Search

A 46-year-old woman with stage 5 chronic kidney disease was unable to undergo hemodialysis treatment due to thoracic central venous obstruction (TCVO) and blockage of the tunneled cuffed catheter. This patient also presented with symptoms of TCVO. When percutaneous procedure was not possible, we resolved the obstruction with the innominate-to-right-atrial bypass grafting technique under extracorporeal circulation. There are few reports on this surgical approach. In terms of patient prognosis, this may be an effective solution to this problem. [ABSTRACT FROM AUTHOR]

We report the case of a 60-year-old woman who sought medical attention for left cervical and supraclavicular pain and swelling. Previous computed tomography, intravascular ultrasound, and venography studies were reviewed, confirming extrinsic compression of the left innominate vein by the left common carotid artery against the left clavicle head. Stenting of the lesion was performed, with good mid-term symptom relief and patency. It is, to the best of our knowledge, the first case study in the literature to report endovascular treatment of this syndrome.

Balloon rupture during angioplasty can with calcified or recalcitrant lesions. A 61-year-old woman presented with worsening arm and facial swelling. She had a history of left upper extremity thrombolysis and stenting of the innominate vein 6 years prior. Venography showed severe in-stent stenosis. After crossing the lesion, a 12-mm balloon was inflated, which ruptured at nominal pressure. The balloon became stuck and could not be moved over the wire even after retraction of the sheath. A limited surgical cutdown was performed, and the balloon and the wire were removed together. The ruptured balloon part was found to be everted and circumferentially wrapped around the wire, preventing the wire exchange. After cutting the everted portion of the balloon, the catheter was removed without losing wire access. A high-pressure balloon was subsequently used to treat the lesion successfully. Her symptoms had resolved on follow-up, and the stent remained patent after 6 months.

Objectives: Stenting of central venous stenosis to preserve upper extremity hemodialysis access is well-described, though upper extremity complications secondary to these stents are less frequently discussed. Methods: We present the case of a 43-year-old male with a right brachiocephalic fistula who developed symptoms of venous hypertension following placement of a Wallstent for central venous stenosis. Workup demonstrated venous outflow obstruction secondary to stent foreshortening into the right subclavian vein. Results: The Wallstent was removed in a piecemeal fashion using an open surgical technique and a HeRO graft was placed for dedicated fistula outflow with complete relief of the patient's symptoms. Conclusion: In situations where a stent has migrated and endovascular removal is not possible, individual Wallstent fibers can be removed through a limited venotomy. [ABSTRACT FROM AUTHOR]

Background: The use of real-time ultrasound has become the standard of care for percutaneous central venous access and shown to decrease overall number of attempts and complication rates., Material and Method: A retrospective analysis of a prospective database was done focusing on three types of central access: non-tunneled, tunneled, and implantable, placed via ultrasound-guided Brachiocephalic Vein (BCV) between January 2019 and January 2023. Data were recorded: gender, age, weight, side (left or right), number of puncture attempts, arterial puncture, change of operator or puncture side, and mechanical complications (pneumothorax and hemothorax)., Results: A total of 1028 non-tunneled, tunneled, and implantable central lines were placed. Five hundred and eighty seven were Male. The children were aged from 0 to 18 years and their weights ranged from 1 to 113 kg. Nine hundred and thirty-five were left BCV. Right BCV was cannulated in 93 patients. Failure to cannulate left BCV was recorded in seven cases. Three arterial punctures were recorded. Cannulation success rate was 97.2% (999/1028) and was higher in left BCV than right BCV ( p  < 0.001)., Discussion: Based on the above, we believe that ultrasound-guided BCV is an easy and secure method to cannulate children, in our series left BCV showed a higher cannulation success rate rather than right BCV., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract Background Repair of the absence of the whole or major parts of pulmonary arteries is a challenge, and the choice of conduit material to reconstruct the pulmonary arteries is under dispute. We used the autologous innominate vein to construct pulmonary arteries. Case presentation l We present a novel technique using the autologous innominate vein as a free graft in a 6-month-old infant with pulmonary atresia and absence of central pulmonary arteries. Double ductus arteriosus were the only source of perfusion of the lungs. The innominate vein was substituted for the central pulmonary artery between the two lung hila. Total repair by using Contegra graft was performed 9 months later. The patient has been followed for 5 years. Conclusions The autologous innominate vein could be used as inter-hilar pulmonary arteries with no calcification and fibrosis in 5-year follow-up.

Abstract Background Aneurysm of the left brachiocephalic vein is a very rare clinical disease and only 40 cases have been reported so far. Case presentation The patient was a 61-year-old woman with no related medical history. She underwent CT to investigate the cause of a cough and a mass was noted in the anterior mediastinum. Dynamic computed tomography with contrast medium injected into the left basilic vein demonstrated the venous aneurysm with blood flow to the left brachiocephalic vein. The patient had no symptoms, but because of the risk of pulmonary infarction and aneurysm rupture, the aneurysm was surgically resected. A median sternotomy was a reasonable approach because of the fragility of the venous aneurysm wall with little working space in the anterior mediastinum. Conclusions We diagnosed an aneurysm of the left brachiocephalic vein on preoperative imaging and excised it through a median sternotomy. The venous wall was thin and fragile in some areas and so this approach was appropriate in view of the possibility of intraoperative injury.

Abstract We report a case of vascular injury caused by a multi‐lumen catheter for CRRT inserted through left jugular vein. Diagnosis was delayed because CRRT could be continued. Clinicians should be aware of potential vascular complications associated with the wrong placement of multi‐lumen catheters even if blood flow continues without difficulty.

Abstract Background To compare the efficacy and safety of right internal jugular vein (IJV) approach and right innominate vein (INV) approach for US-guided totally implantable venous access devices (TIVADs), and to explore the advantages and disadvantages of the two approaches. Methods Six hundred and nineteen adult patients had long-term infusion and chemotherapy needs and inconvenience of peripheral venous infusion. Right INV approach was used to implant 339 cases of TIVADs, and right IJV approach was used to implant 280 cases of TIVADs. The success rate of one-time catheterization and the incidence of complications in the two groups were retrospectively analyzed. Results All patients were successfully implanted in TIVAD. The success rates of one-time puncture in INV group and IJV approach group were 98.53% (334/339) and 95.36% (267/280), respectively. There was significant difference between the two groups (P = 0.020). The incidence of perioperative complications and long-term complications in the right INV group were 1.18% (4/339) and 3.54% (12/339), respectively, while those in the right IJV group were 1.43% (4280) and 3.93% (11280). There was no significant difference in the incidence of perioperative or long-term complications between the two groups (P = 0.785, P = 0.799, respectively). Conclusions US-guided TIVADs via the right INV approach and the right IJV approach are both safe and reliable. The right INV approach improves the one-time puncture success rate, as long as the technique is properly operated, serious complications rarely occur.

The brachiocephalic vein (BCV), also known as the innominate vein, is a central vein in the upper chest formed by merging the internal jugular and subclavian veins. It plays a crucial role in venous return from the head, neck, and upper extremities and is significant in procedures such as pacemaker and implantable cardioverter-defibrillator (ICD) placement, chemotherapy ports, and central venous catheter insertions. The presence of foreign bodies and local malignancy are major risk factors for thrombosis in the BCV. As part of the deep venous system, BCV thrombosis (BCVT) is a rare condition but can lead to serious complications like superior vena cava syndrome and, rarely, pulmonary embolism. This case report presents an 82-year-old woman with a history of heart failure with reduced ejection fraction, coronary artery disease, atrial fibrillation, HIV, pulmonary embolism, systemic lupus erythematosus, and breast cancer who required an ICD placement due to persistent systolic dysfunction. During the procedure, chronic BCVT leading to the stenosis was incidentally discovered, necessitating urgent vascular intervention to establish venous patency. The patient's complex medical history, including previous chemotherapy through a central venous catheter, contributed to the risk factors for BCVT. The multidisciplinary approach led to successful ICD placement and the reinstatement of anticoagulation therapy. This case underscores the rarity and severity of BCVT and highlights the importance of pre-procedural imaging, such as CT venography, in patients with multiple risk factors. Additionally, the report suggests considering leadless ICD technology for patients with limited venous access to avoid complications. The findings emphasize the critical need for thorough evaluation and planning in complex cases to ensure successful outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Stojanovic et al.)

Abstract Background To evaluate the feasibility and safety of ultrasound-guided totally implantable venous access port (TIVAP) implantation via the right innominate vein in patients with breast cancer. Methods Sixty-seven breast cancer patients underwent ultrasound-guided implantation of TIVAPs via the right innominate vein for administration of chemotherapy. Clinical data including technical success, success rate for the first attempt, periprocedural, and postoperative complications were recorded and retrospectively studied. Results All patients underwent successful surgery. The success rate of the first attempt was 95.52% (64/67). The operation time was 28 to 45 min, with an average of 36 ± 6 min. Periprocedural complications included artery punctures in 1 (1.50%, 1/67) patient. Prior to this study, the mean TIVAP time was 257 ± 3 days (range 41 to 705 days). The rate of postoperative complications was 4.48% (3/67), including catheter-related infections in 1 case and fibrin sheath formation in 2 cases. Up to the present study, three people had unplanned port withdrawal due to complications, and the TIVAPs for 25 patients were still in normal use. Conclusions The success rate of ultrasound-guided TIVAPs via the right innominate vein is high with low complications, thus safe and feasible. This technique can provide a new option for chemotherapy of breast cancer patients.

Introduction: Our experience in minimally invasive procedures and improvement of graft technology enables easy and successful operation carried out even with complex thoracic aortic diseases from limited surgical area. However, it should be more than one incision or cannulation site for such intervention. We aimed to present our experience and results of 23 patients who has ascending aorta and aortic arch pathologies of which we operated with J-shaped partial sternotomy and innominate vein cannulation. Methods: From January 2014 to January 2016, 23 patients with aorta and aortic valve pathologies who underwent aortic surgery with J-shaped partial sternotomy and innominate vein cannulation included. Operation findings, cardiopulmonary bypass (CPB) values, postoperative results, surgical mortality and morbidity rates, late conversion to full sternotomy rates, ICU and hospital length of stay were evaluated. Results: The mean age of the patients was 53.7±12 (range 19-68) and 18 (78.2%) were males. Arcus aorta debranching applied to 4 patients (17.3%) and one of these procedures was frozen elephant trunk procedure (%4.3). Neither mortality nor cerebrovascular accident occurred. Mean CPB peak flow was 4.6±0.4 L/min, mean flow index calculated as 2.01±0.38 L/min/m2 and there was no CPB problem intraoperatively. Innominate vein ligation was carried out in 5 patients but no complication was seen except one who had left arm swelling treated with elevation. Conclusion: Innominate vein cannulation with J-shaped partial sternotomy is a reliable and easily applicable method providing effective utilization of limited operative field not only in ascending aorta and aortic arch operations but also with the advancements of hybrid systems used in descending aorta pathologies.

Background: Repair of the absence of the whole or major parts of pulmonary arteries is a challenge, and the choice of conduit material to reconstruct the pulmonary arteries is under dispute. We used the autologous innominate vein to construct pulmonary arteries.Case PresentationL: We present a novel technique using the autologous innominate vein as a free graft in a 6-month-old infant with pulmonary atresia and absence of central pulmonary arteries. Double ductus arteriosus were the only source of perfusion of the lungs. The innominate vein was substituted for the central pulmonary artery between the two lung hila. Total repair by using Contegra graft was performed 9 months later. The patient has been followed for 5 years.Conclusions: The autologous innominate vein could be used as inter-hilar pulmonary arteries with no calcification and fibrosis in 5-year follow-up. [ABSTRACT FROM AUTHOR]

Background: Aneurysm of the left brachiocephalic vein is a very rare clinical disease and only 40 cases have been reported so far. Case presentation: The patient was a 61-year-old woman with no related medical history. She underwent CT to investigate the cause of a cough and a mass was noted in the anterior mediastinum. Dynamic computed tomography with contrast medium injected into the left basilic vein demonstrated the venous aneurysm with blood flow to the left brachiocephalic vein. The patient had no symptoms, but because of the risk of pulmonary infarction and aneurysm rupture, the aneurysm was surgically resected. A median sternotomy was a reasonable approach because of the fragility of the venous aneurysm wall with little working space in the anterior mediastinum. Conclusions: We diagnosed an aneurysm of the left brachiocephalic vein on preoperative imaging and excised it through a median sternotomy. The venous wall was thin and fragile in some areas and so this approach was appropriate in view of the possibility of intraoperative injury. [ABSTRACT FROM AUTHOR]

We report a case of vascular injury caused by a multi‐lumen catheter for CRRT inserted through left jugular vein. Diagnosis was delayed because CRRT could be continued. Clinicians should be aware of potential vascular complications associated with the wrong placement of multi‐lumen catheters even if blood flow continues without difficulty. [ABSTRACT FROM AUTHOR]

Thoracic aortocaval fistulae are rare entities where a direct shunt between thoracic arteries and systemic veins is seen. They can be traumatic or congenital in origin. Congenital thoracic aortocaval fistulae usually involve descending aorta and azygos, hemiazygos systems. Presenting symptoms range from continuous murmur to signs of congestive heart failure. In this case report, imaging findings of a 3-year-old girl referred for continuous murmur over the left sternal border are presented. Computed tomography angiography revealed multiple tortuous vessels along the descending aorta with a course toward the left brachiocephalic vein, and was suspicious for an aorta-venous fistula. Subsequent digital subtraction angiography for treatment planning showed a fistula originating at the level of the left 6th intercostal artery, with direct drainage into the left brachiocephalic vein without involvement of the azygos/hemiazygos system. [ABSTRACT FROM AUTHOR]

Background: To compare the efficacy and safety of right internal jugular vein (IJV) approach and right innominate vein (INV) approach for US-guided totally implantable venous access devices (TIVADs), and to explore the advantages and disadvantages of the two approaches.Methods: Six hundred and nineteen adult patients had long-term infusion and chemotherapy needs and inconvenience of peripheral venous infusion. Right INV approach was used to implant 339 cases of TIVADs, and right IJV approach was used to implant 280 cases of TIVADs. The success rate of one-time catheterization and the incidence of complications in the two groups were retrospectively analyzed.Results: All patients were successfully implanted in TIVAD. The success rates of one-time puncture in INV group and IJV approach group were 98.53% (334/339) and 95.36% (267/280), respectively. There was significant difference between the two groups (P = 0.020). The incidence of perioperative complications and long-term complications in the right INV group were 1.18% (4/339) and 3.54% (12/339), respectively, while those in the right IJV group were 1.43% (4280) and 3.93% (11280). There was no significant difference in the incidence of perioperative or long-term complications between the two groups (P = 0.785, P = 0.799, respectively).Conclusions: US-guided TIVADs via the right INV approach and the right IJV approach are both safe and reliable. The right INV approach improves the one-time puncture success rate, as long as the technique is properly operated, serious complications rarely occur. [ABSTRACT FROM AUTHOR]

Central vein stenosis is frequently seen in patients on maintenance hemodialysis. This results in venous hypertension, swelling of the limb and malfunctioning of arterio-venous (AV) dialysis fistula. Percutaneous intervention of central vein stenosis is technically challenging with high failure rates, complications and repeated interventions. We hereby report a case of end-stage renal disease on maintenance hemodialysis, who presented with malfunctioning dialysis AV fistula following occlusion of left innominate vein. Successful endovascular stenting of left innominate vein was done with favorable short and long term outcomes.

Lung cancers and mediastinal masses can invade the veins in the upper mediastinum and neck. It can be challenging to determine management options and the feasibility of resection particularly when tumors involve the major venous junctions. Furthermore, impaired flow in these veins can have devastating complications such as Paget-Schroetter syndrome, which describes a constellation of symptoms (arm swelling, cyanosis, pain) due to stenosis of the subclavian vein. This section will provide an overview of venous drainage of the brain, which can be divided into two major systems-superficial medullary venous system and deep medullary venous system. The anatomy and function of the great veins of the neck and upper mediastinum, including the internal jugular vein, subclavian vein, and brachiocephalic (i.e., innominate) vein will be described. Also discussed will be principles of ligation of the venous structures and the importance of keeping the venous junctions intact to facilitate and maximize the development of collateral flow. This section will also discuss ensuing complications when blood flow is impaired, such as development of upper extremity deep venous thrombosis and cerebral venous thrombosis (CVT). CVT can result in a stroke and is an umbrella term that refers to problems in cerebral venous outflow due to numerous etiologies., Competing Interests: Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-23-15/coif). The series “Venous Surgery of the Mediastinum” was commissioned by the editorial office without any funding or sponsorship. A.S. served as the unpaid Guest Editor of the series. The authors have no other conflicts of interest to declare., (2024 Mediastinum. All rights reserved.)

Aim: Ultrasound guidance has become the routine method for catheterization, dramatically reducing failure and complication rates for totally implantable venous access devices (TIVAD) placement. The aim of the present study was to report the safety and efficacy of ultrasound‐guided right innominate vein TIVAD placement in older patients. Methods: Between September 2015 and September 2017, 55 older patients underwent right innominate vein TIVAD placement under ultrasound guidance. Intraoperative fluoroscopy was always carried out. The technical success rate and complications were recorded and retrospectively analyzed. Results: The technical success rate was 100%. The success rate of the first puncture was 96.36% (53/55). The mean operation time was 28 ± 7 min (range 23–39 min), and the mean length of catheter introduction was 19.24 ± 2.65 cm (range 17–21 cm). The overall incidence of complications was 7.27% (4/55), including one arterial puncture with self‐limiting hematoma, two cases of catheter‐related infection and one case of fibrin sheath. No catheter malposition or catheter fracture was observed. At the time of this study, three TIVAD were pulled out unexpectedly, and 32 TIVAD are still in functional use. Conclusions: Ultrasound‐guided puncture of the right innominate vein is safe and reliable to implant TIVAD, which can provide new options for older patients. Geriatr Gerontol Int 2019; 19: 218–221. [ABSTRACT FROM AUTHOR]

Abstract Background Totally implantable venous access ports (TIVAPs) are widely used and are an essential tool in the efficient delivery of chemotherapy. This study aimed to evaluate the feasibility and safety of implantation of ultrasound (US)-guided TIVAPs via the right innominate vein (INV) for adult patients with cancer. Methods This study retrospectively reviewed the medical records of 283 adult patients with cancer who underwent US-guided INV puncture for TIVAPs between September 2015 and September 2017. It also analysed the technical success rate, operation time, and short-term and long-term surgical complications. Results Technical success was achieved in all patients (100%). The mean operation time was 28.31 ± 7.31 min (range: 23–39 min), and the puncture success rate for the first attempt was 99.30% (281/283). Minor complications included artery puncture during the operation in one patient, but no pneumothorax was encountered. The mean TIVAP time was 304.16 ± 42.54 days (range: 38–502 days). The rate of postoperative complications was 2.83% (8/283), including poor healing of the incision in one patient, catheter-related infections in three patients, port thrombosis in one patient, and fibrin sheath formation in three patients; no catheter malposition, pinch-off syndrome, catheter fracture, or other serious complications were observed. Conclusions TIVAPs are widely employed for chemotherapy. The present study found that the novel approach of using US-guided INV puncture to implant TIVAPs in adult patients with cancer is both short-termly feasible and safe for long-term central venous access. [ABSTRACT FROM AUTHOR]

Persistence of the left superior vena cava (PLSVC) is a congenital anomaly reported in 0.3–0.5% of patients. Due to the multiple and complex anatomical variations, transvenous lead placement can become challenging. We report the case of a 47-year-old patient diagnosed with non-ischemic dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF—27%), who was referred to our clinic for implantation of a dual-chamber cardioverter defibrillator for primary prevention of sudden cardiac death. During the procedure we encountered an abnormal guidewire trajectory and after venographic examination we established the diagnosis of persistent left superior vena cava. After difficult implantation of a 7F defibrillation lead through the coronary sinus, we managed to place the atrial lead through a narrow brachiocephalic vein into the right atrial appendage. In this paper, we aim to illustrate the medical and technical implications of implanting a cardioverter defibrillator in patients with PLSVC, highlighting the benefit of identifying and utilizing both the innominate vein, and the left superior vena cava and coronary sinus for placement of multiple leads, which would otherwise have been impossible.

Introduction: Our experience in minimally invasive procedures and improvement of graft technology enables easy and successful operation carried out even with complex thoracic aortic diseases from limited surgical area. However, it should be more than one incision or cannulation site for such intervention. We aimed to present our experience and results of 23 patients who has ascending aorta and aortic arch pathologies of which we operated with J-shaped partial sternotomy and innominate vein cannulation. Methods: From January 2014 to January 2016, 23 patients with aorta and aortic valve pathologies who underwent aortic surgery with J-shaped partial sternotomy and innominate vein cannulation included. Operation findings, cardiopulmonary bypass (CPB) values, postoperative results, surgical mortality and morbidity rates, late conversion to full sternotomy rates, ICU and hospital length of stay were evaluated. Results: The mean age of the patients was 53.7±12 (range 19-68) and 18 (78.2%) were males. Arcus aorta debranching applied to 4 patients (17.3%) and one of these procedures was frozen elephant trunk procedure (4.3%). Neither mortality nor cerebrovascular accident occurred. Mean CPB peak flow was 4.6±0.4 L/min, mean flow index calculated as 2.01±0.38 L/min/m2 and there was no CPB problem intraoperatively. Innominate vein ligation was carried out in 5 patients but no complication was seen except one who had left arm swelling treated with elevation. Conclusion: Innominate vein cannulation with J-shaped partial sternotomy is a reliable and easily applicable method providing effective utilization of limited operative field not only in ascending aorta and aortic arch operations but also with the advancements of hybrid systems used in descending aorta pathologies. [ABSTRACT FROM AUTHOR]

Introduction: Recently, arthroscopy of the sternoclavicular joint (SCJ) has been described in clinical setting. The aim of this study is to examine the accessibility and safety of the SCJ by arthroscopy in a cadaveric model. Materials and methods: An inferolateral and superomedial portal to the SCJ was created in 20 cadaveric specimens. After debridement, the specimens were dissected with a needle positioned in the portal tracts. The distance between the needles and bony landmarks, tendons and ligaments were measured. The integrity of the posterior capsule was evaluated macroscopically. In eight specimens, after anterior dissection, the needles were replaced by K-wires that perforated the posterior capsule to evaluate the distance to the neurovascular structures behind the SCJ. Results: Both portals were found to be safe while allowing good access to the joint. The superomedial portal went through the tendon of the sternocleidomastoideus muscle and the inferolateral portal through the pectoralis major muscle. The portals entered the capsule medial and lateral to the anterior sternoclavicular ligament. The posterior capsule was never perforated during debridement. The perforating K-wires, however, usually perforated either a major vein or artery, but were at a safe distance from the vagal nerve. Conclusions: In this cadaver study, arthroscopy of the sternoclavicular joint could be used as a minimally invasive procedure allowing debridement of the joint without damaging the posterior capsule of the joint. If the capsule is inadvertently be breached, a major risk of neurovascular damage exists. We advise to have a backup of a cardiothoracic surgeon when performing this procedure. [ABSTRACT FROM AUTHOR]

Major vessels of the mediastinum such as the superior vena cava (SVC) and bilateral innominate veins can occasionally become involved with aggressive tumors or the mediastinum, including non-small cell lung cancer and thymoma. This may result in partial or complete obstruction. With presentation of these tumors symptoms can often be debilitating and would otherwise be treated with palliative therapy. A select population of patients are candidates for tumor resection. The ability to perform an adequate resection will depend on the ability to create a durable reconstruction of the SVC and bilateral innominate veins. Pre-operative and intra-operative considerations will allow for a safe surgery with few complications to the patient. Furthermore, depending on the extent of resection, there are a variety of techniques for reconstruction. These can range from a primary repair of a partial venous wall resection to a complex replacement of both the SVC and one or both innominate veins. Multiple options exist for the use of these conduits, such as polytetrafluoroethylene, homograft, autologous vein, and bovine or porcine pericardium. Depending on the type of conduit used, the post-operative outcomes will differ. In order to perform this operation safely, proper knowledge and experience is required. We review a variety of strategies used to manage these rare but complex scenarios., Competing Interests: Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-20-70/coif). The series “Venous Surgery of the Mediastinum” was commissioned by the editorial office without any funding or sponsorship. JOW is a Consultant for Intuitive, Boston Scientific, Meditronic, and Ethicon. The authors have no other conflicts of interest to declare., (2022 Mediastinum. All rights reserved.)

Partial anomalous pulmonary venous connection is a rare congenital anomaly in which one or more pulmonary veins are connected to the venous circulation. The condition is frequently misdiagnosed, and usually identified by transesophageal echocardiography or invasive cardiac catheterization. We present the case of a 26-year-old female with new onset dyspnea on exertion who was diagnosed with the left superior and inferior pulmonary veins draining into the innominate vein via a vertical vein by two and three-dimensional transthoracic echocardiography and multidetector computed tomographic angiography. [ABSTRACT FROM AUTHOR]

Background: The need to add a lead(s) despite subclavian/innominate obstruction is increasing. Subclavian venoplasty may be a good alternative to the commonly employed options; however, there are few reports in the literature, and all are by interventional radiologists. Objective: To describe the procedural details, results and safety of venoplasty by implanting physicians in a large group of consecutive patients. Methods: Safety, lead function and success were established from review of the procedure reports and clinical complications in 373 consecutive venoplasty patients from 1999–2010. Procedural details were obtained by review of the angiograms (venograms) and procedural flow charts of 152 consecutive patients from 2004–2007. Results: Venoplasty was successful in 371 of 373 patients without damage to the existing leads and without clinical complications. Total angiographic occlusion was demonstrated in 65% of cases by peripheral venogram, but in only 20% of cases by contrast injection at the site of obstruction; 86% were crossed with a hydrophilic wire. Microdissection and excimer laser were used to cross three of the four wire-refractory occlusions. Obstruction was both central and peripheral in 22.1% of cases and central only in 17%. The time required to cross the obstruction and perform venoplasty was 13 ± 21 minutes. A noncompliant balloon was successful in most, but an ultranoncompliant balloon was required in 13% of cases. Contrast extravasation was common during crossing of a total obstruction and also was observed with balloon rupture on three occasions, but was not clinically significant. Conclusions: Subclavian venoplasty is a safe, practical lead-management option that can be used by implanting physicians. [ABSTRACT FROM AUTHOR]

Abstract: Innominate vein compression syndrome and May-Thurner syndrome (also called iliac vein compression syndrome) are venous compression syndromes caused by normal anatomic structures. Here, we present a case in which these two conditions were found in the same patient using multidetector row computed tomography. This case is significant for two reasons: (1) it is, to the best of our knowledge, the first case study in the literature to report coexisting innominate vein compression syndrome and May-Thurner syndrome; and (2) it shows that multidetector row computed tomography has powerful diagnostic ability for venous diseases. [Copyright &y& Elsevier]

Mediastinitis is a life-threatening condition and would appear to have been rarely reported as arising as a central-venous catheter-associated complication. Here we report on one cancer patient featuring a Port-A catheter tip positioned within the innominate vein, who developed mediastinitis and mediastinitis-like symptoms subsequent to chemotherapeutic-agent infusion through this catheter. The relevant literature pertaining to this condition was reviewed, and the possible pathophysiology of the condition was discussed. [ABSTRACT FROM AUTHOR]

Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In a 2002 cadaveric dissection course, a complex manner of rare variation was found in the abnormal venous system of the heart of an 88-year-old Japanese man who died of acute pneumonia. The superior vena cava and the left and right brachiocephalic veins were normal. In this case, a complex venous system existed as follows. (1) A left superior vena cava was persistent. (2) The innominate vein was present. It went upward between the ascending aorta and the pulmonary trunk, passed through the ventral side of the bifurcation of the pulmonary trunk, and then anastomosed with the left superior vena cava. The oblique vein of the left atrium, as a fibrous bundle, was connected to the junction of the left superior vena cava and the innominate vein in the pericardium. (3) The great cardiac vein was divided into two branches. One was located at the right side of the left coronary artery, forming the origin of the innominate vein. The other extended to the coronary sinus as a normal great cardiac vein. (4) The orifice of the coronary sinus on the right atrium was obliterated. (5) The abnormal orifice existed between the left atrium and the coronary sinus. The formation process and functional significance of such venous variations are discussed. [ABSTRACT FROM AUTHOR]

Abstract Transvenous (TV) pacing and defibrillation leads are frequently implanted in children as part of treatment for various congenital and acquired rhythm abnormalities. However, the lead-vascular endothelial interaction is not a benign process and is associated with a risk of progressive venous obstruction. Often, this obstruction requires surgical or interventional relief. The risk of obstruction is related to venous diameters at implant and lead size. Since venous diameters are largely unknown at different ages, the purpose of this study was to correlate innominate vein (iNN) and superior vena cava (SVC) diameters with body dimensions in growing children. [ABSTRACT FROM AUTHOR]

Thrombosis of the brachiocephalic veins or superior vena cava (SVC) is rare. This study was conducted to determine the prevalence and characteristics of thrombosis of brachiocephalic veins and SVC, and its association with symptomatic pulmonary embolism CPE). The prevalence of thrombosis involving the brachiocephalic veins and SVC was evaluated retrospectively at a university hospital during the 3-year period. Patients were identified by hospital records and review of computer-generated lists of of all venograms, contrast-enhanced chest computed tomography, and magnetic resonance angiograms of the upper extremity and SVC. Thrombosis of the brachiocephalic veins and SVC was diagnosed in 33 (0.03 %) of 100,942 patients of all ages [(32 of 70,751 adult patients ≥ 20 years; 0.04%)]. Twenty-three (70%) patients initially had secondary thrombosis with multiple risk factors: associated with malignancy in 14 (42%) patients, chronic disorders in 13 (39%) patients, central venous lines (CVL) and peripheral venous lines (PVL) in 9 (27%) patients, and thrombophilia in 10 (38%) of 26 patients. Swelling of the arm, head, and neck was present in 32 (97%) patients. Symptomatic PE developed before thrombosis being treated in 12 (36%) patients. All patients except eight (three, thrombolytic; five, thrombectomy) received anticoagulant therapy. Thrombosis of the SVC and brachiocephalic veins is an uncommon but serious complication in patients with malignancy, chronic disorders, CVL, PVL, and thrombophilia. Because it is important clinical problem with frequent PE, the patients with appropriate clinical findings should be diagnosed early with imaging tests and treated with anticoagulant drugs. [ABSTRACT FROM AUTHOR]

Objective: A case-control comparison of Doppler guidance on the success rate of central venous cannulation in patients with normal or reduced intracranial compliance.Design: A single operator performed central venous access procedures with continuous wave Doppler guidance. It was used on patients on a ventilator. The position of patients with reduced intracranial compliance (RIC) was not changed for the procedure. Patients with normal intracranial compliance (NIC) were put in the Trendelenburg position.Setting: We prospectively evaluated 249 Doppler-guided central venous access procedures performed over a 12-month period at our 10-bed neuro-intensive care unit at a university hospital.Patients and Participants: The group with RIC included 26 males and 35 females (n=61) aged 16-79 years. In this group 155 Doppler-guided cannulation procedures (62%) were performed. The group with NIC (n=52) comprised 29 males and 23 females aged 34-76 years; 94 Doppler-guided cannulation procedures (38%) were carried out.Measurements and Results: The veins cannulated in RIC and NIC, respectively, were: right innominate vein: 24/18, left innominate vein 26/12, right subclavian vein 12/7, left subclavian vein 25/14, and right internal jugular vein 33/18 and left internal jugular vein 35/24. The absence of one left internal jugular vein was identified in the NIC group. The success rate of first needle pass in patients with RIC was 92% and in patients with NIC 89%.Conclusions: This study showed that Doppler guidance allows the cannulation of central veins in patients with RIC placed in head-up position. Cannulation can be ensured and first-pass needle placement maximised. [ABSTRACT FROM AUTHOR]

This case illustrates a rare finding of flow reversal within the internal jugular vein associated with innominate occlusion and ipsilateral arteriovenous fistula. The patient was an adult male who presented with extreme pain and swelling of the left upper extremity and an ipsilateral nonfunctioning hemodialysis shunt. Doppler waveforms demonstrated turbulence and retrograde flow of the internal jugular vein (IJV). Sonography demonstrated complete occlusion of the left innominate vein. Angiography confirmed the IJV flow reversal and the full extent of the innominate vein clot. Angiography also showed bilateral indwelling innominate stents, as well as visualized the retrograde flow from the IJV crossing left to right via the transfer sinus and descending caudally to the right IJV. As demonstrated in this case, ultrasound works well in tandem with special procedures. [ABSTRACT FROM PUBLISHER]

INTRODUCTION: Iatrogenic damage of the innominate vein is a possible complication with extracorporeal central venous line catheter insertion techniques. When perforation occurs, the catheter is left in place and surgery is required for careful removal and repair of other possible complications, including hemothorax and cardiac tamponade. The traditional approach for innominate vein repair is via a complete median sternotomy. PRESENTATION OF CASE: A 75-year-old female patient with hypertension, diabetes mellitus type two and end stage renal failure, coronary artery disease presenting with iatrogenic innominate vein perforation and pulmonary effusion status post placement of a tunneled hemodialysis catheter through the left subclavian vein. DISCUSSION: The patient underwent a partial upper sternotomy into the right fourth intercostal space. Ministernotomy and endovascular techniques provide similar outcomes to those of traditional surgical approaches. However, with minimal access and trauma, these new methods provide better post-operative outcomes for patients. CONCLUSION: The case presented in this report suggests a new approach to replace the traditional complete median sternotomy in attempts to repair the innominate vein. The mini-sternotomy approach provides sufficient visualization of the vessel and surrounding structures with minimal post-operative complications and healing time. [ABSTRACT FROM AUTHOR]

Obstruction of the major venous channels from the upper body is rarely due to benign disorders. We report a 53-year-old man with a ten year history of sarcoidosis who developed acute symptomatic left innominate vein obstruction and massive left-sided pleural effusions. Left neck exploration revealed obstruction of the innominate vein and thoracic duct by the matted sarcoid lymph nodes. Symptoms of left innominate vein obstruction and the massive effusion subsided shortly after lymphadenectomy. In view of the frequency of sarcoid cervical lymphadenopathy, this disease should be considered in the differential diagnosis of benign causes of symptomatic obstruction of the venous drainage of the upper part of the body. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the feasibility of stent dilation of venous obstructions/occlusions to permit transvenous pacing lead implantation. Innominate vein or superior vena cava (SVC) obstruction may preclude the implantation of transvenous pacing leads. Patients with d-transposition of the great arteries, after a Mustard or Senning procedure, and children with previously placed transvenous pacing leads are at higher risk for this vascular complication. From May 1993 to January 1996, eight pediatric patients who underwent transvenous pacing lead implantation or replacement were found to have significant innominate vein or SVC obstruction or occlusion. Utilizing intravascular stents, a combined interventional and electrophysiological approach was used to relieve the venous obstruction and to permit implantation of a new transvenous pacing lead. Two patients had complete SVC occlusion requiring puncture through the obstruction with a transseptal needle. Vessel recanalization was achieved with balloon dilation and stent implantation. The remaining six patients had severe venous obstruction with a mean minimum diameter of 3.1 ± 3.3 mm. The mean pressure gradient across the obstructed veins was 8.6 ± 7.3 mmHg. Following implantation of 15 Palmaz P308 stents in eight vessels, the mean diameter increased to 14.2 ± 1.9 mm and the mean pressure gradient across the stented vessels decreased to 1.0 ± 2.0 mmHg. A transvenous pacing lead was implanted successfully through the stent(s) immediately or 6–8 weeks later. Innominate vein and SVC obstruction can be safely and effectively relieved with intravascular stents and permit immediate or subsequent transvenous pacing lead implantation. [ABSTRACT FROM AUTHOR]

Thrombosis of the innominate vein and SVC is a serious complication in patients with pacemakers, inducing pulmonary embolism or SVC syndrome. Venography is the definitive method for its diagnosis; however, it is too invasive for related studies. The purpose of this study was to validate sonograpby, pulse Doppler, and color flow in detecting noninvasively innominate vein or SVC thrombosis in patients with pacemakers. In 53 patients with pacemakers, the 1 severe SVC stenosis and 18 severe innominate vein stenoses due to thrombosis were diagnosed by digital subtraction angiography. Sonography accurately showed the severe SVC stenosis due to thrombosis, but bad limitations on the innominate vein thrombosis. Color flow demonstrated mosaic flow, indicating poststenotic turbulence due to stenosis of the innominate vein and SVC caused by thrombosis in 15 of 16 patients, and pulse Doppler disclosed absence of flow due to complete occlusion of the innominate vein in 2 of 2 patients. Sensitivity and specificity for detecting severe innominate vein stenosis due to thrombosis using combined color flow and pulse Doppler was 94% and 100%, respectively. In conclusion, sonography, pulse Doppler, and color flow allow accurate detection of severe innominate vein or SVC stenosis due to thrombosis, and are therefore useful for the follow-up of patients with a pacemaker. [ABSTRACT FROM AUTHOR]

Persistence of the left superior vena cava (PLSVC) is a congenital anomaly reported in 0.3–0.5% of patients. Due to the multiple and complex anatomical variations, transvenous lead placement can become challenging. We report the case of a 47-year-old patient diagnosed with non-ischemic dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF—27%), who was referred to our clinic for implantation of a dual-chamber cardioverter defibrillator for primary prevention of sudden cardiac death. During the procedure we encountered an abnormal guidewire trajectory and after venographic examination we established the diagnosis of persistent left superior vena cava. After difficult implantation of a 7F defibrillation lead through the coronary sinus, we managed to place the atrial lead through a narrow brachiocephalic vein into the right atrial appendage. In this paper, we aim to illustrate the medical and technical implications of implanting a cardioverter defibrillator in patients with PLSVC, highlighting the benefit of identifying and utilizing both the innominate vein, and the left superior vena cava and coronary sinus for placement of multiple leads, which would otherwise have been impossible. [ABSTRACT FROM AUTHOR]

Injuries to the branches of the aortic arch are rare and may be caused by blunt, penetrating, blast or iatrogenic trauma. Innominate vascular injury is a rare entity, particularly in blunt trauma. It is estimated that 71% of patients with innominate injuries die before arrival at the hospital. We report here a successfully managed case of a combined blunt trauma of the innominate artery and transection of the left innominate vein after blunt injury to the chest. [ABSTRACT FROM AUTHOR]

A case of chylothorax following innominate vein thrombosis which developed as a late complication of transvenous pacemaker implantation is discussed. A 78-year-old man presented with a refractory left-sided pleural effusion, which turned out to be a chylothorax. He had undergone a transvenous pacemaker implantation 6 years earlier for sick sinus syndrome. Aetiological work-up showed occlusion of the innominate vein as the cause for the chylothorax. The chylothorax resolved following pleurodesis with talc slurry, and the innominate vein was recanalized by angioplasty. To our knowledge, this is the first report of a case of this nature. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A case of chylothorax following innominate vein thrombosis, which developed as a late complication of transvenous pacemaker implantation, is discussed. A 78-year-old man presented with a refractory left-sided pleural effusion, which turned out to be chylothorax. He had undergone a transvenous pacemaker implantation 6 years earlier for sick sinus syndrome. The aetiological workup showed occlusion of the innominate vein as the cause for the chylothorax. The chylothorax resolved following pleurodesis with talc slurry, and the innominate vein was recanalized by angioplasty. To our knowledge this is the first report of a case of this nature. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]