left sides and various anatomical parameters were measured. Demographic information was also collected and included in the data processing. The Pearson coefficient was derived from each possible relationship between the measured parameters and was plotted in a correlation heatmap. Strong correlations were observed between the body mass index and the depth of the IJV and common carotid artery (CCA), the relative depth of the IJV to the CCA. No significant correlations were found in the dimensions of both vessels. Anatomical variations were more common than anticipated and should be taken into account when performing central line catheterization in order to minimize post-procedure complications.
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Affiliation(s)
- Anna Iankovitch
- St. George's University School of Medicine, St. George's University, Grenada, West Indies
| | - Johanna Shapiro Ledley
- St. George's University School of Medicine, St. George's University, Grenada, West Indies
| | - Tarek Almabrouk
- Department of Anatomy, St. George's University School of Medicine, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Nahidh Al-Jaberi
- Department of Anatomy, St. George's University School of Medicine, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - James Coey
- St. George's University School of Medicine, St. George's University, Grenada, West Indies.,Department of Anatomy, St. George's University School of Medicine, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Kosnik N, Kowalski T, Lorenz L, Valacer M, Sakthi-Velavan S. Anatomical review of internal jugular vein cannulation. Folia Morphol (Warsz) 2023; 83:1-19. [PMID: 36794685 DOI: 10.5603/fm.a2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/14/2023] [Accepted: 01/14/2023] [Indexed: 02/17/2023]
Abstract
The internal jugular veins (IJV) are the primary venous outflow channels of the head and neck. The IJV is of clinical interest since it is often used for central venous access. This literature aims at presenting an overview of the anatomical variations, morphometrics based on various imaging modalities, cadaveric and surgical findings, and the clinical anatomy of IJV cannulation. Additionally, the anatomical basis of complications, techniques to avoid complications, and cannulation in special instances are also included in the review. The review was performed by a detailed literature search and review of relevant articles. A total of 141 articles were included and organized into anatomical variations, morphometrics, and clinical anatomy of IJV cannulation. The IJV is next to important structures such as the arteries, nerve plexus, and pleura, which puts them at risk of injury during cannulation. Anatomical variations such as duplications, fenestrations, agenesis, tributaries, and valves, may lead to an increased failure rate and complications during the procedure, if unnoticed. The morphometrics of IJV, such as the cross-sectional area, diameter, and distance from the skin-to-cavo-atrial junction may assist in choosing the appropriate cannulation techniques and hence reduce the incidence of complications. Age, gender, and side-related differences explained variations in the IJV-common carotid artery relationship, cross-sectional area, and diameter. Accurate knowledge of anatomical variations in special considerations such as paediatrics and obesity may help prevent complications and facilitate successful cannulation.
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Affiliation(s)
- Natalie Kosnik
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, United States
| | - Taylor Kowalski
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, United States
| | - Lorraine Lorenz
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, United States
| | - Mercedes Valacer
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, United States
| | - Sumathilatha Sakthi-Velavan
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, United States.
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Osman D, Mehmet K, Halil K. US-guided central venous catheter placement in the neonatal intensive care unit: Brachiocephalic vein or internal jugular vein? J Vasc Access 2023:11297298231152679. [PMID: 36750956 DOI: 10.1177/11297298231152679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Centrally inserted central catheters (CICCs) are commonly used to monitor venous pressure and administer parenteral nutrition and drugs in newborns. In the present study, we evaluated cannulation success rates, cannulation time, and frequency of complications in catheterization of the internal jugular vein (IJV) and brachiocephalic vein (BCV). METHODS The present study included patients who underwent IJV and BCV catheterization under ultrasound (US) guidance. The patients were divided into two groups, IJV and BCV, depending on the vein in which the CICC was utilized. We documented the diameters of the IJVs and BCVs, first attempt and overall success rates, mean cannulation time, and complication rates. RESULTS A total of 79 patients were evaluated, 37 in the BCV group and 42 in the IJV group. No significant differences were observed between the two groups in terms of sex, mean age, or weight range (p > 0.05).The mean vein diameter was significantly larger in the BCV group than in the IJV group (p < 0.001); the mean number of attempts was significantly higher in the IJV group than in the BCV group (p < 0.001); the mean cannulation time was significantly longer in the IJV group than in the BCV group (p < 0.001); and the first attempt success rate was 50% in the IJV group, versus 94.6% in the BCV group. The overall success rate was 100% in both groups. The rate of complications was 8.6% in the IJV group, while no complications developed in the BCV group. CONCLUSIONS Given the larger diameter of the vessel, BCV catheterization was found to result in quicker cannulation and lower complication rates. The results of the present study suggest that BCV catheterization should be the first choice for neonatal intensive care unit (NICU) patients who require parenteral support or close venous pressure monitoring.
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Affiliation(s)
- Dere Osman
- Department of Radiology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Kolu Mehmet
- Department of Radiology, Dicle Memorial Hospital, Diyarbakir, Turkey
| | - Kazanasmaz Halil
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa, Turkey
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Czarnik T, Czuczwar M, Borys M, Chrzan O, Filipiak K, Maj M, Marszalski M, Miodonska M, Molsa M, Pietka M, Piwoda M, Piwowarczyk P, Rogalska Z, Stachowicz J, Gawda R. Ultrasound-Guided Infraclavicular Axillary Vein Versus Internal Jugular Vein Cannulation in Critically Ill Mechanically Ventilated Patients: A Randomized Trial. Crit Care Med 2023; 51:e37-44. [PMID: 36476809 DOI: 10.1097/CCM.0000000000005740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This clinical trial aimed to compare the ultrasound-guided in-plane infraclavicular cannulation of the axillary vein (AXV) and the ultrasound-guided out-of-plane cannulation of the internal jugular vein (IJV). DESIGN A prospective, single-blinded, open label, parallel-group, randomized trial. SETTING Two university-affiliated ICUs in Poland (Opole and Lublin). PATIENTS Mechanically ventilated intensive care patients with clinical indications for central venous line placement. INTERVENTIONS Patients were randomly assigned into two groups: the IJV group ( n = 304) and AXV group ( n = 306). The primary outcome was to compare the IJV group and AXV group through the venipuncture and catheterization success rates. Secondary outcomes were catheter tip malposition and early mechanical complication rates. All catheterizations were performed by advanced residents and consultants in anesthesiology and intensive care. MEASUREMENTS AND MAIN RESULTS The IJV puncture rate was 100%, and the AXV was 99.7% (chi-square, p = 0.19). The catheterization success rate in the IJV group was 98.7% and 96.7% in the AXV group (chi-square, p = 0.11). The catheter tip malposition rate was 9.9% in the IJV group and 10.1% in the AXV group (chi-square, p = 0.67). The early mechanical complication rate in the IJV group was 3% (common carotid artery puncture-4 cases, perivascular hematoma-2 cases, vertebral artery puncture-1 case, pneumothorax-1 case) and 2.6% in the AXV group (axillary artery puncture-4 cases, perivascular hematoma-4 cases) (chi-square, p = 0.79). CONCLUSIONS No difference was found between the real-time ultrasound-guided out-of-plane cannulation of the IJV and the infraclavicular real-time ultrasound-guided in-plane cannulation of the AXV. Both techniques are equally efficient and safe in mechanically ventilated critically ill patients.
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Whittle RS, Diaz-Artiles A. Gravitational effects on carotid and jugular characteristics in graded head-up and head-down tilt. J Appl Physiol (1985) 2023; 134:217-229. [PMID: 36476158 PMCID: PMC9870583 DOI: 10.1152/japplphysiol.00248.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Altered gravity affects hemodynamics and blood flow in the neck. At least one incidence of jugular venous thrombosis has been reported in an astronaut on the International Space Station. This investigation explores the impact of changes in the direction of the gravitational vector on the characteristics of the neck arteries and veins. Twelve subjects underwent graded tilt from 45° head-up to 45° head-down in 15° increments in both supine and prone positions. At each angle, the cross-sectional area of the left and right common carotid arteries (ACCA) and internal jugular veins (AIJV) were measured by ultrasound. Internal jugular venous pressure (IJVP) was also measured by compression sonography. Gravitational dose-response curves were generated from experimental data. ACCA did not show any gravitational dependence. Conversely, both AIJV and IJVP increased in a nonlinear fashion with head-down tilt. AIJV was significantly larger on the right side than the left side at all tilt angles. In addition, IJVP was significantly elevated in the prone position compared with the supine position, most likely because of raised intrathoracic pressure while prone. Dose-response curves were compared with existing experimental data from parabolic flight and spaceflight studies, showing good agreement on an acute timescale. The quantification of jugular hemodynamics as a function of changes in the gravitational vector presented here provides a terrestrial model to reference spaceflight-induced changes, contributes to the assessment of the pathogenesis of spaceflight venous thromboembolism events, and informs the development of countermeasures.NEW & NOTEWORTHY Flow stasis and thrombosis have been identified in the jugular vein during spaceflight. We measured the area and pressure of the internal jugular vein and the area of the common carotid artery in graded head-up and head-down tilt. Experimental data are used to generate gravitational dose-response curves for the measured variables, demonstrating that jugular vein area and pressure exhibit a nonlinear response to altered gravity. Gravitational dose-response curves show good agreement with spaceflight and parabolic flight studies.
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Affiliation(s)
- Richard S Whittle
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas
| | - Ana Diaz-Artiles
- Department of Aerospace Engineering, Texas A&M University, College Station, Texas
- Department of Kinesiology & Sport Management, Texas A&M University, College Station, Texas
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Koziatek CA, Idowu D, White R. A Rare Malposition of a Left Internal Jugular Central Venous Catheter into the Left Internal Mammary Vein. Clin Pract Cases Emerg Med 2023; 7:51-53. [PMID: 36859327 PMCID: PMC9983341 DOI: 10.5811/cpcem.2022.12.58202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/15/2022] [Indexed: 02/23/2023] Open
Abstract
CASE PRESENTATION We describe a case of left internal jugular central venous access with rare malpositioning into the internal mammary vein. Despite various confirmatory measures at the time of placement including ultrasonography of the internal jugular vein, as well as blood gas analysis consistent with venous blood by oxygen saturation and good venous flow in all three ports of the catheter, subsequent imaging confirmed misplacement into the internal mammary vein. DISCUSSION Central venous access is a frequently used procedure by emergency physicians for a variety of indications. Emergency physicians must be facile with both the technical process of central venous catheter placement, as well as possible pitfalls and complications of the procedure. Common complications, such as bleeding, pneumothorax, arterial injury, infection, and hematomas, are usually well known; less frequently encountered is malposition of the catheter despite seemingly appropriate placement.
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Affiliation(s)
- Christian A. Koziatek
- NYU School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York,Bellevue Hospital Center, Department of Emergency Medicine, New York, New York
| | - Damilola Idowu
- NYU School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York,Bellevue Hospital Center, Department of Emergency Medicine, New York, New York
| | - Richard White
- NYU School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York,Bellevue Hospital Center, Department of Emergency Medicine, New York, New York
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Liu W, Han Q, Li L, Chi J, Liu X, Gu Y. Catheter malposition analysis of totally implantable venous access port in breast cancer patients. Front Surg 2023; 9:1061826. [PMID: 36684345 PMCID: PMC9852749 DOI: 10.3389/fsurg.2022.1061826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background To investigate the occurrence of catheter malposition in breast cancer patients undergoing Totally Implantable Venous Access Port (TIVAP) implantation and analyze the effect of TIVAP implantation site on the incidence of catheter malposition. Methods Clinical data of Breast cancer patients underwent TIVAP implantation in our department from 2017 to 2021 was collected by reviewing the electronic medical records. The catheter malposition rate, location and management of malposed catheters in TIVAP implantation were analyzed. We divided the patients into the left internal jugular vein (IJV) group and the right IJV group according to the site of TIVAP implantation and compared the difference in the catheter malposition incidence between the two groups. In addition, we counted the catheter malposition rate of TIVAP implantion via the left and right IJV in right breast cancer patients to analyze the effect of tumor status on the side of TIVAP implantation on the catheter malposition rate. Results A total of 1,510 catheters were implanted in 1,504 patients, and 16 (1.06%) had catheter malposition. The catheter malposition rate was 4.96% (7/141) for TIVAP implanted via the left IJV and 0.66% (9/1,369) for right IJV, with a statistically significant difference (χ 2 = 18.699, P < 0.05). 743 TIVAPs were implanted in patients with right-sided breast tumor, of which the incidence of catheter malposition was 5.15% (7/136) for TIVAP implanted via left IJV and 0.82% (5/607) for right IJV, with a statistically significant difference (χ 2 = 10.290, P < 0.05). Malposed catheters were found in the subclavian vein, IJV, brachiocephalic vein, internal thoracic vein, undefined collateral veins, and outside the blood vessels. All malposed catheters were successfully adjusted to the proper position by simple manipulative repositioning or percutaneous positioning with the assistance of digital subtraction angiography (DSA), except for 1 case was removed the port because the catheter tip was located outside the vessel. Conclusion The catheter malposition rate of ultrasound-guided TIVAP implantation via IJV is low, and the malposed catheter can be successfully adjusted to the proper position by simple manipulative repositioning or DSA-assisted percutaneous positioning, however, the catheter malposition incidence of TIVAP implanted via left IJV is higher than that via the right side.
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Bhutia KO, Sharma A, Goyal S, Kothari N, Kumari K, Goel AD, Sethi P, Bhatia P. Comparison of novel anteroposterior short-axis in-plane technique with conventional short-axis out-of-plane technique for ultrasound-guided internal jugular vein cannulation: A randomized-controlled trial. Turk J Emerg Med 2023; 23:17-23. [PMID: 36818948 PMCID: PMC9930384 DOI: 10.4103/2452-2473.366485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/02/2022] [Accepted: 09/21/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES Various ultrasound (US)-guided probe positioning and needle procedures have been described in the literature for cannulation of the internal jugular vein (IJV). In the present study, we compared the conventional short-axis out-of-plane (SAX-OOP) method with a novel anteroposterior short-axis in-plane (APSAX-IP) technique for IJV cannulation under US guidance. The APSAX-IP method of IJV cannulation has not been compared to other IJV cannulation techniques. METHODS A total of 104 patients above 18-year-old were randomly allocated to one of two groups - APSAX-IP or SAX-OOP and evaluated for US-guided IJV cannulation in either the operating room or critical care unit. The primary outcome of this research was the access time for IJV cannulation using both approaches. The secondary outcomes were the number of attempts of needle insertion, success rate, and complications of IJV cannulation. RESULTS The access time for IJV cannulation was 13.0 (12.0-15.0) sec in the APSAX-IP group and 13.0 (12.0-14.0) sec in the SAX-OOP group; P = 0.947. The number of successful 1st attempts was 90.91%, and the 2nd attempts were 9.09% in the APSAX-IP group and 85.19% and 14.81% in the SAX-OOP group, respectively. Both techniques did not have any complications. CONCLUSIONS We conclude that the US-guided APSAX-IP IJV cannulation method has comparable access time to the SAX-OOP technique.
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Affiliation(s)
- Karma Ongmu Bhutia
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ankur Sharma
- Department of Trauma and Emergency (Anaesthesiology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,Address for correspondence: Dr. Ankur Sharma, 58, Subhash Nagar – 2, Jodhpur - 342 008, Rajasthan, India. E-mail:
| | - Shilpa Goyal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Nikhil Kothari
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kamlesh Kumari
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Akhil Dhanesh Goel
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Priyanka Sethi
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Morvan JB, Boudin L, Metivier D, Delarbre D, Bouquillon E, Thariat J, Pascaud D, Marcy PY. Internal Jugular Vein Tumor Thrombus: A Tricky Question for the Thyroid Surgeon. Curr Oncol 2022; 29:9235-41. [PMID: 36547137 DOI: 10.3390/curroncol29120723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Internal jugular vein tumor thrombus is an extremely rare condition in thyroid carcinoma, but it does exist. Correlated with greater aggressiveness with a higher incidence of distant metastases at diagnosis and a higher recurrence rate, this important prognostic element should be systematically investigated by ultrasound operators in all patients presenting with thyroid carcinoma. The patient's follow-up must be careful. This can be a trap that surgeons must look for in their preoperative checklist. We report the case of a 58-year-old woman with an IJV thrombus associated with multiple bone metastases. She underwent successful surgical treatment, and postoperative pathology showed a poorly differentiated follicular carcinoma of the thyroid and a tumor thrombus in the internal jugular vein.
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Rashid A, Iqrar SA, Rashid A, Simka M. Results of Numerical Modeling of Blood Flow in the Internal Jugular Vein Exhibiting Different Types of Strictures. Diagnostics (Basel) 2022; 12. [PMID: 36428922 DOI: 10.3390/diagnostics12112862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
The clinical relevance of nozzle-like strictures in upper parts of the internal jugular veins remains unclear. This study was aimed at understanding flow disturbances caused by such stenoses. Computational fluid dynamics software, COMSOL Multiphysics, was used. Two-dimensional computational domain involved stenosis at the beginning of modeled veins, and a flexible valve downstream. The material of the venous valve was considered to be hyperelastic. In the vein models with symmetric 2-leaflets valve without upstream stenosis or with minor 30% stenosis, the flow was undisturbed. In the case of major 60% and 75% upstream stenosis, centerline velocity was positioned asymmetrically, and areas of reverse flow and flow separation developed. In the 2-leaflet models with major stenosis, vortices evoking flow asymmetry were present for the entire course of the model, while the valve leaflets were distorted by asymmetric flow. Our computational fluid dynamics modeling suggests that an impaired outflow from the brain through the internal jugular veins is likely to be primarily caused by pathological strictures in their upper parts. In addition, the jugular valve pathology can be exacerbated by strictures located in the upper segments of these veins.
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Soliman M, Mowafy K, Mustafa W, Elsaadany N, Soliman R. Surgical Fixation of Jugular Bulb Abnormalities Associated With Phelebectasia in Patients With Vascular Tinnitus. Innovations (Phila) 2022; 17:562-566. [PMID: 36571246 DOI: 10.1177/15569845221137892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Internal jugular phlebectasia is a rare entity in which there is a fusiform dilatation of the internal jugular vein (IJV), usually presenting as a neck mass or tinnitus. The jugular bulb (JB) is an enlarged confluence connecting the sigmoid sinus and the IJV. It has been suggested that JB abnormality might also cause vertigo and pulsatile tinnitus. This prospective interventional study involved 15 patients with pulsatile tinnitus associated with internal jugular phlebectasia. Four patients presented with recurrent vertigo attacks. IJV diameter at rest ranged from 11 to 18 mm. Eight patients have had inner ear bone dehiscence, and 40% had high JB. All cases were treated by surgical fixation using a ringed polytetrafluoroethylene graft extending from the costoclavicular joint to the sigmoid sinus under fluoroscopic guidance. Tinnitus disappeared immediately postoperatively in all cases, followed by the disappearance of vertigo on the fourth day. Two cases reported thrombosis of the graft in the sixth and seventh months but maintained symptomatic improvement. Recurrence was reported in 2 cases while the grafts were patent. Surgical fixation by replacing the jugular vein and bulb with a synthetic graft may offer an excellent surgical option for relieving vascular tinnitus, especially in these young patients in whom endovascular therapy may not be a durable treatment.
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Affiliation(s)
- Mosaad Soliman
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Egypt
| | - Khaled Mowafy
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Egypt
| | - Wesam Mustafa
- Department of Neurology, Faculty of Medicine, Mansoura University, Egypt
| | - Nashaat Elsaadany
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Egypt
| | - Reem Soliman
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Egypt
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van Zandwijk JK, Kuijer KM, Stassen CM, ten Haken B, Simonis FF. Internal Jugular Vein Geometry Under Multiple Inclination Angles with 3D Low-Field MRI in Healthy Volunteers. J Magn Reson Imaging 2022; 56:1302-1308. [PMID: 35322920 PMCID: PMC9790417 DOI: 10.1002/jmri.28182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cerebral venous pathways are subjected to geometrical and patency changes due to body position. The internal jugular veins (IJVs) are the main venous drainage pathway in supine position. Their patency and geometry should be evaluated under different body inclination angles over a three-dimensional (3D) volume in the healthy situation to better understand pathological cases. PURPOSE To investigate whether positional changes in the body can affect the geometrical properties and patency of the venous system. STUDY TYPE Prospective. POPULATION 15 healthy volunteers, of which seven males and median age 22 years in a range of 19-59. FIELD STRENGTH/SEQUENCE A 0.25-T tiltable MRI system was used to scan volunteers in 90° (sitting position), 69°, 45°, 21°, and 0° (supine position) in the transverse plane with the top at vertebra C2. A gradient echo sequence was used. ASSESSMENT Three observers assessed IJVs on patency and created automatic centerlines from which diameter and patency were analysed perpendicular to the vessel at every 4 mm starting at the level of C2. STATISTICAL TESTS A Student's t test was used to find statistical difference (p < 0.05) in average IJV diameters per inclination angle. RESULTS The amount of fully collapsed IJVs increased from 33% to 93% (left IJV) and 14% to 80% (right IJV) when increasing the inclination angle from 0° to 90°. In both IJVs, the mean diameter (±SD) of the open vessels was significantly higher at 0° than 90° with 6.3 ± 0.5 mm vs. 4.4 ± 0.1 mm (left IJV) and 6.6 ± 0.6 mm vs. 4.3 ± 0.4 mm (right IJV). DATA CONCLUSION Tiltable low-field MRI can be used to assess IJV geometry and its associated venous pathways in 3D under multiple inclination angles. Next to a higher amount of collapsed vessels, the average diameter of noncollapsed vessels decreases with increasing inclination angles for both left and right IJVs. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Jordy K. van Zandwijk
- Magnetic Detection & Imaging, TechMed CentreUniversity of TwenteEnschedeThe Netherlands,Department of Vascular SurgeryMedisch Spectrum TwenteEnschedeThe Netherlands
| | - Koen M. Kuijer
- Magnetic Detection & Imaging, TechMed CentreUniversity of TwenteEnschedeThe Netherlands
| | - Chrit M. Stassen
- Department of RadiologyZiekenhuisgroep TwenteHengeloThe Netherlands
| | - Bernard ten Haken
- Magnetic Detection & Imaging, TechMed CentreUniversity of TwenteEnschedeThe Netherlands
| | - Frank F.J. Simonis
- Magnetic Detection & Imaging, TechMed CentreUniversity of TwenteEnschedeThe Netherlands
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Kohyama K, Kato H, Kuroki M, Okuda H, Shibata H, Ohashi T, Ogawa T. Posterior ischemic optic neuropathy following postoperative bleeding and internal jugular vein compression. Nagoya J Med Sci 2022; 84:877-883. [PMID: 36544603 PMCID: PMC9748323 DOI: 10.18999/nagjms.84.4.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
Perioperative blindness, especially posterior ischemic optic neuropathy (PION), is an uncommon but potentially devastating complication. We report a case of a 65-year-old male patient who underwent laryngopharyngectomy, bilateral neck dissection, and free jejunum flap reconstruction, but then experienced PION in his right eye following postoperative bleeding and bilateral internal jugular veins (IJVs) compression. Despite systemic corticosteroid therapy, his visual recovery prognosis was poor. The specific mechanism responsible for PION remains unclear, and no therapy has been shown to improve this condition. As such, prevention of perioperative PION remains the only available strategy. Surgeons should be aware of this rare potential complication and its risk factors and strive to avoid it. As postoperative bleeding and IJV compression are one of important risk factors for PION, avoiding these are critical.
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Affiliation(s)
- Keishi Kohyama
- Department of Plastic and Reconstructive Surgery, Gifu University Hospital, Gifu, Japan
| | - Hisakazu Kato
- Department of Plastic and Reconstructive Surgery, Gifu University Hospital, Gifu, Japan
| | - Masashi Kuroki
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshi Okuda
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hirofumi Shibata
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Toshimitsu Ohashi
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takenori Ogawa
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
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Min SW, Kim H, Won D, Chang JE, Lee JM, Hwang JY, Kim TK. Comparison of the needle tip location with the operator's position during ultrasound-guided internal jugular vein catheterization: A randomized controlled study. Medicine (Baltimore) 2022; 101:e31249. [PMID: 36316874 PMCID: PMC9622659 DOI: 10.1097/md.0000000000031249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE We hypothesized that when a right-handed operator catheterizes the left internal jugular vein (IJV), the tip of the needle might be positioned closer to the center of the vessel after puncture if the operator is standing in the patient's left axillary line, rather than standing cephalad to the patient. METHODS The study randomly allocated 44 patients undergoing elective surgery under general anesthesia with planned left central venous catheterization to either conventional (operator stood cephalad to the patient) or intervention (operator stood in the patient's axillary line) groups. The left IJV was catheterized by 18 anesthesiologists. The distance between the center of the vessel and the needle tip, first-attempt success rate, and procedure time were compared. RESULTS The distance from the needle tip to the center of the IJV after needle puncture was 3.5 (1.9-5.5) and 3.2 (1.7-4.9) cm in the conventional and intervention groups, respectively (P = .47). The first-attempt success rate was significantly higher in the intervention group (100% vs 68.2%, P = .01). Overall time to successful guidewire insertion was faster in the intervention group (P = .007). CONCLUSIONS There was no significant difference in needle tip position when the right-handed operator was standing in the patient's left axillary line compared to standing cephalad to the patient during left IJV catheterization. However, it increased the first-attempt success rate and reduced the overall time for guidewire insertion.
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Affiliation(s)
- Seong-Won Min
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyerim Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dongwook Won
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee-Eun Chang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Hwang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Tae Kyong Kim, Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Republic of Korea (e-mail: )
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Amin MA, Nahin S, Hawlader MDH. Persistent headaches sometimes concern incidental findings: A rare case of internal jugular vein agenesis in a 32-year-old man. Clin Case Rep 2022; 10:e6423. [PMID: 36237945 PMCID: PMC9536497 DOI: 10.1002/ccr3.6423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/12/2022] Open
Abstract
Absence of an internal jugular vein at birth is infrequent. These developmental anomalies affect approximately 0.05 percent to 0.25 percent of the population in the general community. Avascular abnormalities emerging from the internal jugular vein were detected during radiographic studies of chronic headache in an adult male patient. A dull headache troubled a 32-year-old man for more than 20 years. After taking most of NSAIDs and other medications for the condition, which persisted, a diagnosis of left internal jugular vein agenesis was made, which was most likely the cause of the headaches. When treating recurrent, persistent headaches in the emergency room and outdoor medical services, keep in mind that agenesis of the jugular venous system can play a role-one of the uncommon causes of headaches we have observed in our cases.
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Affiliation(s)
- Mohammad Ashraful Amin
- Department of Public HealthNorth South UniversityDhakaBangladesh,Public Health Professional Development Society (PPDS)DhakaBangladesh
| | - Sabrina Nahin
- Department of PhysiologyGreen Life Medical College HospitalDhakaBangladesh
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Shiozaki E, Morofuji Y, Kutsuna F, Uchida D, Kawahara I, Ono T, Haraguchi W, Tsutsumi K. Subarachnoid hemorrhage due to a craniocervical junction arteriovenous fistula associated with thrombus formation in the internal jugular vein: illustrative case. J Neurosurg Case Lessons 2022; 4:CASE22278. [PMID: 36593679 PMCID: PMC9514286 DOI: 10.3171/case22278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND A craniocervical junction arteriovenous fistula (CCJAVF) is a rare vascular malformation, and its etiology remains unclear. Here, to the best of the authors' knowledge, they present the first case of CCJAVF associated with thrombus formation in the ipsilateral internal jugular vein. OBSERVATIONS An 80-year-old man presented with a sudden occipital headache. Computed tomography revealed a subarachnoid hemorrhage surrounding the brainstem and upper cervical cord. Digital subtraction angiography showed a CCJAVF fed by the left C2 radiculomeningeal artery with ascending intracranial drainage and epidural plexus. After endovascular treatment, the authors retrospectively found that his ipsilateral internal jugular vein and innominate vein were occluded with a huge thrombus at admission. LESSONS This case suggested a restricted antegrade venous flow due to thrombus-induced progressive retrograde intracranial drainage causing hemorrhage. Venous hypertension should be considered one of the causes of hemorrhage due to CCJAVF as well as intracranial arteriovenous fistulas.
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Affiliation(s)
| | | | - Fumiya Kutsuna
- Neurology, Nagasaki Medical Center, Kubara Omura-city, Nagasaki, Japan
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40
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Saleem-Talib S, van Driel VJ, Nikolic T, van Wessel H, Louman H, Borleffs CJW, van der Heijden J, Cox M, Ramanna H. The jugular approach for leadless pacing. A novel and safe alternative. Pacing Clin Electrophysiol 2022; 45:1248-1254. [PMID: 36031774 DOI: 10.1111/pace.14587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/10/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate safety of leadless pacemaker implantation through the internal jugular vein in a larger cohort with longer follow-up. Moreover, feasibility of non-apical pacing as well as relation between pacing site and QRS duration were assessed. METHODS 82 consecutive patients, who received a leadless pacemaker though the internal jugular vein were included. Electrical parameters were measured at regular follow-up and any complications were registered. Paced QRS interval was compared for three pacing sites, RVOT, RV mid septum and RV apical septum. RESULTS In all patients the leadless pacemaker was implanted successfully. In 69 patients the device was implanted in a non-apical position. In 71% of cases, the device could be deployed at first attempt. The median fluoroscopy time was 4.4minutes (range 0.9-51-) The paced QRS interval was significantly narrower for non-apical pacing compared to apical pacing 156ms. vs 179 ms. P = 0.04 respectively. During mean follow-up of 16 months (range 0-43 months) electrical parameters remained stable. Two complications occurred which could be resolved during the implant procedure. There were no access site related complications. CONCLUSION The jugular approach for leadless pacemaker implantation is feasibly and may avoid vascular complications. It facilitates non-apical positioning of leadless pacemakers leading to a narrower paced QRS interval. The jugular approach allows for immediate post procedural ambulation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Tanja Nikolic
- Department of Cardiology Haga Teaching hospital, the Hague, The Netherlands
| | - Harry van Wessel
- Department of Cardiology Haga Teaching hospital, the Hague, The Netherlands
| | - Hellen Louman
- Department of Cardiology Haga Teaching hospital, the Hague, The Netherlands
| | | | | | - Moniek Cox
- Department of Cardiology Haga Teaching hospital, the Hague, The Netherlands
| | - Hemanth Ramanna
- Department of Cardiology Haga Teaching hospital, the Hague, The Netherlands
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41
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Chen Q, Tang X, Wang T, Zheng L, Liu H. Influence of internal jugular vein catheterisation on optic nerve sheath diameter in patients undergoing robot-assisted laparoscopic surgery: a prospective cohort study. Br J Anaesth 2022; 129:e105-e107. [PMID: 35987707 DOI: 10.1016/j.bja.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Qi Chen
- Department of Anaesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Xixi Tang
- Department of Anaesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Tongxuan Wang
- Department of Anaesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Lamei Zheng
- Department of Anaesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Hongliang Liu
- Department of Anaesthesiology, Chongqing University Cancer Hospital, Chongqing, China.
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Akhtar A, Dhungana S, Bhagat N, Bachuwa G. Left internal jugular vein thrombosis secondary to pacemaker insertion. Clin Case Rep 2022; 10:e05935. [PMID: 35662772 PMCID: PMC9163670 DOI: 10.1002/ccr3.5935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/20/2022] [Indexed: 11/08/2022] Open
Abstract
Venous thrombosis associated with pacemaker implant is a known phenomenon. We present a clinical video emphasizing on an important physical examination finding suggesting propagation of thrombus in internal jugular vein secondary to pacemaker insertion, which would be educational and help readers visualize the sign on physical examination.
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Affiliation(s)
- Aisha Akhtar
- Department of Internal Medicine Michigan State University at Hurley Medical Center Flint Michigan USA
| | - Santosh Dhungana
- Department of Internal Medicine Michigan State University at Hurley Medical Center Flint Michigan USA
| | - Nidhi Bhagat
- Department of Internal Medicine Michigan State University at Hurley Medical Center Flint Michigan USA
| | - Ghassan Bachuwa
- Department of Internal Medicine Michigan State University at Hurley Medical Center Flint Michigan USA
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Okyere I, Okyere P, Singh S, Brenu SG. Portacath Implantation in Ghana: Initial Experience at the Komfo Anokye Teaching Hospital in Kumasi. Clin Med Insights Case Rep 2022; 15:11795476221087910. [PMID: 35342320 PMCID: PMC8943456 DOI: 10.1177/11795476221087910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/24/2022] [Indexed: 12/04/2022] Open
Abstract
Current practice for chemotherapy in most oncology departments is the use of
dedicated venous access for the continuous and frequent delivery of drugs,
fluids and blood products, and the monitoring of the effects of treatment. The
frequent venipuncture of peripheral veins is associated with various
complications and discomfort to the patients. Permanent central venous access is
therefore very important. Totally Implantable Vascular Access Device (TIVAD) is
a type of central venous access that utilizes the central veins; the internal
jugular vein, the subclavian or the femoral veins. It is a kind of permanent
central venous access where a central venous catheter is connected to a
subcutaneously buried port or septum which can be accessed at any time and has
the ability to stay for almost 5 years. They are therefore the preferred form of
long-term central venous access in patients treated by oncology departments. We
share our initial experience of 5 patients in our institution. There were 4
females and one young boy who had been diagnosed with Hemophilia. Three of the
patients had new implantation, one had removal of her 5-year-old TIVAD that had
been implanted in another country and one had the TIVAD accessed when she had
been referred to our hospital for breast surgery after neoadjuvant
chemotherapy.
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Affiliation(s)
- Isaac Okyere
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Anesthesia and Intensive Care, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Perditer Okyere
- Department of Internal Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sanjeev Singh
- Department of Anesthesia and Intensive Care, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Weber MD, Conlon T, Woods-Hill C, Watts SL, Nelson E, Traynor D, Zhang B, Davis D, Himebauch AS. Retrospective Assessment of Patient and Catheter Characteristics Associated With Malpositioned Central Venous Catheters in Pediatric Patients. Pediatr Crit Care Med 2022; 23:192-200. [PMID: 34999641 PMCID: PMC8897221 DOI: 10.1097/pcc.0000000000002882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary objective was to determine the prevalence and characteristics associated with malpositioned temporary, nontunneled central venous catheters (CVCs) placed via the internal jugular (IJ) and subclavian (SC) veins in pediatric patients. DESIGN Single-center retrospective cohort study. SETTING Quaternary academic PICU. PATIENTS Children greater than 1 month to less than 18 years who had a CVC placed between January 2014 and December 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the CVC tip position located on the first postprocedural radiograph. CVC tip was defined as follows: "recommended" (tip location between the carina and two vertebral bodies inferior to the carina), "high" (tip location between one and four vertebral bodies superior to the carina), "low" (tip position three or more vertebral bodies inferior to the carina), and "other" (tip grossly malpositioned). Seven hundred eighty-one CVCs were included: 481 (61.6%) were in "recommended" position, 157 (20.1%) were "high," 131 (16.8%) were "low," and 12 (1.5%) were "other." Multiple multinomial regression (referenced to "recommended" position) showed that left-sided catheters (adjusted odds ratio [aOR], 2.00, 95% CI 1.17-3.40) were associated with "high" CVC tip positions, whereas weight greater than or equal to 40 kg had decreased odds of having a "high" CVC tip compared with the reference (aOR, 0.45; 95% CI, 0.24-0.83). Further, weight category 20-40 kg (aOR, 2.42; 95% CI, 1.38-4.23) and females (aOR, 1.51; 95% CI, 1.01-2.26) were associated with "low" CVC tip positions. There was no difference in rates of central line-associated blood stream infection, venous thromboembolism, or tissue plasminogen activator usage or dose between the CVCs with tips outside and those within the recommended location. CONCLUSIONS The prevalence of IJ and SC CVC tips outside of the recommended location was high. Left-sided catheters, patient weight, and sex were associated with malposition. Malpositioned catheters were not associated with increased harm.
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Affiliation(s)
- Mark D. Weber
- Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, School of Nursing at the University of Pennsylvania, Philadelphia Pennsylvania
| | - Thomas Conlon
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Charlotte Woods-Hill
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stephanie L. Watts
- Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, School of Nursing at the University of Pennsylvania, Philadelphia Pennsylvania
| | - Eileen Nelson
- Children’s Hospital of Philadelphia, Department of Nursing, Philadelphia Pennsylvania
| | - Danielle Traynor
- Children’s Hospital of Philadelphia, Department of Nursing, Philadelphia Pennsylvania
| | - Bingqing Zhang
- Children’s Hospital of Philadelphia, Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit
| | - Daniela Davis
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam S. Himebauch
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Patterson CA, Amelard R, Saarikoski E, Heigold H, Hughson RL, Robertson AD. Sex-dependent jugular vein optical attenuation and distension during head-down tilt and lower body negative pressure. Physiol Rep 2022; 10:e15179. [PMID: 35150210 PMCID: PMC8838633 DOI: 10.14814/phy2.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 11/24/2022] Open
Abstract
Non‐contact coded hemodynamic imaging (CHI) is a novel wide‐field near‐infrared spectroscopy system which monitors blood volume by quantifying attenuation of light passing through the underlying vessels. This study tested the hypothesis that CHI‐based jugular venous attenuation (JVA) would be larger in men, and change in JVA would be greater in men compared to women during two fluid shift challenges. The association of JVA with ultrasound‐based cross‐sectional area (CSA) was also tested. Ten men and 10 women completed three levels of head‐down tilt (HDT) and four levels of lower body negative pressure (LBNP). Both JVA and CSA were increased by HDT and reduced by LBNP (all p < 0.001). Main effects of sex indicated that JVA was higher in men than women during both HDT (p = 0.003) and LBNP (p = 0.011). Interaction effects of sex and condition were observed for JVA during HDT (p = 0.005) and LBNP (p < 0.001). We observed moderate repeated‐measures correlations (rrm) between JVA and CSA in women during HDT (rrm = 0.57, p = 0.011) and in both men (rrm = 0.74, p < 0.001) and women (rrm = 0.66, p < 0.001) during LBNP. While median within‐person correlation coefficients indicated an even stronger association between JVA and CSA, this association became unreliable for small changes in CSA. As hypothesized, JVA was greater and changed more in men compared to women during both HDT and LBNP. CHI provides a non‐contact method of tracking large changes in internal jugular vein blood volume that occur with acute fluid shifts, but data should be interpreted in a sex‐dependent manner.
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Affiliation(s)
- Courtney A Patterson
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Robert Amelard
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Essi Saarikoski
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - Hannah Heigold
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard L Hughson
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - Andrew D Robertson
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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46
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Liu Y, Wang XJ, Wang JL, Liu LH, Zhao SR, Yu SJ, Yang BB, Xu QL, Li JK, Wang SR. Internal Jugular Vein Thrombosis After Microwave Ablation of Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Case Report. Front Endocrinol (Lausanne) 2022; 13:792715. [PMID: 35574012 PMCID: PMC9092279 DOI: 10.3389/fendo.2022.792715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
In this study, two patients with papillary thyroid carcinoma and lymph node metastasis were treated by Dr. Shurong Wang's team and are reported. The two patients refused surgery and underwent microwave ablation (MWA) of the thyroid and lymph node lesions. Ultrasound review 2 days after MWA revealed internal jugular vein thrombosis. Patient #1 received low molecular weight heparin calcium injection, Xueshuantong injection, Xiangdan injection, and rivaroxaban. Patient #2 was treated with enoxaparin sodium injection, Xueshuantong injection, urokinase, and warfarin sodium tablet. The thrombus was successfully managed in each patient using anticoagulant treatment. Such complication of MWA has not been reported in many cases before. According to the relevant literature, thrombosis after thyroid cancer ablation might be related to subclinical hypothyroidism, increased heme oxidase 1 (HO-1) levels in the blood of patients with papillary thyroid cancer, and increased platelet content and mean platelet volume in patients with thyroid cancer. No specific cause of thrombosis was identified in the two cases reported here. No recurrence was observed after 1 (patient #1) and 4 (#2) years of follow-up. In conclusion, patients with papillary thyroid carcinoma and lymph node metastasis should undergo color Doppler ultrasound of the neck after MWA of thyroid lesions and neck metastasis.
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Affiliation(s)
- Ying Liu
- Department of Ultrasound Intervention, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Xi-Ju Wang
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Jin-Ling Wang
- Department of Ultrasound Intervention, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China
| | - Li-Hong Liu
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Shuo-Ran Zhao
- Intensive Care Unit, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Shou-Jun Yu
- Department of Ultrasound Intervention, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China
| | - Bei-Bei Yang
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Qing-Ling Xu
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Jin-Ke Li
- Department of Ultrasound Intervention, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China
| | - Shu-Rong Wang
- Department of Ultrasound Intervention, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
- *Correspondence: Shu-Rong Wang,
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47
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Xiong J, Wang H, Zhu Y, Zhou Y, Pang Y, Zhang L. The Right Internal Jugular at the Cricoid Cartilage Level May Represent the Optimal Central Vein Puncture Site in Pediatric Patients. Front Pediatr 2022; 10:833845. [PMID: 35273930 PMCID: PMC8901722 DOI: 10.3389/fped.2022.833845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Internal jugular vein puncture or cannulation is far more difficult in children compared with adults. Anthropometric measures of the internal jugular vein acquired by two-dimensional ultrasound are useful in the practice of puncture and catheterization. The aim of this study is to measure anthropometric parameters of bilateral internal jugular veins in children and to determine the best puncture site based on these parameters. MATERIALS A total of 107 pediatric patients undergoing elective operation were included. Ultrasound-visible evaluation of bilateral internal jugular veins was used to obtain the depth from skin, maximum antero-posterior diameter, and cross-sectional area at the levels of the superior border of thyroid cartilage and cricoid cartilage. Statistical analysis was performed using these anthropometric data and demographic variables of all studied pediatric patients, such as age, height, and weight. RESULTS A very weak correlation was noted between the depth, maximal antero-posterior diameter, and cross-sectional area of both internal jugular veins and the age, height, weight, and body surface index of all included children. All Pearson's R correlation coefficients were <0.45. The largest diameter and cross-sectional area were in the right internal jugular vein at the cricoid cartilage level (p < 0.01) followed by the left internal jugular vein at this level (p < 0.01). In addition, the internal jugular vein at the cricoid cartilage level was more superficial than that of the superior border of the thyroid cartilage (p < 0.01). CONCLUSION The right internal jugular vein at the cricoid cartilage level is the best site for puncture. The most appropriate alternative site is the left internal jugular vein on the same level. Better correlation was not observed between the anthropometric parameters of the internal jugular vein and children's biological characteristics. This finding should be confirmed in a larger-scale demographical study in the future.
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Affiliation(s)
- Jun Xiong
- Department of Anesthesiology, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China
| | - Huijun Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yun Zhu
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yafen Zhou
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yanan Pang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Liwei Zhang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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48
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Sarwar U, Bardia N, Patel M, Omar B, Malozzi C, Amritphale A, Awan G. Treatment of Inferior Vena Cava Thrombosis by Endovascular Stenting: A Case Report. Cureus 2021; 13:e19612. [PMID: 34956749 PMCID: PMC8674458 DOI: 10.7759/cureus.19612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/23/2022] Open
Abstract
Optimal treatment of inferior vena cava (IVC) thrombosis remains unclear, especially given the contraindications to anticoagulation use and because interventional options remain limited. We present a case of a 62-year-old man with advanced liver cirrhosis who developed IVC thrombosis with symptoms of severe abdominal pain and leg swelling. IVC flow was restored via successful recanalization with a transjugular and common femoral approach after deploying a 22 × 70 mm Wallstent. On follow-up, the patient had a resolution of his symptoms.
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Affiliation(s)
- Usman Sarwar
- Division of Cardiology, University of South Alabama, Mobile, USA
| | - Nikky Bardia
- Division of Cardiology, University of South Alabama, Mobile, USA
| | - Maulikumar Patel
- Division of Cardiology, University of South Alabama, Mobile, USA
| | - Bassam Omar
- Division of Cardiology, University of South Alabama, Mobile, USA
| | | | - Amod Amritphale
- Division of Cardiology, University of South Alabama, Mobile, USA
| | - Ghulam Awan
- Division of Cardiology, University of South Alabama, Mobile, USA
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Proto A, Conti D, Menegatti E, Taibi A, Gadda G. Plethysmography System to Monitor the Jugular Venous Pulse: A Feasibility Study. Diagnostics (Basel) 2021; 11:2390. [PMID: 34943625 DOI: 10.3390/diagnostics11122390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 12/05/2022] Open
Abstract
Cerebral venous outflow is investigated in the diagnosis of heart failure through the monitoring of jugular venous pulse, an indicator to assess cardiovascular diseases. The jugular venous pulse is a weak signal stemming from the lying internal jugular vein and often invasive methodologies requiring surgery are mandatory to detect it. Jugular venous pulse can also be extrapolated via the ultrasound technique, but it requires a qualified healthcare operator to perform the examination. In this work, a wireless, user-friendly, wearable device for plethysmography is developed to investigate the possibility of monitoring the jugular venous pulse non-invasively. The proposed device can monitor the jugular venous pulse and the electrocardiogram synchronously. To study the feasibility of using the proposed device to detect physiological variables, several measurements were carried out on healthy subjects by considering three different postures: supine, sitting, and upright. Data acquired in the experiment were properly filtered to highlight the cardiac oscillation and remove the breathing contribution, which causes a considerable shift in the amplitude of signals. To evaluate the proper functioning of the wearable device for plethysmography, a comparison with the ultrasound technique was carried out. As a satisfactory result, the acquired signals resemble the typical jugular venous pulse waveforms found in literature.
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Chang SH, Huang HY, Hung HY, Sung WY, Chang CH. Central venous catheter penetrating the spinal canal via the spinal foramen: A case report and literature review. Ann Vasc Surg 2021:S0890-5096(21)00804-9. [PMID: 34780938 DOI: 10.1016/j.avsg.2021.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/20/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
The insertion of a neck central venous catheter (CVC) is a common procedure in medical practice; however, malposition and complications frequently occur. A 66-year-old woman had CVC inserted through the right internal jugular vein. CVC malposition was observed on chest radiography and computed tomography. The catheter was accidentally inserted via the vertebral vein and had entered the C6-C7 intervertebral foramen, penetrating the spinal canal with the tip at the T2 epidural space. We present this rare CVC complication to demonstrate the possibility of incorrect insertion of the catheter and penetration of the spinal canal, possibly causing neuronal damage.
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