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Elshafie S, Tariq AT, Leon FL. Device implantation complicated by a retrosternal goiter. Pacing Clin Electrophysiol 2024; 47:673-675. [PMID: 37594289 DOI: 10.1111/pace.14806] [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: 03/11/2023] [Revised: 08/05/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Abstract
Central venous obstruction in the cardiac implantable electronic devices (CIED) population is commonly due to thrombosis and fibrosis secondary to the passage of pre-existing leads. However, vein occlusion before CIED implantation is uncommon, and one cause is retrosternal goiters. We report a case where the failure of the initial implantation of a primary CIED led to an unusual implantation route without goiter excision. The patient had an indication for cardiac resynchronization therapy (CRT) given his left ventricular (LV) function was impaired and had second-degree heart block Mobitz Type II; however, he had occluded bilateral subclavian veins due to a sizeable retrosternal goiter. This obstruction led to the implantation of a single lead pacemaker via the right femoral vein after multiple failed attempts at CRT, dual chamber pacemaker and left bundle branch area pacing (LBBaP).
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Affiliation(s)
- Sally Elshafie
- Cardiology Department, University Hospitals of Derby and Burton, Derby, UK
| | - Abu Taher Tariq
- Cardiology Department, University Hospitals of Derby and Burton, Derby, UK
| | - Francisco Leyva Leon
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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2
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Kawano D, Mori H, Taniwaki M, Tsutsui K, Kato R. Venous thoracic outlet syndrome, as a pitfall for cardiac implantable electronic device implantations. Pacing Clin Electrophysiol 2024; 47:664-667. [PMID: 37561371 DOI: 10.1111/pace.14799] [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: 06/22/2023] [Revised: 07/15/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
The subclavian vein is typically used in cardiovascular implantable electronic device (CIED) implantations. External stress on the subclavian vein can lead to lead-related complications. There are several causes of this stress, such as frequent upper extremity movements or external injury. Venous thoracic outlet syndrome (TOS) can also become the cause of external lead stress. However, the diagnosis of venous TOS can be challenging because subclavian venography can appear normal at first glance. We present a unique case of a device infection in a patient with venous TOS. A careful observation of the imaging studies is vital for diagnosing venous TOS and a leadless pacemaker implantation could be an alternative therapeutic option.
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Affiliation(s)
- Daisuke Kawano
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka-shi, Saitama, Japan
- Department of Cardiology, Tokorozawa Heart Center, Tokorozawa, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka-shi, Saitama, Japan
| | - Masanori Taniwaki
- Department of Cardiology, Tokorozawa Heart Center, Tokorozawa, Japan
| | - Kenta Tsutsui
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka-shi, Saitama, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka-shi, Saitama, Japan
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3
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Wang B, Hui K, Xiong J, Yang C, Cao X, Zhu G, Ang Y, Duan M. Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II. BMC Anesthesiol 2024; 24:138. [PMID: 38600439 PMCID: PMC11005262 DOI: 10.1186/s12871-024-02514-9] [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: 01/20/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Perioperative hypotension is frequently observed following the initiation of general anesthesia administration, often associated with adverse outcomes. This study assessed the effect of subclavian vein (SCV) diameter combined with perioperative fluid therapy on preventing post-induction hypotension (PIH) in patients with lower ASA status. METHODS This two-part study included patients aged 18 to 65 years, classified as ASA physical status I or II, and scheduled for elective surgery. The first part (Part I) included 146 adult patients, where maximum SCV diameter (dSCVmax), minimum SCV diameter (dSCVmin), SCV collapsibility index (SCVCI) and SCV variability (SCVvariability) assessed using ultrasound. PIH was determined by reduction in mean arterial pressure (MAP) exceeding 30% from baseline measurement or any instance of MAP < falling below 65 mmHg for ≥ a duration of at least 1 min during the period from induction to 10 min after intubation. Receiver Operating Characteristic (ROC) curve analysis was employed to determine the predictive values of subclavian vein diameter and other relevant parameters. The second part comprised 124 adult patients, where patients with SCV diameter above the optimal cutoff value, as determined in Part I study, received 6 ml/kg of colloid solution within 20 min before induction. The study evaluated the impact of subclavian vein diameter combined with perioperative fluid therapy by comparing the observed incidence of PIH after induction of anesthesia. RESULTS The areas under the curves (with 95% confidence intervals) for SCVCI and SCVvariability were both 0.819 (0.744-0.893). The optimal cutoff values were determined to be 45.4% and 14.7% (with sensitivity of 76.1% and specificity of 86.7%), respectively. Logistic regression analysis, after adjusting for confounding factors, demonstrated that both SCVCI and SCVvariability were significant predictors of PIH. A threshold of 45.4% for SCVCI was chosen as the grouping criterion. The incidence of PIH in patients receiving fluid therapy was significantly lower in the SCVCI ≥ 45.4% group compared to the SCVCI < 45.4% group. CONCLUSIONS Both SCVCI and SCVvariability are noninvasive parameters capable of predicting PIH, and their combination with perioperative fluid therapy can reduce the incidence of PIH.
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Affiliation(s)
- Bin Wang
- Department of Anesthesiology, Jinling College affiliated to Nanjing Medical University, Zhongshan East Road #305, Nanjing, Jiangsu Province, 210002, China
| | - Kangli Hui
- Department of Anesthesiology, Jinling College affiliated to Nanjing Medical University, Zhongshan East Road #305, Nanjing, Jiangsu Province, 210002, China
| | - Jingwei Xiong
- Department of Anesthesiology, Jinling College affiliated to Nanjing Medical University, Zhongshan East Road #305, Nanjing, Jiangsu Province, 210002, China
| | - Chongya Yang
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
| | - Xinyu Cao
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
| | - Guangli Zhu
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
| | - Yang Ang
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, 210002, China
| | - Manlin Duan
- Department of Anesthesiology, Jinling College affiliated to Nanjing Medical University, Zhongshan East Road #305, Nanjing, Jiangsu Province, 210002, China.
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210019, China.
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Harnal R, Shiraev T. Subclavian Vein Aneurysm: An Unusual Cause of Massive Pulmonary Embolism. Eur J Vasc Endovasc Surg 2024; 67:661. [PMID: 38141958 DOI: 10.1016/j.ejvs.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/24/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Richa Harnal
- Resident, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Timothy Shiraev
- Vascular Surgeon, Royal Prince Alfred Hospital, Sydney, Australia
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Imai E, Kataoka Y, Watanabe J, Okano H, Namekawa M, Owada G, Matsui Y, Yokozuka M. Ultrasound-guided central venous catheterization around the neck: Systematic review and network meta-analysis. Am J Emerg Med 2024; 78:206-214. [PMID: 38330835 DOI: 10.1016/j.ajem.2024.01.043] [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: 11/01/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Ultrasound-guided central venous catheterization (CVC) has become the standard of care. However, providers use a variety of approaches, encompassing the internal jugular vein (IJV), supraclavicular subclavian vein (SupraSCV), infraclavicular subclavian vein (InfraSCV), proximal axillary vein (ProxiAV), distal axillary vein (DistalAV), and femoral vein. OBJECTIVE This review aimed to compare the first-pass success rate and arterial puncture rate for different approaches to ultrasound-guided CVC above the diaphragm. METHODS In May 2023, Embase, MEDLINE, CENTRAL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Platform were searched for randomized controlled trials (RCTs) comparing the 5 CVC approaches. The Confidence in Network Meta-Analysis tool was used to assess confidence. Thirteen RCTs (4418 participants and 13 comparisons) were included in this review. RESULTS The SupraSCV approach likely increased the proportion of first-attempt successes compared to the other 4 approaches. The SupraSCV first-attempt success demonstrated risk ratios (RRs) > 1.21 with a lower 95% confidence interval (CI) exceeding 1. Compared to the IJV, the SupraSCV approach likely increased the first-attempt success proportion (RR 1.22; 95% confidence interval [CI] 1.06-1.40, moderate confidence), whereas the DistalAV approach reduced it (RR 0.72; 95% CI 0.59-0.87, high confidence). Artery puncture had little to no difference across all approaches (low to high confidence). CONCLUSION Considering first-attempt success and mechanical complications, the SupraSCV may emerge as the preferred approach, while DistalAV might be the least preferable approach. Nevertheless, head-to-head studies comparing the approaches with the greatest first attempt success should be undertaken.
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Affiliation(s)
- Eriya Imai
- Division of Anesthesia, Mitsui Memorial Hospital, Tokyo, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Yuki Kataoka
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Kyoto, Japan
| | - Jun Watanabe
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Surgery, Division of Gastroenterological, General, and Transplant Surgery, Jichi Medical University, Tochigi, Japan; Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Hiromu Okano
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Motoki Namekawa
- Division of Anesthesia, Mitsui Memorial Hospital, Tokyo, Japan
| | - Gen Owada
- Department of Intensive Care Medicine, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Yuko Matsui
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Kanagawa, Japan
| | - Motoi Yokozuka
- Division of Anesthesia, Mitsui Memorial Hospital, Tokyo, Japan
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İlhan B, Azamat İF, Bademler S, Avlanmis O, Uzunyolcu G, Erginel B, Yanar F. Is ultrasound guidance necessary to avoid complications in the implantation of venous access ports? ULUS TRAVMA ACIL CER 2024; 30:210-215. [PMID: 38506386 DOI: 10.14744/tjtes.2024.58665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND The aim of this study was to present demographic information of patients undergoing totally implantable venous access port (TIVAP) implantation and to investigate the rates of early and late complications, assessing the benefits of performing the procedure underUS guidance. METHODS From May 2018 to December 2023, the outcomes of a total of 537 TIVAP implantation procedures were analyzed retrospectively. Data of the surgeons' experiences for both puncture methods (anatomical landmarks and ultrasound guidance) are presented in the study. RESULTS The average age of the patients was 53.1±11.9 years, and 261 (48.6%) were female. The right subclavian vein was the preferred insertion site. Fourteen patients developed early complications and 11 developed late complications. Arterial puncture was the most common early complication, while catheter-related infection was the most common late complication. The age, sex, and body mass index of the patients were not independent risk factors for developing complications. Early complications increased as the number of puncture attempts did (p=0.034) and developed significantly less when ultrasound guidance was used during insertion (p=0.011). CONCLUSION The risk of developing complications was not affected by patient's age or sex. In addition, body mass index was not shown to be an independent risk factor for patients developing complications. It may be concluded from the study that early complications in particular can be reduced with ultrasound-guided implantation.
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Affiliation(s)
- Burak İlhan
- Department of General Surgery, Istanbul University Faculty of Medicine, İstanbul-Türkiye
| | - İbrahim Fethi Azamat
- Department of General Surgery, Istanbul University Faculty of Medicine, İstanbul-Türkiye
| | - Süleyman Bademler
- Department of General Surgery, Istanbul University, Oncology Institute, İstanbul-Türkiye
| | - Omer Avlanmis
- Department of General Surgery, Liv Hospital Ulus, İstanbul-Türkiye
| | - Görkem Uzunyolcu
- Department of General Surgery, Istanbul University Faculty of Medicine, İstanbul-Türkiye
| | - Basak Erginel
- Department of Pediatric Surgery, Istanbul University Faculty of Medicine, İstanbul-Türkiye
| | - Fatih Yanar
- Department of General Surgery, Istanbul University Faculty of Medicine, İstanbul-Türkiye
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Fereydooni A, Sgroi MD. Management of thoracic outlet syndrome in patients with hemodialysis access. Semin Vasc Surg 2024; 37:50-56. [PMID: 38704184 DOI: 10.1053/j.semvascsurg.2024.01.004] [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: 10/24/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 05/06/2024]
Abstract
Patients with threatened arteriovenous access are often found to have central venous stenoses at the ipsilateral costoclavicular junction, which may be resistant to endovascular intervention. Stenoses in this location may not resolve unless surgical decompression of thoracic outlet is performed to relieve the extrinsic compression on the subclavian vein. The authors reviewed the management of dialysis patients with central venous lesions at the thoracic outlet, as well as the role of surgical decompression with first-rib resection or claviculectomy for salvage of threatened, ipsilateral dialysis access.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Suite CJ350, MC5639, Palo Alto, CA, 94304
| | - Michael David Sgroi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Suite CJ350, MC5639, Palo Alto, CA, 94304.
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Jeong HK, Kim SS. A successful case of percutaneous retrieval of anchoring sleeve that migrated into the subclavian vein during left bundle branch area pacing. J Interv Card Electrophysiol 2024; 67:247-248. [PMID: 37670064 DOI: 10.1007/s10840-023-01635-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Hyung Ki Jeong
- Department of Cardiovascular Medicine, Won Kwang University Medical School, Iksan, Korea
| | - Sung Soo Kim
- Department of Cardiovascular Medicine, Chosun University Medical School, Donggu, Gwangju, Korea.
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9
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Patel MS. Novel Percutaneous Mechanical Thrombectomy Device for Treating Upper Extremity Deep Vein Thrombosis in Patient With Paget-Schroetter Syndrome. Vasc Endovascular Surg 2024; 58:235-239. [PMID: 37732898 DOI: 10.1177/15385744231203752] [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] [Indexed: 09/22/2023]
Abstract
Paget-Schroetter Syndrome (PSS) is a form of upper extremity deep vein thrombosis (DVT) caused by the external compression of the subclavian vein at the thoracic outlet. Here we describe a complex PSS case in a 43-year-old female who experienced multiple recurrent DVTs and a right-sided hemothorax following two continuous aspiration thrombectomy procedures and a first rib resection. Rapid and complete symptom resolution was achieved with the InThrill Thrombectomy System (Inari Medical), a novel, thrombolytic-free, percutaneous mechanical thrombectomy device that removed all recurrent acute and subacute thrombus in a single session without significant blood loss.
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Affiliation(s)
- Mitul S Patel
- NJ Endovascular Therapeutics, Vascular Surgery, The Valley Hospital, Ridgewood, NJ, USA
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10
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Ogoshi Y, Matsuoka A, Takeo M. [Descending Necrotizing Mediastinitis with Subclavian Vein Injury due to Cervical Re-debridement: Report of a Case]. Kyobu Geka 2024; 77:146-149. [PMID: 38459865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
A 58-year-old man was admitted to our hospital with fever and neck swelling after dental treatment. He was diagnosed with a cervical abscess and underwent cervical abscess drainage, but 1 week later he developed descending necrotizing mediastinitis and was referred to our department. He underwent mediastinal and pleural drainage, but neck abscess was recured, Re-debridment of the neck abscess resulted in bleeding from right subclavian vein. The bleeding was successfully stopped with TacoSeal after L-shaped sternotomyand dissection of sternocleidomostoid muscle.
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Affiliation(s)
- Yusuke Ogoshi
- Department of Thoracic Surgery, Kobe City Medical Center West Hospital, Kobe, Japan
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Musella G, Crespi A, Apostolou G, Azzari S, Ambrosoli AL. Inadvertent intra-arterial catheterisation using ultrasound guidance and endocavitary electrocardiography in a paediatric patient. J Vasc Access 2024; 25:336-339. [PMID: 35891591 DOI: 10.1177/11297298221113695] [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] [Indexed: 11/16/2022] Open
Abstract
Venous access in small infants is difficult and central venous catheter placed into the brachiocephalic vein is often the preferred approach. Ultrasound guided vein cannulation is standard practice and endocavitary electrocardiography is a reliable catheter tip location method. We report a not immediately recognised 2 month old case of inadvertent intra-arterial catheterisation with a 3 Fr - 8 cm catheter during right innominate vein cannulation under ultrasound guidance. Endocavitary electrocardiography showed an increased amplitude P wave with a low P/R wave ratio but further insertion of the catheter resulted in a reduction of the P wave amplitude. At ultrasound re-evaluation of the innominate vein, the catheter seemed to be inside the vessel into the proximal part of the vein, but distally appeared to surpass the vein to get into the brachiocephalic artery at the level of the bifurcation of the right common carotid artery and the right subclavian artery. Cardiac ultrasound from the suprasternal notch view identified the catheter into the aortic arch. Contrast-enhanced CT scan with 3D reconstruction confirmed the intra-arterial catheterisation and showed that the innominate vein was shifted and partially compressed but not transfixed by the catheter. The catheter was non-surgically removed uneventfully. During innominate vein cannulation the catheter cannot always be visualised into the distal tract of the vein and the maximal P wave may have a low P/R ratio; a chest X-ray can identify intra-arterial but false negative results are possible. We recommend always using a real time ultrasound tip navigation and location protocol, like the Neo-ECHOTIP protocol, to confirm the correct position of the guidewire and the catheter. If the catheter cannot be identified inside the venous system, we suggest systematically visualising the aortic arch from the suprasternal notch view and the aortic root from the parasternal view to identify arterial malposition.
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Affiliation(s)
- Giuseppe Musella
- Anesthesiology and ICU, ASST Sette Laghi, Varese, Lombardia, Italy
| | - Andrea Crespi
- Anesthesiology and ICU, ASST Sette Laghi, Varese, Lombardia, Italy
| | | | - Serena Azzari
- Anesthesiology and ICU, ASST Sette Laghi, Varese, Lombardia, Italy
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Naddi L, Borgquist O, Adrian M, Bark BP, Kander T. Ultrasound-guided subclavian vein catheterisation with a needle guide (ELUSIVE): protocol for a randomised controlled study. BMJ Open 2023; 13:e080515. [PMID: 38114277 DOI: 10.1136/bmjopen-2023-080515] [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] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Central venous catheters are indispensable in modern healthcare. Unfortunately, they are accompanied by minor as well as major complications, leading to increased morbidity, mortality and costs. Immediate insertion-related complications (mechanical complications) have decreased due to the implementation of real-time ultrasound guidance, but they still occur and additional efforts to enhance patient safety are warranted. This study aims to investigate whether the use of a needle guide mounted on the ultrasound probe in subclavian catheterisations may decrease the number of catheterisations with >1 skin puncture (primary outcome). METHODS AND ANALYSIS This is an investigator-initiated, non-commercial, randomised, controlled, parallel-group study conducted at Skåne University Hospital, Lund, Sweden. Adults (≥18 years) with a clinical indication for a subclavian central venous catheter and the ability to give written informed consent will be eligible for inclusion. Exclusion criteria include subclavian catheterisation deemed unsuitable based on the preprocedural ultrasound examination. Patients will be randomised to catheterisation by certified operators using a microconvex probe (long-axis, in-plane technique) with (n=150) or without (n=150) a needle guide. The ultrasound imaging from the procedures will be recorded and assessed by two reviewers individually. The assessors will be blinded for group affiliation. Secondary outcomes include the total number of skin punctures, mechanical complications, time to successful venous puncture, number of failed catheterisations and operator satisfaction with the needle guide at the end of the study period.Recruitment started on 8 November 2022 and will continue until the sample size is achieved. ETHICS AND DISSEMINATION This study was approved by the Swedish Ethical Review Authority (#2022-04073-01) and the Swedish Medical Products Agency (#5.1-2022-52130; CIV-21-12-038367). The findings will be submitted to an international peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05513378, clinicaltrials.gov.
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Affiliation(s)
- Leila Naddi
- Faculty of Medicine, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
| | - Ola Borgquist
- Faculty of Medicine, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
| | - Maria Adrian
- Faculty of Medicine, Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
| | - Björn P Bark
- Faculty of Medicine, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
| | - Thomas Kander
- Faculty of Medicine, Lund University, Lund, Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
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13
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Cralle LE, Harris LM, Lum YW, Deery SE, Humphries MD. Thoracic outlet syndrome in females: A systematic review. Semin Vasc Surg 2023; 36:487-491. [PMID: 38030322 DOI: 10.1053/j.semvascsurg.2023.09.003] [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: 07/15/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023]
Abstract
Thoracic outlet syndrome (TOS) is a rare anatomic condition caused by compression of neurovascular structures as they traverse the thoracic outlet. Depending on the primary structure affected by this spatial narrowing, patients present with one of three types of TOS-venous TOS, arterial TOS, or neurogenic TOS. Compression of the subclavian vein, subclavian artery, or brachial plexus leads to a constellation of symptoms, including venous thrombosis, with associated discomfort and swelling; upper extremity ischemia; and chronic pain due to brachial plexopathy. Standard textbooks have reported a predominance of females patients in the TOS population, with females comprising 70%. However, there have been few comparative studies of sex differences in presentation, treatment, and outcomes for the various types of TOS.
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Affiliation(s)
- Lauren E Cralle
- Division of Vascular Surgery, University of California Davis, 2335 Stockton Boulevard, NAOB 5001, Sacramento, CA, 95811.
| | | | | | | | - Misty D Humphries
- Division of Vascular Surgery, University of California Davis, 2335 Stockton Boulevard, NAOB 5001, Sacramento, CA, 95811
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14
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Choudhary N, Banerjee N, Singh J, Kumari M, Kaur M. Comparison of success rate of abducted and neutral arm position for right infraclavicular subclavian vein cannulation under real-time ultrasound guidance in patients undergoing elective neurosurgery under general anesthesia. Ann Card Anaesth 2023; 26:418-422. [PMID: 37861576 PMCID: PMC10691558 DOI: 10.4103/aca.aca_32_23] [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] [Received: 03/08/2023] [Revised: 05/17/2023] [Accepted: 06/20/2023] [Indexed: 10/21/2023] Open
Abstract
Background Classically subclavian vein catheterization is done in neutral arm position; recently, it has been done in different arm positions to compare success rate and catheter misplacement. There is a paucity of literature for comparing abducted and neutral arm position for right infraclavicular subclavian vein cannulation. Aim Comparison of success rate of abducted and neutral arm position for right infraclavicular subclavian vein cannulation under real-time ultrasound guidance in patients undergoing elective neurosurgery under general anesthesia. Design Randomized comparative study. Materials and Methods After approval from Institutional Review Board and Ethical Committee, 100 patients of 18-70 years of age, of either sex, posted for elective neurosurgery under general anesthesia, requiring right subclavian vein cannulation were included in our study. They were randomly divided into two groups: abducted arm position (group 1-AG) and neutral arm position (group 2-NG) using sealed envelope technique. Results First attempt success rate was higher in AG group compared to NG group (P value- 0.741). Times taken (seconds) for cannulation in NG and AG group, catheter misplacement and hematoma (P value- 0.37, P value- 0.37, P value- 1, respectively) were lesser in AG Group. Conclusion For USG-guided infraclavicular subclavian vein cannulation, abducted arm position, and neutral arm position in terms of first attempt success rate, number of attempts and associated complications has comparable results; however, further studies with larger group of patients are required to assess the overall advantage of abducted arm position over neutral arm position.
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Affiliation(s)
- Nirmala Choudhary
- Department of Anesthesiology, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India
| | - Neerja Banerjee
- Department of Anesthesiology, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India
| | - Jyoti Singh
- Department of Anesthesiology, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India
| | - Meena Kumari
- Department of Anesthesiology, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India
| | - Mohandeep Kaur
- Department of Anesthesiology, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India
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15
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Meric M, Oztas DM, Cakir MS, Ulukan MO, Sayin OA, Kilickesmez O, Erdinc I, Rodoplu O, Oteyaka E, Ugurlucan M. A surgical method to be reminded for the treatment of symptomatic ipsilateral central venous occlusions in patients with hemodialysis access: Axillo-axillary venous bypass case report and review of the literature. Vascular 2023; 31:1017-1025. [PMID: 35549494 DOI: 10.1177/17085381221092502] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND In this case report, we present two chronic hemodialysis patients with upper extremity swelling due to central venous occlusions together with their clinical presentation, surgical management and brief review of the literature. METHODS The first patient who was a 63-year-old female patient with a history of multiple bilateral arteriovenous fistulas (AVFs) was referred to our clinic. Physical examination demonstrated a functioning right brachio-cephalic AVF, with severe edema of the right arm, dilated venous collaterals, facial edema, and unilateral breast enlargement. In her history, multiple ipsilateral subclavian venous catheterizations were present for sustaining temporary hemodialysis access. The second patient was a 47-year-old male with a history of failed renal transplant, CABG surgery, multiple AV fistula procedures from both extremities, leg amputation caused by peripheral arterial disease, and decreased myocardial functions. He was receiving 3/7 hemodialysis and admitted to our clinic with right arm edema, accompanied by pain, stiffness, and skin hyperpigmentation symptoms ipsilateral to a functioning brachio-basilic AVF. He was not able to flex his arms, elbow, or wrist due to severe edema. RESULTS Venography revealed right subclavian vein stenosis with patent contralateral central veins in the first patient. She underwent percutaneous transluminal angioplasty (PTA) twice with subsequent re-occlusions. After failed attempts of PTA, the patient was scheduled for axillo-axillary venous bypass in order to preserve the AV access function. In second patient, venography revealed right subclavian vein occlusion caused secondary to the subclavian venous catheters. Previous attempts for percutaneously crossing the chronic subclavian lesion failed multiple times by different centers. Hence, the patient was scheduled for axillo-axillary venous bypass surgery. CONCLUSION In case of chronic venous occlusions, endovascular procedures may be ineffective. Since preserving the vascular access function is crucial in this particular patient population, venous bypass procedures should be kept in mind as an alternative for central venous reconstruction, before deciding on ligation and relocation of the AVF.
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Affiliation(s)
- Mert Meric
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Didem Melis Oztas
- Cardiovascular Surgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Semih Cakir
- Radiology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozer Ulukan
- Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Omer Ali Sayin
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | | | - Ibrahim Erdinc
- Cardiovascular Surgery Clinic, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Orhan Rodoplu
- Cardiovascular Surgery Clinic, Atasehir Florence Nightingale Hospital, Istanbul, Turkey
| | - Emre Oteyaka
- Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
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16
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Blunt J, Avila L, Temple M, Thornton J. Exercise-induced deep vein thrombosis in the subclavian vein in an elite female athlete. BMJ Case Rep 2023; 16:e253751. [PMID: 37666570 PMCID: PMC10481743 DOI: 10.1136/bcr-2022-253751] [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] [Indexed: 09/06/2023] Open
Abstract
An adolescent female presented to the emergency room with pain, swelling and a palpable lump in the right axilla following activity on a rowing ergometer. The differential diagnosis at the time of presentation was deep vein thrombosis, mass compression and cellulitis. An ultrasound scan revealed an occlusive thrombus of the right axillary and subclavian veins, basilic vein and proximal cephalic vein. The patient underwent pharmacomechanical thrombolysis followed by catheter-directed thrombolysis. Dynamic venogram testing revealed venous thoracic outlet syndrome (VTOS) and a transaxillary first rib resection was performed to decompress the costoclavicular space. Genetic testing revealed the patient was heterozygous for factor V Leiden. Two rounds of balloon dilatation plasty were performed to relieve recurring symptoms due to scarring and persisting compression, 1 and 3 years post rib resection. After extensive shared decision-making, the patient returned to sport, reporting only intermittent symptoms of post-thrombotic syndrome. This case sheds light on the importance of early diagnosis of VTOS for successful return to sport.
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Affiliation(s)
- Jacqueline Blunt
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Avila
- Department of Pediatrics, Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Temple
- Medical Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jane Thornton
- Family Medicine, Western University, London, Ontario, Canada
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17
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He Y, Yang W, Zhao Y, Cheng H, Zhang M, Yuan Y. Individualized Blind Techniques for Puncture of Intrathoracic and Extrathoracic Subclavian Vein: Three Simple Experience Tips. Anatol J Cardiol 2023; 27:534-538. [PMID: 37288868 PMCID: PMC10510415 DOI: 10.14744/anatoljcardiol.2023.2893] [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: 12/10/2022] [Accepted: 04/25/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Although several procedures of subclavian venipuncture have been reported, no standard method has been established yet. The purpose of this study was to investigate some more accurate and improved blind puncture tips. METHODS A prospective study was conducted on patients who underwent cardiac radio-frequency ablation with the blind technique of subclavian venipuncture from August 2018 to June 2022. All patients were randomly assigned to an intrathoracic approach group or extrathoracic approach group. Each group of patients followed their own specific puncture scheme and tips. RESULTS About 371 punctures were included. Blind subclavian venipunctures were performed with 98.9% technical success and without complications in all patients. The over-all success rate with an intrathoracic and extrathoracic approach was equivalent (96.7% vs. 98.3%, P =.23). The intrathoracic group showed a higher first-pass success compared with the extrathoracic group (91.9% vs. 80.2%, P = 0.003, respectively). CONCLUSION We localized the landmark/reference and skin puncture site of an intrathoracic and extrathoracic subclavian venipuncture individually and quantitatively. These experiences make blind techniques more accurate and faster.
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Affiliation(s)
- Yula He
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Weiping Yang
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Ying Zhao
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Hexiang Cheng
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Minxia Zhang
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, China
| | - Yuan Yuan
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, China
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18
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Lu Y, Zhang Y, Xu Z, Shen F, Wang J, Liu Z. Subclavian vein ultrasound-guided fluid management to prevent post-spinal anesthetic hypotension during cesarean delivery: a randomized controlled trial. BMC Anesthesiol 2023; 23:288. [PMID: 37620761 PMCID: PMC10464078 DOI: 10.1186/s12871-023-02242-6] [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: 04/24/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Hypotension frequently occurs after spinal anesthesia during cesarean delivery, and fluid loading is recommended for its prevention. We evaluated the efficacy of subclavian vein (SCV) ultrasound (US)-guided volume optimization in preventing hypotension after spinal anesthesia during cesarean delivery. METHODS This randomized controlled study included 80 consecutive full-term parturients scheduled for cesarean delivery under spinal anesthesia. The women were randomly divided into the SCVUS group, with SCVUS analysis before spinal anesthesia with SCVUS-guided volume management, and the control group without SCVUS assessment. The SCVUS group received 3 mL/kg crystalloid fluid challenges repeatedly within 3 min with a 1-min interval based on the SCV collapsibility index (SCVCI), while the control group received a fixed dose (10 mL/kg). Incidence of post-spinal anesthetic hypotension was the primary outcome. Total fluid volume, vasopressor dosage, changes in hemodynamic parameters, maternal adverse effects, and neonatal status were secondary outcomes. RESULTS The total fluid volume was significantly higher in the control group than in the SCVUS group (690 [650-757.5] vs. 160 [80-360] mL, p < 0.001), while the phenylephrine dose (0 [0-40] vs. 0 [0-30] µg, p = 0.276) and incidence of post-spinal anesthetic hypotension (65% vs. 60%, p = 0.950) were comparable between both the groups. The incidence of maternal adverse effects, including nausea/vomiting and bradycardia (12.5% vs. 17.5%, p = 0.531 and 7.5% vs. 5%, p = 1.00, respectively), and neonatal outcomes (Apgar scores) were comparable between the groups. SCVCI correlated with the amount of fluid administered (R = 0.885, p < 0.001). CONCLUSIONS SCVUS-guided volume management did not ameliorate post-spinal anesthetic hypotension but reduced the volume of the preload required before spinal anesthesia. Reducing preload volume did not increase the incidence of maternal and neonatal adverse effects nor did it increase the total vasopressor dose. Moreover, reducing preload volume could relieve the heart burden of parturients, which has high clinical significance. CLINICAL TRIAL REGISTRATION The trial was registered with the Chinese Clinical Trial Registry at chictr.org.cn (registration number, ChiCTR2100055050) on December 31, 2021.
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Affiliation(s)
- Yan Lu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yueqi Zhang
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Zhendong Xu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Fuyi Shen
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jian Wang
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Azarang A, Blogg SL, Currens J, Lance RM, Moon RE, Lindholm P, Papadopoulou V. Development of a graphical user interface for automatic separation of human voice from Doppler ultrasound audio in diving experiments. PLoS One 2023; 18:e0283953. [PMID: 37561745 PMCID: PMC10414643 DOI: 10.1371/journal.pone.0283953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/21/2023] [Indexed: 08/12/2023] Open
Abstract
Doppler ultrasound (DU) is used in decompression research to detect venous gas emboli in the precordium or subclavian vein, as a marker of decompression stress. This is of relevance to scuba divers, compressed air workers and astronauts to prevent decompression sickness (DCS) that can be caused by these bubbles upon or after a sudden reduction in ambient pressure. Doppler ultrasound data is graded by expert raters on the Kisman-Masurel or Spencer scales that are associated to DCS risk. Meta-analyses, as well as efforts to computer-automate DU grading, both necessitate access to large databases of well-curated and graded data. Leveraging previously collected data is especially important due to the difficulty of repeating large-scale extreme military pressure exposures that were conducted in the 70-90s in austere environments. Historically, DU data (Non-speech) were often captured on cassettes in one-channel audio with superimposed human speech describing the experiment (Speech). Digitizing and separating these audio files is currently a lengthy, manual task. In this paper, we develop a graphical user interface (GUI) to perform automatic speech recognition and aid in Non-speech and Speech separation. This constitutes the first study incorporating speech processing technology in the field of diving research. If successful, it has the potential to significantly accelerate the reuse of previously-acquired datasets. The recognition task incorporates the Google speech recognizer to detect the presence of human voice activity together with corresponding timestamps. The detected human speech is then separated from the audio Doppler ultrasound within the developed GUI. Several experiments were conducted on recently digitized audio Doppler recordings to corroborate the effectiveness of the developed GUI in recognition and separations tasks, and these are compared to manual labels for Speech timestamps. The following metrics are used to evaluate performance: the average absolute differences between the reference and detected Speech starting points, as well as the percentage of detected Speech over the total duration of the reference Speech. Results have shown the efficacy of the developed GUI in Speech/Non-speech component separation.
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Affiliation(s)
- Arian Azarang
- Biomedical Engineering Department of University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - S. Lesley Blogg
- SLB Consulting, Winton, Cumbria, United Kingdom
- Department of Emergency Medicine, School of Medicine, University of California, La Jolla, CA, United
States of America
| | - Joshua Currens
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- North Carolina State University, Raleigh, NC, United States of America
| | - Rachel M. Lance
- Center for Hyperbaric Medicine and Environmental Physiology, Duke University, Durham, NC, United States of America
| | - Richard E. Moon
- Center for Hyperbaric Medicine and Environmental Physiology, Duke University, Durham, NC, United States of America
| | - Peter Lindholm
- Department of Emergency Medicine, School of Medicine, University of California, La Jolla, CA, United
States of America
| | - Virginie Papadopoulou
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- North Carolina State University, Raleigh, NC, United States of America
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20
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Vetrugno L, Deana C, Cammarota G, Maggiore SM. Define Subclavian Vein Anatomy Before Comparing Cannulation With the Landmark Technique Versus Real-Time Ultrasound Guidance: A Plea for Honesty! Crit Care Med 2023; 51:e145-e146. [PMID: 37318297 DOI: 10.1097/ccm.0000000000005895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS, Annunziata Hospital, Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Gianmaria Cammarota
- Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS, Annunziata Hospital, Chieti, Italy
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy
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21
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Zawadka M, La Via L, Wong A, Olusanya O, Muscarà L, Continella C, Andruszkiewicz P, Sanfilippo F. Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis. Crit Care Med 2023; 51:642-652. [PMID: 36861982 DOI: 10.1097/ccm.0000000000005819] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis to assess the effectiveness of real-time dynamic ultrasound-guided subclavian vein cannulation as compared to landmark technique in adult patients. DATA SOURCES PubMed and EMBASE until June 1, 2022, with the EMBASE search restricted to the last 5 years. STUDY SELECTION We included randomized controlled trials (RCTs) comparing the two techniques (real-time ultrasound-guided vs landmark) for subclavian vein cannulation. The primary outcomes were overall success rate and complication rate, whereas secondary outcomes included success at first attempt, number of attempts, and access time. DATA EXTRACTION Independent extraction by two authors according to prespecified criteria. DATA SYNTHESIS After screening, six RCTs were included. Two further RCTs using a static ultrasound-guided approach and one prospective study were included in the sensitivity analyses. The results are presented in the form of risk ratio (RR) or mean difference (MD) with 95% CI. Real-time ultrasound guidance increased the overall success rate for subclavian vein cannulation as compared to landmark technique (RR = 1.14; [95% CI 1.06-1.23]; p = 0.0007; I2 = 55%; low certainty) and complication rates (RR = 0.32; [95% CI 0.22-0.47]; p < 0.00001; I2 = 0%; low certainty). Furthermore, ultrasound guidance increased the success rate at first attempt (RR = 1.32; [95% CI 1.14-1.54]; p = 0.0003; I2 = 0%; low certainty), reduced the total number of attempts (MD = -0.45 [95% CI -0.57 to -0.34]; p < 0.00001; I2 = 0%; low certainty), and access time (MD = -10.14 s; [95% CI -17.34 to -2.94]; p = 0.006; I2 = 77%; low certainty). The Trial Sequential Analyses on the investigated outcomes showed that the results were robust. The evidence for all outcomes was considered to be of low certainty. CONCLUSIONS Real-time ultrasound-guided subclavian vein cannulation is safer and more efficient than a landmark approach. The findings seem robust although the evidence of low certainty.
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Affiliation(s)
- Mateusz Zawadka
- 2nd Department of Anesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland
- Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy
- Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Adrian Wong
- Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Olusegun Olusanya
- Department of Perioperative Medicine, St Bartholomew's Hospital, London, United Kingdom
| | - Liliana Muscarà
- Department of Medical and Surgical Sciences, School of Specialization in Anesthesia and Intensive Care, University "Magna Graecia," Catanzaro, Italy
| | - Carlotta Continella
- Department of Medical and Surgical Sciences, School of Specialization in Anesthesia and Intensive Care, University "Magna Graecia," Catanzaro, Italy
| | - Pawel Andruszkiewicz
- 2nd Department of Anesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy
- Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
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22
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Celik IE, Duran M, Yarlıoglu M, Murat SN. Placement of permanent pacemaker in a patient with venous anomaly through the right subclavian vein. Rev Port Cardiol 2023; 42:75-76. [PMID: 36370990 DOI: 10.1016/j.repc.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/07/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ibrahim Etem Celik
- Department of Cardiology, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey.
| | - Mustafa Duran
- Department of Cardiology, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
| | - Mikail Yarlıoglu
- Department of Cardiology, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
| | - Sani Namık Murat
- Department of Cardiology, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
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23
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Zhou J, Wu L, Zhang C, Wang J, Liu Y, Ping L. Ultrasound guided axillary vein catheterization versus subclavian vein cannulation with landmark technique: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31509. [PMID: 36316830 PMCID: PMC9622689 DOI: 10.1097/md.0000000000031509] [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: 11/21/2022] Open
Abstract
BACKGROUND Although ultrasound (US) guided axillary vein (AV) catheterization has been well described, evidence for its efficacy and safety compared with conventional infraclavicular landmark guided subclavian vein (SCV) cannulation have not been comprehensively appraised. Thus, we conducted a systematic review and meta-analysis to determine whether US guided AV catheterization reduces catheterization failures and adverse events compared to SCV puncture based on landmark technique. METHODS We searched the PubMed, Embase, Cochrane Library, CINAHL, Web of Science, SCOPUS, China Biology Medicine, China National Knowledge Infrastructure, Wan Fang, and Wei Pu databases for randomized controlled trials (RCTs) studies published from inception to May 2021. Two investigators reviewed and extracted data on study design, number and type of inclusion criteria. Study quality was assessed using the Jadad scale. Outcomes included the puncture success rates and the incidence of adverse events. RESULTS Data of 1852 patients from five RCTs were included in this meta-analysis. The analysis showed that US guided AV catheterization increased the first (risk ratio (RR), confidence interval (CI)) (RR = 1.17, 95% CI = 1.13~1.22, P < .01) and overall (RR = 1.09, 95% CI = 1.04~1.15, P < .01) puncture success rate, and reduce the occurrence of adverse events, including the risk of arterial puncture (RR = 0.18, 95% CI = 0.06~0.55, P < .01), pneumo-and hemothorax (RR = 0.12, 95% CI = 0.02~0.64, P = .01). CONCLUSION This meta-analysis indicates that US guided AV catheterization reduces catheterization failures and mechanical complications compared with conventional landmark guided SCV puncture.
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Affiliation(s)
- Jinchuan Zhou
- The Emergency Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Lidong Wu
- The Emergency Department, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Jiwei Wang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Yanna Liu
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Luyi Ping
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
- *Correspondence: Luyi Ping, Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, 330006, Jiangxi, China (e-mail: )
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24
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Thakkar AN, Alnabelsi TS, Al-Mallah MH. Go with the flow: Abnormal extra-cardiac Rb-82 flow as a diagnostic clue for subclavian vein stenosis. J Nucl Cardiol 2022; 29:2042-2044. [PMID: 33258077 DOI: 10.1007/s12350-020-02442-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Akanksha N Thakkar
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St, Sm 1801, Houston, TX, 77030, USA
| | - Talal S Alnabelsi
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St, Sm 1801, Houston, TX, 77030, USA
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St, Sm 1801, Houston, TX, 77030, USA.
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Kumar A, Mahendran M, Hari S, Ranjan P, Soneja M, Wig N. Subclavian vein collapsibility as a predictor of fluid responsiveness in spontaneously breathing hypotensive patients. J Assoc Physicians India 2022; 70:11-12. [PMID: 35443482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Volume replacement remains the cornerstone of resuscitation in critically ill patients. This study explored the ability of subclavian vein collapsibility index in predicting fluid responsiveness. MATERIAL AND METHODS In this prospective observational study conducted in the Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, hypotensive patients presenting to the emergency underwent sonographic evaluation of Inferior Vena Cava and right Subclavian vein at three time points. The study population was divided into two groups: Responders and non-responders, based on ≥ 15 % increase in stroke volume following fluid bolus. OBSERVATION AND RESULTS Among 45 recruited patients, 33 patients were responders. The area under ROC curve for SCV CI at baseline to predict fluid responsiveness was 0.745 (95% confidence interval: 0.549 - 0.941; p = 0.014). An SCV-CI of 46 % predicts fluid responsiveness in a hypotensive patient in terms of change in stroke volume by 15% following fluid bolus with a sensitivity of 87.88 % (95 % confidence interval: 71.80% to 96.60%) and specificity of 66.67 % (95 % confidence interval: 34.89% to 90.08%). Spearman's correlation coefficient between IVC CI and SCV CI was 0.59 (p < 0.001, n = 135). CONCLUSION The results of the study show that right subclavian vein respiratory variation has the ability to predict fluid responsiveness in a spontaneously breathing patient in circulatory shock and correlates with Inferior Vena Cava collapsibility index. Subclavian vein can be an alternative to Inferior Vena Cava in predicting fluid responsiveness in spontaneously breathing patients.
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Affiliation(s)
- Arvind Kumar
- All India institute of Medical Sciences, New Delhi
| | | | - Smriti Hari
- All India institute of Medical Sciences, New Delhi
| | | | | | - Naveet Wig
- All India institute of Medical Sciences, New Delhi
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Gulpen AJW, Teijink JAW. Pectoralis minor muscle causes venous thoracic outlet syndrome: visualised using venography. Lancet 2022; 399:e1. [PMID: 34998504 DOI: 10.1016/s0140-6736(21)02647-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/04/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Anouk J W Gulpen
- Department of Internal Medicine, Elkerliek Hospital, Helmond, Netherlands.
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, Netherlands
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Kim H, Chang JE, Won D, Lee JM, Kim TK, Min SW, Kim C, Hwang JY. Effect of head and shoulder positioning on the cross-sectional area of the subclavian vein in obese subjects. Am J Emerg Med 2021; 50:561-565. [PMID: 34555660 DOI: 10.1016/j.ajem.2021.08.013] [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: 04/18/2021] [Revised: 07/08/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Head and shoulder positioning may affect cross-sectional area (CSA) and location of the subclavian vein (SCV). We investigated the CSA of the SCV and the depth of the SCV, depending on the head and shoulder positions. METHODS In 24 healthy obese volunteers, the short axis ultrasound images of the SCV and adjacent structures were obtained in three different head positions (neutral, 30° turned to the contralateral side, and 30° turned to the ipsilateral side) and two different shoulder positions (neutral and lowered). Images of the right and left SCVs were obtained in the supine and Trendelenburg positions. Subsequently, the CSA and depth of the SCV were measured. RESULTS Significant differences were found in the CSA of the SCV in different head positions (30° turned to contralateral side vs. neutral: -0.06 cm2, 95% confidence interval [CI], -0.10 to -0.02; Pcorrected = 0.002, 30° turned to contralateral side vs. 30° turned to ipsilateral side: -0.16 cm2, 95% CI, -0.22 to -0.11; Pcorrected < 0.001, Neutral vs. 30° turned to ipsilateral side: -0.10 cm2, 95% CI, -0.14 to -0.07; Pcorrected < 0.001). The CSA of the SCV was significantly different, depending on shoulder positions (neutral vs. lowered: 0.44 cm2, 95% CI, 0.33 to 0.54; Pcorrected < 0.001), and body position (supine vs. Trendelenburg: -0.15 cm2, 95% CI, -0.19 to -0.12; Pcorrected < 0.001). However, the depth of the SCV did not differ with respect to head, shoulder, and body positions. CONCLUSIONS Ipsilateral 30° head rotation, neutral shoulder position, and Trendelenburg position significantly enhanced the CSA of the SCV in obese participants.
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Affiliation(s)
- Hyerim Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jee-Eun Chang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Dongwook Won
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Anesthesiology & Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seong-Won Min
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Anesthesiology & Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chanho Kim
- Department of Anesthesiology & Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Young Hwang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Anesthesiology & Pain Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
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28
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Israel CW. ["That's torn it": my daftest complication in transvenous device implantation : And its fast solution]. Herzschrittmacherther Elektrophysiol 2020; 31:414-416. [PMID: 33026472 DOI: 10.1007/s00399-020-00723-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
The loss of a guidewire in the subclavian vein represents an unpleasant complication during pacemaker implantation with venous access by puncture in Seldinger's technique. Using another venous puncture and a gooseneck snare, this problem can be solved quickly and without any trace.
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Affiliation(s)
- Carsten W Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Klinikum Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland.
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29
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Souadka A, Essangri H, Boualaoui I, Ghannam A, Benkabbou A, Amrani L, Mohsine R, Majbar MA. Supraclavicular versus infraclavicular approach in inserting totally implantable central venous access for cancer therapy: A comparative retrospective study. PLoS One 2020; 15:e0242727. [PMID: 33232361 PMCID: PMC7685501 DOI: 10.1371/journal.pone.0242727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/06/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The insertion of an implantable central venous access is performed according to a variety of approaches which allow the access to the subclavian vein, yet the supraclavicular technique has been underused and never compared to the other methods. The aim of this study was to testify on the efficacy and safety of the subclavian puncture without ultrasound guidance « Yoffa » in comparison with the classical infraclavicular approach (ICA). MATERIAL AND METHODS This is a retrospective study with prospective data collection on patients followed at the national oncology institute for cancer, in the period extending from May 1st 2017 to August 31st 2017. All patients had a totally implantable central venous access device inserted by the same surgeon AS for chemotherapy administration and demographic characteristics, as well as procedure details were examined. The primary outcomes were the intraoperative complications, while the secondary outcomes represented immediate postoperative and mid-term complications (at 15 months of follow up). Outcomes were compared between techniques by means of non parametric tests and the Fischer test. RESULTS Our study included 135 patients with 70 patients undergoing the subclavian technique, while 65 were subject to the infraclavicular approach. Both groups had no statistically significant demographic characteristics. The number of vein puncture attempts exceeding once, the accidental artery puncture and operative time were more significant in the ICA group; (39,6 vs 17,6 p = 0,01) (9.2% vs 0; p = 0,01) and (27± 13 vs 23± 8min, p = 0.045) respectively. There was no statistically significant difference in the immediate and midterm complication rate between the two methods 1(1,4) vs 2 (3) p = 0.5. CONCLUSION In case of unavailability of ultrasonographic guidance, the use of the supra-clavicular landmarks approach is linked to higher success rates and less arterial punctures, thereby proving to be a safe and reliable approach.
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Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
- * E-mail:
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Imad Boualaoui
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Abdelilah Ghannam
- Anesthesia and Intensive Care Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Laila Amrani
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University Medical School, Rabat, Morocco
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30
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Weber V, Zdoroveac A, Turkalj I, Gähwiler R, Thalhammer C, Isaak A. [Not Another Arm Vein Thrombosis - Memories of the Past]. Praxis (Bern 1994) 2020; 109:1205-1209. [PMID: 33234040 DOI: 10.1024/1661-8157/a003559] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Not Another Arm Vein Thrombosis - Memories of the Past Abstract. This article points out relevant differential diagnoses of a unilateral arm swelling that is a key clinical sign of an upper extremity vein thrombosis. The presented case is a patient with a symptomatic, iatrogenic arteriovenous fistula between the subclavian artery and vein due to central venous port system implantation.
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Affiliation(s)
- Viktoria Weber
- Angiologie, Universitätsklinik, Kantonsspital Aarau, Aarau
| | | | - Igor Turkalj
- Gesundheitszentrum Fricktal, Innere Medizin, Laufenburg
| | - Roman Gähwiler
- Angiologie, Universitätsklinik, Kantonsspital Aarau, Aarau
| | | | - Andrej Isaak
- Gefässchirurgie, Universitäres Zentrum Aarau-Basel, Aarau
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31
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Tanabe H, Miyamori D, Shigenobu Y, Ito Y, Kametani T, Kakimoto M, Kawahara A, Kikuchi Y, Kobayashi T, Otani Y, Kishikawa N, Kanno K, Ito M. Two Patients with Paget-Schroetter Syndrome That Were Successfully Diagnosed by Doppler Ultrasonography: Case Studies with a Literature Review. Intern Med 2020; 59:2623-2627. [PMID: 32581157 PMCID: PMC7662054 DOI: 10.2169/internalmedicine.4349-20] [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: 12/05/2022] Open
Abstract
We herein report on two male patients (age, 22 and 44 years) who were referred to our department with swelling of the upper right arm after attending other hospitals. Right subclavian vein thrombosis was demonstrated by ultrasonography and they were then further evaluated by contrast-enhanced computed tomography (CT). Successful treatment involved venous thrombectomy in one patient and anticoagulant therapy in the other. Paget-Schhroetter syndrome was confirmed using standard vascular ultrasonography. Despite the accuracy of this method for diagnosing Paget-Schroetter syndrome, some cases are difficult to confirm. We reviewed 29 previously published case reports of Paget-Schroetter syndrome and analyzed the patient baseline characteristics, time to diagnosis, and the diagnostic methods used.
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Affiliation(s)
- Hiromasa Tanabe
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Daisuke Miyamori
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuya Shigenobu
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yayoiko Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Takahiro Kametani
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Masaki Kakimoto
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Akihiro Kawahara
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuka Kikuchi
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Tomoki Kobayashi
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuichiro Otani
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Nobusuke Kishikawa
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Keishi Kanno
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Masanori Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
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Gallieni M, Matoussevitch V, Steinke T, Ebner A, Brunkwall S, Cariati M, Gallo S, Reindl-Schwaighofer R, Sengölge G. Multicenter Experience with the Surfacer Inside-Out Access Catheter System in Patients with Thoracic Venous Obstruction: Results from the SAVE Registry. J Vasc Interv Radiol 2020; 31:1654-1660.e1. [PMID: 32951972 DOI: 10.1016/j.jvir.2020.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report the device performance and safety for the Surfacer Inside-Out access catheter system in patients with thoracic central venous obstruction (TCVO) requiring central venous access (CVA). MATERIALS AND METHODS Five sites prospectively enrolled 30 patients requiring a tunneled dialysis catheter between February 2017 and September 2018 in the SAVE (Surfacer System to Facilitate Access in Venous Obstructions) registry. Patient demographics, medical history, and type of TCVO were documented at enrollment. Device performance and adverse events were collected during the procedure and upon hospital discharge. Twenty-nine of the 30 patients enrolled required CVA for hemodialysis. Retrospective classification of TCVOs according to SIR reporting standards showed 9 patients (30%) had Type 4 obstructions, 8 (26.7%) had Type 3, 5 (16.7%) had Type 2, and 8 (26.7%) had Type 1 obstruction. RESULTS Central venous catheters (CVCs) were successfully placed in 29 of 30 patients (96.7%). The procedure was discontinued in 1 patient due to vascular anatomical tortuosity. All 29 patients with successful CVC placement achieved adequate catheter patency and tip positioning. There were no device-related adverse events, catheter malposition, or intra- or postprocedural complications. Mean time from device insertion to removal for the 29 patients who successfully completed the procedure was 24 ± 14.9 (range, 6-70) minutes. Mean fluoroscopy time was 6.8 ± 4.5 (range, 2.2-25.5) minutes. CONCLUSIONS The Surfacer Inside-Out procedure provided an alternative option to restore right-sided CVA in patients with TCVO.
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Affiliation(s)
- Maurizio Gallieni
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Vladimir Matoussevitch
- Department of Vascular Surgery, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany.
| | | | | | - Silke Brunkwall
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Maurizio Cariati
- Department of Radiology, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Roman Reindl-Schwaighofer
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Gürkan Sengölge
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
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33
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Kulick-Soper CV, McKee JL, Wolf RL, Mohan S, Stein JM, Masur JH, Lazor JW, Dunlap DG, McGinniss JE, David MZ, England RN, Rothstein A, Gelfand MA, Cucchiara BL, Davis KA. Pearls & Oy-sters: Bilateral globus pallidus lesions in a patient with COVID-19. Neurology 2020; 95:454-457. [PMID: 32586898 PMCID: PMC7538218 DOI: 10.1212/wnl.0000000000010157] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
MESH Headings
- Betacoronavirus
- COVID-19
- Cerebral Infarction/complications
- Cerebral Infarction/diagnostic imaging
- Cerebral Infarction/metabolism
- Cerebral Infarction/physiopathology
- Coronavirus Infections/complications
- Coronavirus Infections/diagnostic imaging
- Coronavirus Infections/metabolism
- Coronavirus Infections/physiopathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/metabolism
- Diabetic Ketoacidosis/complications
- Diabetic Ketoacidosis/metabolism
- Diagnosis, Differential
- Female
- Globus Pallidus/diagnostic imaging
- Humans
- Hyperglycemic Hyperosmolar Nonketotic Coma/complications
- Hyperglycemic Hyperosmolar Nonketotic Coma/metabolism
- Hypertension/complications
- Hypertension/physiopathology
- Hypoxia/complications
- Hypoxia/diagnosis
- Hypoxia/metabolism
- Hypoxia-Ischemia, Brain/diagnosis
- Leukoencephalitis, Acute Hemorrhagic/diagnosis
- Lung/diagnostic imaging
- Magnetic Resonance Imaging
- Middle Aged
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/metabolism
- Pneumonia, Viral/physiopathology
- Respiratory Insufficiency/complications
- Respiratory Insufficiency/metabolism
- Respiratory Insufficiency/physiopathology
- SARS-CoV-2
- Shock/complications
- Shock/metabolism
- Shock/physiopathology
- Subclavian Vein/diagnostic imaging
- Tomography, X-Ray Computed
- Venous Thrombosis/complications
- Venous Thrombosis/diagnostic imaging
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Affiliation(s)
- Catherine V Kulick-Soper
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Jillian L McKee
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Ronald L Wolf
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Suyash Mohan
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Joel M Stein
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Jonathan H Masur
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Jillian W Lazor
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Daniel G Dunlap
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - John E McGinniss
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Michael Z David
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Ross N England
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Aaron Rothstein
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Michael A Gelfand
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Brett L Cucchiara
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA
| | - Kathryn A Davis
- From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA.
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Tasaki Y, Sueyoshi E, Takamatsu H, Matsushima Y, Miyamura S, Sakamoto I, Mochizuki Y, Uetani M. The outcomes of carbon dioxide digital subtraction angiography for percutaneous transluminal balloon angioplasty of access circuits and venous routes in hemodialysis patients. Medicine (Baltimore) 2020; 99:e21890. [PMID: 32899019 PMCID: PMC7478692 DOI: 10.1097/md.0000000000021890] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The outcomes of carbon dioxide digital subtraction angiography (CO2-DSA) for performing percutaneous transluminal balloon angioplasty (balloon PTA) in hemodialysis patients has not been fully clarified. The purpose was to compare the outcomes of balloon PTA of hemodialysis shunts in terms of vessel patency between patients treated using CO2-DSA and conventional digital subtraction angiography using iodine contrast medium (C-DSA).We retrospectively evaluated 76 patients (38 males and 38 females, mean age: 65.0 ± 14.0 years). They were under hemodialysis and treated with balloon PTA using CO2-DSA or C-DSA at our institution between 2009 and 2016. Mean duration of the follow-up period was 25.59 ± 21.45 months. We compared the patency rates obtained after CO2-DSA-based balloon PTA with those after C-DSA-based balloon PTA. Secondary patency, which was defined as the duration of patency after all further endovascular interventions until surgical repair, was considered as the endpoint in this study.Overall, 19 and 57 patients underwent CO2-DSA- and C-DSA-based balloon PTA, respectively. CO2-DSA- and C-DSA-based balloon PTA produced clinical success rates of 100% and 96.5%, respectively. Blood vessel injury occurred in one patient who underwent C-DSA-based balloon PTA. No major complications occurred in CO2 group. At 24 months, the post-PTA secondary patency rates of CO2-DSA- and C-DSA-based balloon PTA were 94.1% and 93.9%, respectively (P = .9594).CO2-DSA is safe for hemodialysis patients. Compared with C-DSA, CO2-DSA-based balloon PTA produces have a similar secondary patency rate.
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Affiliation(s)
- Yutaro Tasaki
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Eijun Sueyoshi
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Hiroko Takamatsu
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Yoshifumi Matsushima
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Shuto Miyamura
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Ichiro Sakamoto
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Yasushi Mochizuki
- Division of Blood Purification, Nagasaki University Hospital, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences
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Zhou C, Lu L, Yang L, Xi W, Ma T, Yang C, Wu J, Shangguan C, Zhu Z, Zhang J. Modified surface measurement method to determine catheter tip position of totally implantable venous access port through right subclavian vein. J Vasc Surg Venous Lymphat Disord 2020; 9:409-415. [PMID: 32726669 DOI: 10.1016/j.jvsv.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/23/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Optimal catheter tip position of a totally implantable venous access port (TIVAP) is important to maintain its function and to avoid severe complications. In this study, we aimed to assess the reliability of a modified surface measurement method to determine optimal tip position of a TIVAP catheter inserted through the right subclavian vein. METHODS Clinical and radiologic information of 105 patients who underwent TIVAP implantation through the right subclavian vein was collected retrospectively. The length of the implanted catheter was determined by a modified surface measurement method, as follows. The distance from the puncture point (point A) to the middle point of the sternal notch (point B), then from the middle point of the sternal notch (point B) to the middle point of Louis angle (point C) was added up. The equation for the catheter length is given by catheter length (cm) = AB + BC + 3. Postprocedure plain chest radiography (CXR) and enhanced chest computed tomography (CT) were used to check the catheter tip position and to calculate optimal position rate. Distance from the carina to the catheter tip and the length of the vertebral body unit were measured on both CXR and CT. Distances from carina to caval-atrial junction (CAJ) and from catheter tip to CAJ were measured on CT. RESULTS Mean length of the implanted catheter of all patients was 17.0 ± 0.7 cm (male vs female, 17.3 ± 0.5 cm vs 16.7 ± 0.7 cm; P < .001). On CXR, a catheter tip located within 2.4 vertebral body units below the carina was identified as the optimal position, and the optimal position rate was 97.1% (102/105 cases). On CT, two definitions of optimal position were used: within 2 cm above or below the CAJ and within 2 cm above or at the CAJ; the optimal position rate was 92.4% (97/105 cases) and 78.1% (82/105 cases), respectively. Median follow-up time was 9.4 months. During the follow-up, no severe cardiac complication was recorded. CONCLUSIONS The modified surface measurement had high reliability in determining the optimal catheter length to accurately place the tip in the superior vena cava near the CAJ.
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Affiliation(s)
- Chenfei Zhou
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Lu
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liu Yang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqi Xi
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Ma
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Yang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junwei Wu
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengfang Shangguan
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenggang Zhu
- Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Cornacchiari M, Mudoni A, Borin F, Stasi A, Ponticelli MG, Visciano B, Guastoni C. [Evaluation via ecocolordoppler before creating a vascular access for hemodyalisis: a monocentric experience]. G Ital Nefrol 2020; 37:37-03-2020-12. [PMID: 32530157] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The use of a preoperative echocolordoppler improves the clinical evaluation because provides anatomical and hemodynamic information that make it an important tool in planning vascular access strategy. The preoperative ultrasound study of the vessels can significantly reduce the failure rate and the incidence of complications of vascular access. We describe the experience of our center, lasting 10-year, where the ultrasound assessment was performed in all patients before the creation of vascular access. Indeed, ultrasound reduces the rate of fistula failure and increases the utilization of fistula, allowing proper selection of vessels. In addition, the presence of the vascular access team has allowed us to achieve quite satisfactory results.
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Affiliation(s)
- Marina Cornacchiari
- ASST Ovest Milanese, Ospedale G Fornaroli, via Donatore di Sangue 51, Magenta, Italy
| | - Anna Mudoni
- U.O. di Nefrologia e Dialisi A.O. "Card. G. Panico", Tricase (Le), Italy
| | - Fabio Borin
- ASST Ovest Milanese, Ospedale Legnano, via Papa Giovanni Paolo II, Legnano, Italy
| | - Antonia Stasi
- ASST Ovest Milanese, Ospedale G Fornaroli, via Donatore di Sangue 51, Magenta, Italy
| | | | - Bianca Visciano
- ASST Ovest Milanese, Ospedale G Fornaroli, via Donatore di Sangue 51, Magenta, Italy
| | - Carlo Guastoni
- ASST Ovest Milanese, Ospedale G Fornaroli, via Donatore di Sangue 51, Magenta, Italy; U.O. di Nefrologia e Dialisi A.O. "Card. G. Panico", Tricase (Le), Italy; ASST Ovest Milanese, Ospedale Legnano, via Papa Giovanni Paolo II, Legnano, Italy
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Choi MH, Chae JS, Lee HJ, Woo JH. Pre-anaesthesia ultrasonography of the subclavian/infraclavicular axillary vein for predicting hypotension after inducing general anaesthesia: A prospective observational study. Eur J Anaesthesiol 2020; 37:474-481. [PMID: 32205573 DOI: 10.1097/eja.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Bedside sonography of the inferior vena cava has been demonstrated to be a reliable tool for assessing intravascular volume status. Subclavian vein (SCV) assessment was proposed as a reasonable adjunct for measuring the inferior vena cava. OBJECTIVE We examined whether the preoperative diameter and collapsibility index of the SCV or the infraclavicular axillary vein could predict the incidence of hypotension after induction of general anaesthesia in patients undergoing laparoscopic cholecystectomy. DESIGN Prospective, observational study. SETTING Tertiary university hospital. PATIENTS Adults scheduled for laparoscopic cholecystectomy. INTERVENTION Sonographic evaluation of the SCV or the axillary vein (SCV-AV) before induction of anaesthesia. MAIN OUTCOME MEASURES The main outcome was the association between the SCV-AV measurements (diameter an collapsibility index) and intra-operative hypotension (IOH) after induction of anaesthesia. RESULTS Patients who developed IOH had a higher collapsibility index of the SCV-AV during spontaneous breathing (P = 0.009) and deep inspiration (P = 0.002). After adjusting for confounding variables, the collapsibility index of the SCV-AV during spontaneous breathing was not a significant predictor of a decrease in mean arterial blood pressure (MAP) after inducing anaesthesia (P = 0.127), whereas the collapsibility index of the SCV-AV during deep inspiration was a significant predictor (P < 0.001). CONCLUSION The collapsibility index of the SCV-AV during deep inspiration was a significant predictor of IOH occurrence and the percentage decrease in MAP after inducing anaesthesia. Further studies in patients with higher collapsibility index are needed to confirm our findings, before the collapsibility index of the SCV-AV can be recommended unequivocally for clinical use. TRIAL REGISTRATION This trial was registered on 8 September 2017 at the Clinical Trial Registry of Korea (https://cris.nih.go.kr/cris/index.jsp; Identifier: KCT0001078KCT0002457), and the first patient was enrolled on 14 October 2017.
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Affiliation(s)
- Min Hee Choi
- From the Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Anyangcheon-ro, Yangcheon-gu, Seoul, Korea (MHC), Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Gonghang-daero, Gangseo-gu (JSC) and Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Gonghang-daero, Gangseo-gu, Seoul, Republic of Korea (HJL, JHW)
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Chi WK, Tan GM, Yan BP. Urschel's Sign in Paget-Schroetter Syndrome: Multimodality Evaluation by Extravascular and Intravascular Imaging. J Invasive Cardiol 2020; 32:E47-E48. [PMID: 32005794] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Paget-Schroetter Syndrome is potentially life-threatening. In this case, multidisciplinary imaging with extravascular and intravascular evaluation guided the proper diagnosis and treatment planning.
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Affiliation(s)
- Wai Kin Chi
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Clinical Science Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR, China.
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Sun X, Bai X, Cheng L, Gu X, Xia R, Du X, Shi J, Chen Q, Jin Y. Comparison of Ultrasound-Guided Right Brachiocephalic and Right Subclavian Vein Cannulation in Adult Patients. J Ultrasound Med 2019; 38:2559-2564. [PMID: 30693547 DOI: 10.1002/jum.14947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To compare ultrasound-guided right brachiocephalic vein (BCV) central venous catheter (CVC) placement to right subclavian vein (SCV) CVC insertion in terms of the puncture success rate and complications. METHODS A retrospective review was performed for all adult patients who received an ultrasound-guided CVC via the right BCV or right SCV access route between January 2016 and March 2018. The puncture success rates and procedure-related complications were analyzed. RESULTS Data were analyzed from 755 adult patients who underwent 915 CVC insertions. The overall success rate was higher in the BCV group compared to that in the SCV group (98.99% versus 96.87%; P = .019). The first-attempt success rate was higher in the BCV group compared to that in the SCV group (96.64% versus 89.34%; P < .001). Intraoperative complications were observed in 16 cases in the BCV group (2.68%) and in 12 cases in the SCV group (3.76%). The incidence rates of postprocedure complications were 5.20% in the BCV group and 6.58% in the SCV group and included catheter-related infections and thrombosis. CONCLUSIONS Ultrasound-guided cannulation of the right BCV is an effective and safe method for CVC placement in adult patients and provides an additional option for catheter access.
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Affiliation(s)
- Xingwei Sun
- Department of Intervention, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuming Bai
- Department of Intervention, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Long Cheng
- Department of Intervention, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingshi Gu
- Department of Intervention, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Xia
- Department of Oncology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaolong Du
- Vascular Surgery, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianming Shi
- Department of Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Qian Chen
- Department of Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yong Jin
- Department of Intervention, Second Affiliated Hospital of Soochow University, Suzhou, China
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Kelly J, Aleksandrowicz D, Vargulescu R. Confirmation of central venous catheter placement in the presence of an ipsilateral arteriovenous fistula. J Vasc Access 2019; 21:400-401. [PMID: 31554455 DOI: 10.1177/1129729819879070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Affiliation(s)
- Heather Alva
- 1 Tulane/Ochsner Pediatric Residency, New Orleans, LA, USA
| | | | - Matthew Fletcher
- 3 Ochsner Health Center for Children, New Orleans, LA, USA
- 4 Ochsner Medical Center, New Orleans, LA, USA
| | - Raj Warrier
- 3 Ochsner Health Center for Children, New Orleans, LA, USA
- 4 Ochsner Medical Center, New Orleans, LA, USA
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Abstract
INTRODUCTION Central venous catheterization is performed by the landmark method and ultrasound guided method. The purpose of the study was to compare the success, average number of attempts, average time to return of blood, and complication rate between the two methods. MATERIAL AND METHODS This was a prospective study done in the Intensive Care Unit of the Acibadem Sistina Clinical Hospital, in Skopje. There were 400 patients in need of central venous catheter and they were prospectively randomized in two groups. The patients randomized in the examined-ultrasound group underwent real-time ultrasound-guided catheterization and the patients randomized in the control-landmark group were catheterized using the landmark method. Internal Jugular, Subclavian and Femoral vein were catheterized in both groups. The Overall success, success on the first attempt, time to the return of blood, number of attempts and complications at the moment of catheterization such as arterial puncture, pneumothorax and hematoma formation were the main outcome measures. RESULTS The catheterization using the landmark method was successful in 90.5% of patients, 60.5% of which during the first attempt. The cannulation using real-time ultrasound guidance was successful in 98% of patients with a first pass success of 77%. The complication rate with the landmark method was 14.5% versus 4% with real-time ultrasound guidance p<0.05(p=0.0008). CONCLUSION Real-time ultrasound guidance improves success, decreases number of attempts, decreases average time to the return of blood and reduces mechanical complications rate.
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Araj FG, Pena J, Cox J. Aim For the Bubbles: Agitated Saline Injection as an Adjunct Technique to Ultrasound-Guided Subclavian Vein Cannulation. J Invasive Cardiol 2019; 31:E232. [PMID: 31257222] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Agitated saline during central line placement is described for the purpose of identifying the subclavian vein during ultrasound-guided procedures.
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Affiliation(s)
- Faris G Araj
- University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, Professional Office Bldg 2, Suite 600, Dallas, TX 75390 USA.
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Motz P, Arnim AVSAV, Likes M, Chabra S, Traudt C, Iyer RS, Dighe M. Limited Ultrasound Protocol for Upper Extremity Peripherally Inserted Central Catheter Monitoring: A Pilot Study in the Neonatal Intensive Care Unit. J Ultrasound Med 2019; 38:1341-1347. [PMID: 30244492 DOI: 10.1002/jum.14816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess whether a limited ultrasound (US) scanning protocol to monitor the upper extremity peripherally inserted central catheter (PICC) location in neonates is feasible for experienced US operators. METHODS A radiologist, who was blinded to the PICC location on chest radiography, performed 14 US scans on 11 neonates with upper extremity PICCs. A US machine with 13-6-MHz linear and 8-4-MHz phased array transducers was used for the examinations. RESULTS The study population included 54% (n = 6) preterm infants, with 72% (n = 8) weighing less than 1500 g. The US location of the PICC was the same as the chest radiographic report in all 14 scans. A subclavicular long-axis view of the anterior chest visualized all PICCs in the subclavian or brachiocephalic veins. A parasternal long-axis right ventricular inflow view was able to visualize PICCs in the superior vena cava (SVC), and a subcostal long-axis view evaluated PICCs in the lower SVC and heart. The scanning time was location dependent: less than 5 minutes for PICCs in the brachiocephalic or subclavian vein and 5 to 10 minutes for PICCs in the SVC or heart. There were no desaturations below 90%, increases in the fraction of inspired oxygen need, or hypotension episodes during scanning. CONCLUSIONS A limited US scanning protocol to determine the upper extremity PICC location is feasible. Our protocol needs to be tested in neonatal providers before further dissemination.
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Affiliation(s)
- Patrick Motz
- Departments of Neonatology, University of Washington, Seattle, Washington, USA
| | | | | | - Shilpi Chabra
- Departments of Neonatology, University of Washington, Seattle, Washington, USA
| | - Christopher Traudt
- Departments of Neonatology, University of Washington, Seattle, Washington, USA
| | - Ramesh S Iyer
- Radiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Manjiri Dighe
- Radiology, University of Washington, Seattle, Washington, USA
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Nomura T, Niwa T, Ozawa S, Oguma J, Shibukawa S, Imai Y. The Visibility of the Terminal Thoracic Duct Into the Venous System Using MR Thoracic Ductography with Balanced Turbo Field Echo Sequence. Acad Radiol 2019; 26:550-554. [PMID: 29748046 DOI: 10.1016/j.acra.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/22/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 12/30/2022]
Abstract
RATIONALE AND OBJECTIVES Magnetic resonance thoracic ductography (MRTD) with balanced turbo field echo (bTFE) can visualize both the thoracic duct and its surrounding vessels. This study aimed to investigate the visibility of the terminal thoracic duct into the venous system in the subclavian region using MRTD with bTFE. MATERIALS AND METHODS MRTD was performed with bTFE as a preoperative workup comprising respiratory gating on a 1.5-T magnetic resonance system for patients with esophageal cancer. The portion and the number of terminal thoracic ducts into the venous system and preterminal branching in the left subclavian region were assessed using MRTD in 132 patients. The confidence level of the visibility using MRTD was also evaluated. RESULTS The most frequent terminal portion of the thoracic duct was the jugulovenous angle (92 patients, 69.7%), followed by the subclavian vein (27 patients, 20.5%) and the internal jugular vein (8 patients, 6.1%). Four patients also exhibited double entry of the thoracic duct into the venous system. The preterminal branching was single in 96 patients (72.7%) and multiple in 36 patients (27.3%). The confidence level of the visibility of the thoracic duct using MRTD was absolutely certain in 112 patients (84.8%) and was somewhat certain in 20 patients (15.2%). CONCLUSIONS MRTD with bTFE is a robust imaging modality to visualize the terminal portion of the thoracic duct into the venous system in the subclavian region.
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Affiliation(s)
- Takakiyo Nomura
- Department of Diagnostic Radiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Tetsu Niwa
- Department of Diagnostic Radiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
| | - Soji Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Junya Oguma
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Shuhei Shibukawa
- Department of Radiology, Tokai University Hospital, Isehara, Japan
| | - Yutaka Imai
- Department of Diagnostic Radiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
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Abstract
INTRODUCTION Among hemodialysis population, central vein occlusion (CVO) is a common complication. Percutaneous transluminal angioplasty has become the mainstay treatment these days. But the treatment of long-segment central venous occlusion remains difficult. PATIENT CONCERNS We presented a 73-year-old man on maintenance hemodialysis complaining of swelling of the right arm and face for 20 days. The patient underwent maintenance hemodialysis via a right internal jugular vein catheter for first 2 months of dialysis while the initial right radiocephalic wrist arteriovenous fistula (AVF) blood flow had been unsatisfactory (below 180 mL/min) for 1 month. DIAGNOSIS Digital subtraction angiography revealed long-segment CVO extending from the right subclavian vein (SV) to the right innominate vein (IV), forming an obvious included angle at the right jugular angle. INTERVENTIONS Since conventional guide wire transversal failed, segmented sharp recanalization was performed by separate transversal of the obstructive right SV and right IV, therefore crossing the whole lesion segment by segment, followed by balloon dilation and stent placement. OUTCOMES No procedure-related complication was recorded during or after the operation. After a follow-up period of 5 months, the patient's AVF maintained satisfactory in blood flow, while the edema in his ipsilateral limb and face also notably ameliorated. CONCLUSION The segmented sharp recanalization is a practical strategy in treating angled long-segment CVO which is refractory to traditional guide wire transversal in hemodialysis patients.
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Affiliation(s)
- Yuliang Zhao
- Division of Nephrology, Department of Internal Medicine
- Kidney Research Laboratory, West China Hospital
| | - Letian Yang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Hongxia Mai
- Division of Nephrology, Department of Internal Medicine
- Kidney Research Laboratory, West China Hospital
| | - Yang Yu
- Division of Nephrology, Department of Internal Medicine
- Kidney Research Laboratory, West China Hospital
| | - Ping Fu
- Division of Nephrology, Department of Internal Medicine
- Kidney Research Laboratory, West China Hospital
| | - Tianlei Cui
- Division of Nephrology, Department of Internal Medicine
- Kidney Research Laboratory, West China Hospital
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Jannestad B, Skudal HK, Bock AJ, Bøhme M, Nøstdahl T. A man in his fifties with fever and a swelling on the neck. Tidsskr Nor Laegeforen 2019; 139:18-0157. [PMID: 30808098 DOI: 10.4045/tidsskr.18.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
OBJECTIVE To analyze postoperative complications of totally implantable central venous port system (TIPCVP) deployment and develop methods of their prevention. MATERIAL AND METHODS The study involved 43 patients who underwent TIPCVP implantation through right-sided jugular access and 3 patients with migration of the catheter transferred to the Domodedovo Central City Hospital. RESULTS There were four perioperative and one early postoperative complication. None of the complications was the reason for removal of TIPCVP. Pinch-off syndrome occurred in two patients who were operated in other hospitals and a catheter was inserted through the right subclavian vein. CONCLUSION Injury of the carotid artery and pneumothorax can be avoided by ultrasound navigation during internal jugular vein puncture. Catheterization of the internal jugular vein is useful to avoid pinch-off syndrome. Migration of the catheter is successfully cured by endovascular methods.
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Affiliation(s)
- A N Smolyar
- Domodedovo Central City Hospital, Domodedovo, Russia
| | - L M Ginzburg
- Domodedovo Central City Hospital, Domodedovo, Russia
| | - M A Smirnov
- Domodedovo Central City Hospital, Domodedovo, Russia
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49
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Chi WK, Tam GM, Yan BP. Recanalization of Left Subclavian Vein Total Occlusion Jailed by Superior Vena Cava Stent Using Culotte Stenting Technique With a Dedicated Venous Stent. J Invasive Cardiol 2018; 30:E152-E153. [PMID: 30504518] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This case demonstrates that the high radial strength of a dedicated nitinol venous stent is able to achieve good acute angiographic results and clinical efficacy.
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Affiliation(s)
- Wai Kin Chi
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Clinical Science Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR, China.
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50
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Abstract
Central venous catheter (CVC) insertion is difficult to perform and is a high-risk operation; ultrasound (US)-guided cannulation helps increase the odds of success while reducing the associated complications. The internal jugular vein (IJV) and subclavian vein (SCV) are the most commonly sites in US-guided CVC insertion. In the present study, we evaluated the safety and efficacy of US-guided supraclavicular right brachiocephalic vein (BCV) cannulations in adult patients.Between January 2016 and December 2017, 428 adult patients requiring 536 CVC insertions underwent ultrasound-guided right BCV cannulation. The success rate and complications related to indwelling catheters were analyzed.The technical success rate was 98.32% (527/536). The procedure was successful at the first try in 511 cases (95.34%). The mean operation time was 13.26 ± 3.34 minutes. The mean length of catheter introduction was 13.57 ± 3.53 cm. Incidence of intraoperative complications was 2.61%. For 3 patients, the procedure was terminated due to pneumothorax (PNX), and in 11 arterial punctures there were self-limiting hematomas. The incidence of postprocedure complications was 5.97% (32/536). These complications included catheter-related infections (n = 18) and thromboses (n = 14). Insertion lasted an average of 10.68 ± 8.77 days.Supraclavicular, in-plane, US-guided cannulation of the right BCV is an effective and safe method for inserting central venous catheters in adult patients. It provides another option for catheter access to boost clinical performance in central venous catheterization.
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Affiliation(s)
- Rui Xia
- Department of Oncology
- Department of Intervention, The Second Affiliated Hospital of Soochow University
| | - Xingwei Sun
- Department of Intervention, The Second Affiliated Hospital of Soochow University
| | - Xuming Bai
- Department of Intervention, The Second Affiliated Hospital of Soochow University
| | - Yubin Zhou
- Department of Intervention, The Second Affiliated Hospital of Soochow University
| | - Jianming Shi
- Department of Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, PR China
| | - Yong Jin
- Department of Intervention, The Second Affiliated Hospital of Soochow University
| | - Qian Chen
- Department of Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, PR China
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