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The article discusses the successful creation of an extra-anatomic venous bypass via direct percutaneous puncture of the superior vena cava (SVC) to alleviate severe left upper extremity swelling and pain in a patient with chronic catheters for hemodialysis access. The patient had a history of challenging venous access and declined surgical intervention, opting for a percutaneous approach. The procedure involved multiple steps, including ultrasound and fluoroscopic guidance, to establish a bypass from the left upper extremity to the right groin. The patient experienced resolution of symptoms post-procedure but unfortunately passed away a year later due to complications from other medical conditions. [Extracted from the article]

Oftentimes, incidental findings are made on routine diagnostic imaging. An intra- and extravascular lipoma is one example of an important incidental finding. Intravascular lipomas are rare benign vascular tumors that are typically asymptomatic. They are most commonly found in the inferior vena cava but have also been recorded in the superior vena cava, brachiocephalic vein, subclavian vein, internal jugular vein, external jugular vein, and common femoral vein. Here, we presented the case of a 64-year-old female patient with an incidentally discovered intra- and extravascular lipoma affecting the right subclavian and brachiocephalic veins. While benign, intravascular lipoma on imaging can resemble a malignant tumor such as leiomyosarcoma or thrombus. As a result, appropriate identification and classification of this imaging finding is crucial for avoiding an exorbitant and futile workup. [ABSTRACT FROM AUTHOR]

This article presents a case study of a 35-year-old male with HIV who developed chylothorax, a condition characterized by the accumulation of chylous fluid in the pleural space. The patient underwent various treatments, including thoracic duct ligation, but continued to have high chylous output. A CT scan revealed an occlusion of the superior mesenteric vein (SMV), and the patient subsequently underwent SMV recanalization and stenting. Following the procedure, the chylous output significantly decreased, and the patient's symptoms improved. This case highlights the complexity of diagnosing and managing chylous fluid accumulation and demonstrates the successful use of SMV recanalization and stenting as a treatment option. [Extracted from the article]

Background: Central venous occlusion (CVO) is difficult to treat with percutaneous transluminal angioplasty because the guidewire cannot pass through the occluded segments. In this study, we devised a new method for establishing an extra-anatomic bypass between the right subclavian vein and the superior vena cava via a covered stent to treat whole-segment occlusion of the right brachiocephalic vein (BCV) with calcification. Case presentation: We present the case of a 58-year-old female patient who complained of right arm swelling present for 1.5 years. Twelve years prior, the patient began hemodialysis because chronic glomerulonephritis had progressed to end-stage renal disease. During the first 3 years, a right internal jugular vein (IJV)-tunneled cuffed catheter was used as the dialysis access, and the catheter was replaced once. A left arteriovenous fistula (AVF) was subsequently established. Owing to occlusion of the left AVF, a new fistula was established on the right upper extremity 1.5 years prior to this visit. Angiography of the right upper extremity revealed complete occlusion of the right BCV and IJV with calcification. Because of the failure to pass the guidewire across the lesion, we established an extra-anatomic bypass between the right subclavian vein and the superior vena cava with a covered stent. Angiography confirmed the patency of whole vascular access system. After 3 months of follow-up, the patient's AVF function and the bypass patency were satisfactory. Conclusions: As a new alternative for the treatment of long, angled CVO with or without calcification, a covered stent can be used to establish an extravascular bypass between central veins. [ABSTRACT FROM AUTHOR]

The article discusses a case of a 50-year-old female with a fractured port-a-catheter successfully removed using the Inari ClotTriever device. The patient had a history of breast cancer and experienced complications with the catheter, leading to the need for removal. The innovative technique presented in the article offers a less invasive alternative to open surgery for challenging foreign body removal cases, highlighting the importance of patient preference and psychological impact in medical decision-making. [Extracted from the article]

This article discusses the use of ultrasound guidance in the placement of central venous catheters. The author explains that ultrasound has revolutionized the field by allowing for venipuncture at previously inaccessible sites. The article focuses on the subclavian vein approach and presents a study that compared left and right subclavian access using ultrasound guidance. The study found that left subclavian access had a higher success rate and lower rates of catheter tip malposition. The author suggests that these findings may influence clinical practice and encourage clinicians to consider the infraclavicular subclavian approach. However, the article also acknowledges that further research is needed to fully understand the implications of these findings. [Extracted from the article]

Background: Ultrasound has become the standard of care for the insertion of central venous catheters (CVCs) in the intensive care unit. With the introduction of ultrasonography in CVC insertion, there has been an improvement in the success rate and a dramatic decrease in the rate of complications. Aims and Objectives: The aim of this study was to compare the safety and ease of insertion of ultrasonically guided cannulation of the internal jugular vein (IJV) with that of the supraclavicular subclavian vein (SCV) in adult patients undergoing various surgical procedures. Materials and Methods: All the patients in whom central venous cannulation was planned were assigned to two groups. Group I underwent ultrasound-guided IJV while as Group II underwent cannulation ultrasound-guided SCV cannulation. A comparison was made between the two groups, of the success rates, durations of procedure, number of attempts at needle redirections, difficulties if any during insertion of guidewires, and the complications encountered. Results: The IJV group had a higher proportion of first-attempt success (93.2% versus 62.7%). The IJV group had a lesser incidence (3.2%) of complications such as guidewire progression and needle redirections compared with SCV (15.2%). The frequency of adverse events did not differ between the two study groups with an incidence in 3.2% in IJV group and 9.6% in the subclavian group. Higher first-attempt success rates and fewer procedural complications were seen with ultrasound-guided IJV. Conclusion: IJV central venous catheterization is an easier and less invasive and less risky procedure for patients. [ABSTRACT FROM AUTHOR]

Background: The study aimed to elucidate the clinical application significance of prospective ECG-gated dual-source CT in central venous (CV) imaging. Materials and Methods: Eighty patients who took CT imaging of CV (CTV) check using dual-source Force CT were enrolled. The control group (helical pitch, 0.8; rotation speed, 0.5 s) and the experimental group (rotation speed, 0.25 s). For both groups, image quality and radiation dose were computed. Results: Cases in the experimental group required longer scanning durations than those in the contro lgroup. In respect to the experimental group, the image quality scores of the superior vena cava and left and right brachiocephalic veins of the patients sharply increased relative to those in the control group. Individuals in the experimental group also presented better image quality scores in left and right subclavian veins, left and right jugular veins, however, this difference was not statistically significant. Lastly, no increase in the radiation dose was bited with the application of prospective ECG gating. Conclusion: The clinical use of prospective ECG-gated technology significantly reduced cardiovascular pulsing artifact interference on the central vein, especially the superior vena cava segment, and remarkably improved the image quality without increasing the radiation dose to patients. [ABSTRACT FROM AUTHOR]

Background: Central venous disease is a serious complication in patients undergoing hemodialysis, often presenting with symptoms of venous hypertension. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency. Aim: To describe our experience in the endovascular treatment of central venous stenosis or obstruction in patients undergoing hemodialysis. Settings and Design: This was a retrospective study carried out in a tertiary care center. Study duration was 36 months. Follow-up was variable. Materials and Methods: Fifty six patients of chronic renal failure undergoing hemodialysis presented with central vein stenosis or obstruction having ipsilateral vascular access, between January 2018 and December 2021. All the patients underwent endovascular treatment and were analyzed retrospectively. Results and Conclusion: A total of 56 patients (48 male and 8 female) underwent 72 interventions for 52 stenotic segments during a time period of 3 years. Forty stenotic segments were in brachiocephalic vein, sixteen in subclavian vein. The technical success rate for endovascular treatment was 71.4%. All underwent percutaneous transluminal angioplasty (PTA) alone and Sixteen presented with restenosis later. Repeat Balloon angioplasty was done in Sixteen patients, Eight of which required >=2 reinterventions during follow-up. We found endovascular treatment safe and effective in treating central venous disease. [ABSTRACT FROM AUTHOR]

The letter published in Critical Care Medicine discusses the influence of arm abduction on ipsilateral internal jugular vein misplacement during ultrasound-guided subclavian venous catheterization. The authors highlight the high misplacement rate observed after right subclavian venous catheterization and suggest that arm abduction combined with shoulder elevation may prevent catheter malpositioning in the ipsilateral internal jugular vein. They speculate that an abducted arm position during catheterization procedures may not only prevent misplacement but also facilitate easier puncture. The authors hope that anesthesiologists will consider the effects of arm abduction when performing ultrasound-guided subclavian or infraclavicular axillary venous catheterization. [Extracted from the article]

The article in Critical Care Medicine discusses the findings of a study comparing tip misplacements in right- and left-sided subclavian venous catheterizations. The study suggests that left-sided catheterization is associated with fewer misplacements due to anatomical differences. The authors recommend using the right supraclavicular fossa ultrasound view during insertion to reduce misplacements in right-sided catheterizations. They emphasize the importance of real-time ultrasound guidance to ensure correct tip positioning, advocating for its incorporation into clinical practice guidelines. [Extracted from the article]

Intravascular lipomas (IVL) located in the superior vena cava (SVS) are rare benign primary venous tumors with less than 15 cases reported in the literature. We report a case of a 64-year-old woman with IVL of the SVC extending to the right brachiocephalic vein. She was treated successfully using a hybrid procedure which involved endovascular control of the right subclavian vein and surgical approach via median sternotomy followed by mass resection and use of pericardial patch for vein defect closure. [ABSTRACT FROM AUTHOR]

Background: Repositioning of dislocated port systems' catheters is usually performed with a pigtail catheter and/or a goose snare. In case of an inaccessible port catheter tip due to thrombosis, this classic approach may be not successful. For these cases, we describe a long loop bailout technique with bifemoral access. Technique: Via a right transfemoral access, a first attempt to reposition the dislodged port catheter using pigtail catheter and goose snare was performed. After an unsuccessful attempt and delineation of thrombosis of the catheter tip, the contralateral femoral vein was subsequently punctured and a sheath was placed. Through both vascular sheaths, pigtail catheter and goose wire were advanced distally to the catheter. The guidewire in the pigtail catheter was snared, thus creating a "Long loop" configuration. Pulling down both catheters simultaneously with improved stability allowed to detach the catheter tip from the vessel wall and replacement into the superior vena cava was possible. Refinement of catheter tip position was done using the goose snare. This technique was applied on 5 patients with dislodged port catheters in the jugular vein (2/5), the innominate vein (1/5), the subclavian vein (1/5) and the azygos vein (1/5) with a technical success of 100%. No complications were observed. Conclusion: The Long loop technique can be used as salvage approach to reposition a dislodged catheter in case of failure with pigtail catheter and goose snare. [ABSTRACT FROM AUTHOR]

Background: Many techniques exist for venous access (VA) during cardiac implantable electronic device (CIED) implantation. Objective: We sought to evaluate the learning curve with ultrasound (US) guided axillary vein access (USAA). Methods: Single‐center prospective randomized controlled trial of patients undergoing CIED implantation. Patients were randomized in a 2:1 fashion to USAA versus conventional VA techniques. The primary outcomes were the success rates, VA times and 30‐day complication rates. Results: The study included 100 patients (age 68 ± 14 years, BMI 27 ± 4 kg/m2). USAA was successful in 66/70 implants (94%). Initial attempts at conventional VA included 47% axillary (n = 14), 30% (n = 9) cephalic, and 23% (n = 7) subclavian. The median access time was longer for USAA than conventional access (8.3 IQR 4.2–15.3 min vs. 5.2 IQR 3.4–8.6 min, p =.009). Among the five inexperienced USAA implanters, there was a significant improvement in median access time from first to last tertile of USAA implants (17.0 IQR 7.0–21.0 min to 8.6 IQR 4.5–10.8 min, p =.038). The experienced USAA implanter had similar access times with USAA compared with conventional access (4.0 IQR 3.3–4.7 min vs. 5.2 IQR 3.4–8.6 min, p =.15). Venograms were less common with USAA than conventional access (2% vs. 33%, p <.0001). The 30‐day complication rate was similar with USAA (n = 4/70, 6%) versus conventional (n = 3/30, 10%, p =.44). Conclusion: Although the success rate with USAA was high, there was a significant learning curve. Once experienced with the USAA technique, there is the potential for reduced complications without adding to the procedure duration. [ABSTRACT FROM AUTHOR]

Here we describe an uncommon case of a 48-year-old male patient with an invasive thymoma invading the superior vena cava, bilateral innominate veins, right internal jugular vein, right subclavian vein, right atrium, azygos vein, and part of the lung tissues. The tumor was resected entirely under cardiopulmonary bypass support, and the venous bypass using a vascular graft was successfully established between the left innominate vein and the right atrium. The postoperative course was uneventful, and the patient was discharged 15 days after surgery without complications. [ABSTRACT FROM AUTHOR]

Background and Aims: The internal jugular vein (IJV) is the most common site for central venous cannulation. Ultrasonography (USG)-guided brachiocephalic vein (BCV) cannulation has been described recently. The objective of this study was to compare the first attempt success rate, overall success rate and procedural ease between two techniques. Methods: This was a prospective, single-blinded, randomised clinical study. Patients were randomly allocated into two groups using computer generated random table. Group IJV included 55 patients of USG-guided out-of-plane approach to the right IJV cannulation and group BCV included 55 patients for USG-guided supraclavicular in-plane approach to right BCV cannulation. The success rate, number of redirections needed, vein and needle tip visualisation, cannulation time and complication rate were compared between the groups. Results: Demographic parameters were similar between the groups. Success rate of cannulation was 98.5% in IJV group and 100% in group BCV (P = 0.31). The first attempt success rate was 76.3% and 81.81% in IJV and BCV group, respectively (P = 0.42). IJV was collapsed in 14.5% cases and BCV was collapsed in 0.9% cases. The needle visualisation was better in BCV group (94.54%) compared to IJV (80%) (P = 0.02) group, which was statistically significant. The numbers of redirections of needle were more in IJV group. Thus the procedural ease was better with BCV than IJV. Conclusion: Supraclavicular USG-guided in-plane BCV cannulation is a good alternative to USG-guided out-of-plane IJV cannulation, because of good calibre of the vein and better needle visualisation in the BCV group. [ABSTRACT FROM AUTHOR]

The distance from the skin surface to the cephalic vein may be measured to assess the need for a subsequent superficialization procedure.12,13 If the cephalic vein in the forearm is found to be inadequate for fistula creation, other veins in the forearm may be examined in a similar fashion to determine whether they are adequate. The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of clinical practice parameters, and accreditation of practices performing ultrasound examinations. Note that in case of more central cephalic vein thrombosis or hypoplasia, the forearm portion of the cephalic vein may drain preferentially via a large antecubital vein into the basilic or brachial veins. [Extracted from the article]

This study was to explore the application value for central venous stenosis and occlusion in hemodialysis patients under the CT angiography based on intelligent segmentation algorithm, so that patients can survive better. Spiral CT was used to examine upper limb swelling in 62 uremic hemodialysis patients at a speed of 3.8 mL/s. Nonionic iodine contrast agent was injected around the contralateral limb. The total dosage of 90-102 mL, it was scanned by intelligent trigger technology. The trigger scanning threshold was set. The monitoring point was located in the superior vena cava. CT with convolutional neural network intelligent segmentation algorithm was used to process image data. Finally, the quality of life and related biochemical levels of patients before and after hemodialysis were detected. Under the CT angiography of intelligent segmentation algorithm, 77 stenoses were found in 62 uremic patients, including 48 stenoses of the brachial vein and 17 stenoses of the superior vena cava. The correlation coefficient between CT angiography and digital subtraction angiography (DSA) imaging results of intelligent segmentation algorithm was 0.411. Segmentation effect of the algorithm in this study: automatic segmentation accuracy was greater than 79%. After hemodialysis treatment, the scores of physical fitness, pain, social function, and energy status of patients were significantly increased compared with those before treatment, and the levels of albumin, serum phosphorus, and parathyroid hormone were significantly decreased (P < 0.05). In summary, CT angiography with intelligent segmentation algorithm can obtain clear, intuitive, and complete vascular walking images, and better display subclavian vein, brachiocephalic vein, and superior vena cava. It can provide more valuable support for surgical intervention and has certain application value for better survival of hemodialysis patients. [ABSTRACT FROM AUTHOR]

Summary: Central venous catheter misplacement is common (approximately 7%) after right subclavian vein catheterisation. To avoid it, ultrasound‐guided tip navigation may be used during the catheterisation procedure to help direct the guidewire towards the lower superior vena cava. We aimed to determine the number of central venous catheter misplacements when using the right supraclavicular fossa ultrasound view to aid guidewire positioning in right infraclavicular subclavian vein catheterisation. We hypothesised that the incidence of catheter misplacements could be reduced to 1% when using this ultrasound technique. One ‐hundred and three adult patients were prospectively included. After vein puncture and guidewire insertion, we used the right supraclavicular fossa ultrasound view to confirm correct guidewire J‐tip position in the lower superior vena cava and corrected the position of misplaced guidewires using real‐time ultrasound guidance. Successful catheterisation of the right subclavian vein was achieved in all patients. The guidewire J‐tip was initially misplaced in 15 patients, either in the ipsilateral internal jugular vein (n = 8) or in the left brachiocephalic vein (n = 7). In 12 patients it was possible to adjust the guidewire J‐tip to a correct position in the lower superior vena cava. All ultrasound‐determined final guidewire J‐tip positions were consistent with the central venous catheter tip positions on chest X‐ray. Three out of 103 catheters were misplaced, corresponding to an incidence (95%CI) of 2.9 (0.6–8.3) %. Although the hypothesis could not be confirmed, this study demonstrated the usefulness of the right supraclavicular fossa ultrasound view for real‐time confirmation and correction of the guidewire position in right infraclavicular subclavian vein catheterisation. [ABSTRACT FROM AUTHOR]

Background. Chylopericardium is the accumulation of lymphatic fluid in the pericardial cavity. It can be idiopathic or secondary to trauma, cardiothoracic surgery, neoplasm, radiation, tuberculosis, lymphatic duct dysfunction, thrombosis, or other causes. We present a case of chylopericardium due to subclavian vein thrombosis in a patient with protein S deficiency. Clinical Case. A 48-year-old man with a history of protein S deficiency presented to the emergency department with shortness of breath and a productive cough. CT of the chest showed pulmonary emboli, moderate pericardial effusion, and a large thrombus of the superior vena cava, brachiocephalic vein, and subclavian veins. He developed echocardiographic evidence of cardiac tamponade so he underwent pericardiocentesis with drainage of milky-appearing fluid. Analysis of the fluid showed elevated triglycerides consistent with chylopericardium. The pericardial effusion reaccumulated, likely secondary to lymphatic duct obstruction due to his subclavian vein thrombus. Catheter-assisted thrombolysis was performed with resolution of the patient's effusion and symptoms. Conclusion. Chylopericardium is a rare but important complication of subclavian vein thrombosis. Management is typically with surgical intervention, although our case represents successful treatment with catheter-assisted thrombolysis. [ABSTRACT FROM AUTHOR]

Purpose This article provides evidence that detection of venous air microbubbles (VAMB) in chest computed tomography angiography (CTA) can be an indicator for "normalization of deviance" phenomenon in CT. Method and Materials Institutional review board-approved retrospective study, with waiver for informed consent. Contrast-enhanced chest CT performed during 6 months were reviewed for presence of VAMB in venous segments visible in chest CT (subclavian, brachiocephalic vein, superior vena cava) and cardiac chambers. VAMB volumes were quantified through a semiautomatic method (MIAlite plugin for OsiriX), using a region of interest (ROI) covering the bubble. With basal results, protocols for correct injection technique were reinforced, and VAMB were estimated again at 1 and 3 months. Six months later, questionnaires were sent to the CT technologists to inquire about their perception of VAMB. Descriptive measures with central distribution and dispersion were performed; statistical significance was considered at p < 0.05. Results A total of 602 chest CTA were analyzed, 332 were women (55.14%), with a median age of 58 (interquartile range [IQR] 44–72) years. Among those, 16.11% (100 cases) presented VAMB. Most were emergency department patients (51.6%), male (50.3%), with a median age of 54 (IQR 26) years. There was no difference on detection of VAMB regarding sex (p = 0.19), age (p = 0.46), or referral diagnosis (p = 0.35). Mean air bubbles volume was 0.2 mL (range 0.01–3.4 mL). After intervention, the number of exams with VAMB dropped to 3.29 % (3/91) (p < 0.001). On the 6-month query, 50% of the technicians still considered that VMAB is inevitable, and 60% thought that the occurrence is not associated to risk, and therefore, not actionable. Conclusion VAMB are a frequent finding in chest CTA, and being independent from patient-related variables, it is likely due to technical issues such as intravenous access manipulation during the exam. Reduction after reinforcement of proper performance, and certification of a low concern from CT technicians for any risk associated, provides evidence that there is normalization of deviance in this everyday procedure. [ABSTRACT FROM AUTHOR]

Temporary pacing lead is placed through the internal jugular, subclavian or femoral vein under fluoroscopic, echocardiographic, or electrocardiographic guidance. However, in most of the developing world, this procedure is done without fluoroscopic guidance. Blind procedures are known to be associated with more complications as compared to guided procedures. Here, we report a case of the right internal jugular vein perforation while placing the temporary pacing lead in an 80-year-old male patient who had permanent pacemaker implantation done 10 years back and had developed right subclavian and brachiocephalic vein stenosis. Clinicians need to be aware of this rare complication and preferably do these procedures under fluoroscopic guidance and avoid an overzealous approach if the pacing lead does not pass through easily. Patients who had undergone any procedure through their central venous system, especially with retained catheters and pacing leads in situ in the past should undergo a venogram before planning any reintervention from the ipsilateral side to avoid such complications. [ABSTRACT FROM AUTHOR]

Background: Polyarticular septic arthritis (PASA) accounts for approximately 15% of all septic arthritides and is rare in immunocompetent adults. Even with appropriate therapy PASA's mortality rate is nearly 50%.Case Report: We report a rare presentation of PASA caused by idiopathic septic thrombophlebitis of the brachiocephalic vein in an immunocompetent adult female patient who presented with symptoms of right clavicular, left wrist, and right hip pain associated with fevers. Methicillin-sensitive Staphylococcus aureus was isolated in blood cultures and joint aspiration of one of the affected hips. Transesophageal echocardiogram was negative for valvular vegetations and computed tomography chest with contrast revealed thrombi in the brachiocephalic and subclavian veins extending to the superior vena cava. It also showed bilateral pulmonary nodules consistent with septic pulmonary emboli. No clear precipitant for the underlying septic thrombophlebitis was identified. Management was conservative, with systemic anticoagulation and IV antibiotics. The patient's symptoms improved, and she was discharged to subacute rehabilitation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early diagnosis and treatment of PASA in the emergency department is imperative to reducing overall morbidity and mortality associated with this condition. To the best of our knowledge, this is the only case report of idiopathic septic thrombophlebitis of the subclavian vein causing PASA in an immunocompetent adult. [ABSTRACT FROM AUTHOR]

Background: Mispositioning is common during insertion of peripherally inserted central catheters. Ultrasonographic visualization of anatomical structures may enable continuous guidance during insertion. The aim was to investigate the feasibility of ultrasonographic real‐time guidance of peripherally inserted central catheter placement using the supraclavicular fossa view. Methods: An observational quality control study was performed including 20 patients. Ultrasonography was performed via the right supraclavicular fossa using a microconvex probe identifying the junction between the right internal jugular‐ and the subclavian vein forming the right brachiocephalic vein. The wire guide tip was identified at the junction allowing estimation of catheter length. The catheter stiffening wire was followed in real‐time into the right brachiocephalic vein towards the superior vena cava. Mispositions and the ability to redirect in real‐time were detected. Final catheter tip positions were evaluated by either fluoroscopy or a chest radiograph. Results: Catheters were successfully placed in 19/20 patients. In all patients the junction and the right brachiocephalic vein was identified. Two thrombi were identified in the right brachiocephalic vein and left‐sided insertions were performed. In 16 of 17 right‐sided insertions, wire guide and catheter stiffening wire were visible. Of the 16 visual catheters, 15 could be followed into the right brachiocephalic vein. Real‐time mispositioning was identified in eight cases and optimal redirection was successful in seven. All ultrasound‐guided catheter length estimations were adequate. Conclusions: Supraclavicular ultrasonographic real‐time guidance for peripherally inserted central catheter placement was feasible and enabled successful placement together with detection and redirection of mispositioned catheters without delay. [ABSTRACT FROM AUTHOR]

Background: Presented is a case of persistent left superior vena cava draining into the right atrium through coronary sinus and finally opens into right atrium. Abnormalities of the vascular system are more commonly seen due to its importance in circulation. Persistent left superior vena cava is rare but important congenital vascular anomaly. It results when the left superior cardinal vein caudal to the innominate vein fails to regress. The venous anomaly of a persistent left superior vena cava (PLSVC) affects 0.3%-0.5% of the general population. Normally the superior vena cava is a single vascular structure formed by the union of right and left brachiocephalic veins which are in turn formed by the union of internal jugular and subclavian veins of corresponding side, draining the head and neck as well as the superior extremity. Aims and Objective: To evaluate the accuracy of persistent left superior vena cava and to find out the opening of PLSVC and formations of both SVC. Materials and Methods: During routine dissection of Thorax, we have opened the thoracic cage and take out the Heart. during that we found separate SVC and then we did the study on this PLSVC in the Department of Anatomy, Jaipur National University Institute for Medical Sciences and Research Centre (JNUIMSRC) Jaipur and National Institute of Medical Sciences and Research (NIMS & R). Results: We found persistent left superior vena cava in two cadavers out of 30 cadavers (6.66%) one was 64-year-old male cadaver and another 72-year-old male cadaver. Both the vena cavae were formed as of brachiocephalic veins of the corresponding side. The persistent left superior vena cava opened into the enlarged coronary sinus that drained into the right atrium between the opening of inferior vena cava and right atrio-ventricular orifice. Conclusion: It has important clinical implications in certain clinical interventions. It may complicate placement of cardiac catheters or pacemaker leads. [ABSTRACT FROM AUTHOR]

Background: The background of this study was to explore the success rate and early complications concerning the implantation of totally implantable venous access devices (TIVADs) by percutaneous venipuncture and management strategies for early complications.Materials and Methods: This was a retrospective study of 1923 patients who received TIVAD implantation by percutaneous venipuncture (mostly via the supraclavicular route). The percutaneous access sites were internal jugular vein (810 patients; right/left: 158/652) or proximal right internal jugular vein, brachiocephalic vein, and proximal subclavian vein (1113 patients). Success rates and early complications related to TIVAD placement techniques were summarized, and strategies for managing complications were also analyzed.Results: In 627 patients, TIVAD implantation was first performed by interventional radiologists using a "blind" approach relying on anatomical landmarks, having a 91.9% success rate. In contrast, there was a 100% success rate among the remaining 1296 patients who received ultrasound-guided implantation, a difference which was statistically significant (P < 0.05). Ultrasound-guided implantation was also successful for the 51 patients for whom the first attempt failed using the blind technique. Further, we found that the incidence of early complications was 5.41% (104/1923) and that the occurrence of immediate complications was significantly higher in the blind technique group compared to the ultrasound-guided group (37 vs. 12; P < 0.05).Conclusions: It is safe and feasible to implant TIVADs by supraclavicular venipuncture. Ultrasound guidance combined with X-ray monitoring during operation significantly improves the surgery success rate and reduces the risk of early complications. Unclear anatomical landmarks and vascular variation are the main factors affecting success using a blind (nonguided) technique. [ABSTRACT FROM AUTHOR]

Background: Left innominate vein occlusion is a known complication of pacemaker and central venous catheter placement. For dialysis-dependent patients with an arteriovenous fistula (AVF), this can prevent successful hemodialysis and may require surgical intervention.Case Report: An 8-month-old male was diagnosed with hemolytic uremic syndrome and became dialysis-dependent at 11 months of age. After multiple vascular access and peritoneal dialysis complications, the patient had construction of a brachiobasalic AVF in his left arm at 13 years old. While waiting for the AVF to mature, an attempt to remove a previously placed left subclavian vein port-a-cath was unsuccessful and a follow-up imaging revealed that the vessel had become occluded. The fistula remained patent, but due to arm swelling and venous obstruction, his fistula was not accessible. Multiple attempts to percutaneously cross the left innominate vein were unsuccessful and the patient was referred for surgical intervention. At 15 years old, the patient was taken to the operating room for transposition of the left internal jugular vein (LIJ) to the right internal jugular vein (RIJ). The LIJ was transected under the mandible and anastomosed to the RIJ. Subsequently the patient underwent VWING insertion rather than venous transposition for constant site dialysis. Although he has required frequent transcatheter dilation of the LIJ-RIJ anastomosis, the patient was successfully dialyzed using this fistula for 5 years. The patient received a cadaveric renal transplant at 5 years 20 days.Conclusions: In cases of left innominate vein stenosis, transposing the LIJ can create a new left innominate vein that can alleviate venous hypertension and preserve fistula function. This procedure avoids sternotomy and only requires one anastomosis. [ABSTRACT FROM AUTHOR]

A 75-year-old woman visited a nearby clinic with complaints of right clavicle discomfort, and she underwent diagnostic thoracoscopic lung biopsy, being diagnosed with lung metastasis and a right-upper mediastinal mass. The superior mediastinum mass was extrapulmonary and covered by the pleura, and it was not biopsied. Papillary thyroid carcinoma was diagnosed following biopsy of the lung metastasis. Only a small tumor, with a maximum diameter of 70 mm from the right neck to the superior mediastinum, in the thyroid gland invades the internal jugular vein and subclavian vein, forming a tumor embolus in the right brachiocephalic vein and reaching the vicinity of the superior vena cava. For life-saving purposes, we obtained approval from the Cancer Board of Kanagawa Cancer Center and used lenvatinib according to unresectable undifferentiated cancer IRB approval number 28–41. The tumor had shrunk after 4 months, and surgery was performed. The postoperative course has been good, and the patient is being followed up. The patient is alive three months after surgery, and lung metastases have disappeared on CT images. This case is reported as a successful case of neoadjuvant chemotherapy and interval debulking surgery. [ABSTRACT FROM AUTHOR]

The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of clinical practice parameters, and accreditation of practices performing ultrasound. Patients with calf vein DVT, with DVT involving one of duplicated veins, or with superficial thrombophlebitis may present with tenderness or pain rather than swelling, and such cases of venous thrombus may be detected by these scans. Venous compression is applied to accessible veins in the transverse plane with adequate pressure on the skin to completely obliterate the normal vein lumen. Equipment Specifications Equipment must be capable of duplex imaging, both real-time imaging with compression of the veins and a Doppler evaluation of the blood flow signals originating from within the lumen of the veins. [Extracted from the article]

This article discusses alternative approaches to central venous cannulation (CVC) in cardiac surgery. The internal jugular vein (IJV) approach is typically preferred, but it may not always be feasible. The subclavian vein (SVC) approach is a more comfortable option during the postoperative period, but it is associated with complications. The axillary vein cannulation (AVC) approach is becoming increasingly popular as an alternative to CVC, as it has a lower risk of complications. Ultrasound guidance is recommended for safe and accurate CVC placement. The brachiocephalic vein (BCV) approach is also discussed as an effective alternative for CVC in pediatric cardiac surgery. Overall, these alternative approaches offer safer and more reliable options for CVC in cardiac surgery. [Extracted from the article]

Purpose: To assess the inter-observer agreement of color duplex ultrasound of central vein stenosis in hemodialysis patients. Patients and methods: This prospective study was conducted on 35 hemodialysis patients with suspected central vein stenosis. All patients underwent color flow duplex examination of the subclavian, internal jugular and brachiocephalic veins in hemodialysis patients. Image analysis was performed by two reviewers for diameter reduction, peak venous velocity ratio, post-stenotic turbulent flow, waveform changes, and thrombus formation. Results: There was no significant difference between both observers for diameter reduction (p = 0.105) and for the mean peak systolic velocity ratio (p = 0.515). The overall inter-observer agreement of color duplex ultrasound of central vein stenosis was excellent (k = 0.84, percent agreement = 89.7%, P = 0.001). There was excellent inter-observer agreement of both reviewers for diameter reduction (k = 0.928, percent agreement = 97.14%), peak venous velocity ratio (k = 0.7, percent agreement = 85.7%), waveform changes (k = 0.62, percent agreement = 77.14%), post-stenotic turbulent flow (k = 0.866, percent agreement = 88.6%), thrombus formation (k = 1, percent agreement = 100%). Conclusion: We concluded that color duplex ultrasound is a reliable and reproducible method for diagnosis of central vein stenosis in hemodialysis patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

A 16-month-old girl who was hospitalized with pneumonia and treated with antibiotics died after the nurse erroneously connected her intravenous left forearm catheter to the oxygen supply. Autopsy revealed an impressive gas embolism in the left subclavian and brachiocephalic veins, reduced crepitus and enlarged lung volume, and congestion of the meningeal vessels with some areas showing small air bubbles. Dilation of the right atrium and the right ventricle with efflux under pressure of large amounts of air bubbles were observed. The coronary arteries and veins were filled with air bubbles intercalated with segments containing blood. After exclusion of putrefactive artifacts as the source of such a large amount of gas in the body death was considered to be due to a massive air embolism. While embolisms are well recognized in adults, these cases are only infrequently encountered in forensic practice in younger decedents. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the treatment success rate of percutaneous transluminal angioplasty (balloon angioplasty) for peripheral and central venous stenosis in hemodialysis patients. Study Design: Retrospective/observational study. Place and Duration of Study: Department of Cardiology, Shaikh Zayed Hospital Lahore from 1st January 2018 to 30th June 2018. Methods: Thirteen patients of both genders presenting during from two years of hemodialysis failure and ipsilateral arm and neck swelling followed by peripheral and central venous stenosis were included in this study. Patients ages were ranging from 25 to 70 years. Patient’s detailed history including hemodialysis treatment, age, sex, socio-economic status was examined after taking informed consent from the patients. Percutaneous transluminal angioplasty (PTA) was performed at all the patients. Procedural success rate was examined. Results: There were 9 (69.23%) patients were men and rest (13.77%) were women. 5 (38.46%) patients were ages between 25 to 45 years, 6 (46.15%) patients had an ages 46 to 65 years and 2 (15.38%) patients were ages greater than 65 years. 10 (76.92%) had rural residency. 40 % patients had income >30000 PKR. Location and severity of lesions was examined as brachiocephalic vein, subclavian vein, Axillary vein, basilica, cephalic and median cubtal vein in 1,3,2,3,3 and 1 patients respectively. We determine priority patency rate in central lesion PTA was 82.7%, 62% and 38% at 3, 6 and 12 months and priority patency rate in peripheral lesions PTA was 87%, 79.5% and 67.8% at 3, 6 and 12 months. Conclusion: It is concluded that percutaneous transluminal angioplasty (balloon angioplasty) procedure for treatment of central and peripheral venous stenosis in hemodialysis patients was safe and effective with no procedural complications. [ABSTRACT FROM AUTHOR]

Highlights from the article: Indications for placement of an implantable portacath include the administration of an intravenous treatment that may be toxic to the superficial veins such as chemotherapy, or parenteral nutrition, or in order to preserve the venous capital. Several techniques can be used; either by direct venipuncture of the internal jugular vein [1], or the subclavian vein [2], or by a surgical approach to the cephalic vein. Sutures should be tied down carefully to avoid catheter occlusion and the permeability of the catheter must be verified by flushing.

Background Central venous stenosis (CVS) is a serious problem in hemodialysis (HD) patients, often presenting with symptoms of venous hypertension. Endovascular treatment is aimed to provide symptomatic relief and to maintain HD access patency. Aim To evaluate our experience in the endovascular treatment of CVS in HD patients and to determine the relationship between the temporary catheter insertion, the type of arteriovenous fistula, and development of CVS. Patients and methods A prospective study was carried out on 30 patients with End Stage Renal Disease (ESRD) undergoing HD presented with symptomatic venous hypertension in the same side of vascular access, between October 2015 and October 2017. All the patients underwent endovascular treatment and were analyzed. Results A total of 30 (20 male and 10 female) patients underwent endovascular interventions for CVS during a time period of 2 years, where 20 stenotic segments were in subclavian vein, six in innominate vein, and four in iliac veins. The technical success rate for endovascular treatment was 80%. Eighteen (75%) patients were treated by ballooning of the stenosed segment alone, whereas six (25%) patients needed primary stenting owing to tight recoiling of the stenotic lesion. Four patients needed reintervention during follow-up (three cases managed by balloon dilatation alone and one needed venous stent after dilatation). Conclusion Endovascular treatment is safe and effective in managing CVS. The incidence of CVS is higher with central venous catheter insertion and proximal arteriovenous fistula. [ABSTRACT FROM AUTHOR]

Background: This paper reviews our experience with penetrating cervical venous trauma and aims to validate the selective non-operative management (SNOM) of these injuries.Methods: This was a retrospective review of a prospectively maintained registry. All patients presenting alive with an injury to the internal jugular vein, subclavian vein or innominate vein following a PNI were reviewed for a 6-year period.Results: Among 817 patients admitted for the management of PNI, 76 (9.3%) had a venous injury. Of these, 37 (48.7%) patients were managed non-surgically, 20 (26.3%) required immediate surgical exploration, seven of whom had an associated arterial injury, and 19 (25%) underwent surgery following a diagnostic CTA, 16 of whom had an associated arterial or aero-digestive injury. In total, only 16 (21.1%) of the 76 patients required exploration for venous injury alone. The majority (63.2%) of patients had a history of severe bleeding or hemodynamic instability prior to arrival, but only 20 (26.3%) required immediate exploration. Two (2.6%) patients died as a result of venous injury. No patients developed complications related to the venous injury.Conclusions: SNOM is applicable to a well-defined subset of patients with isolated penetrating cervical venous trauma to the IJV and SCV identified on CTA. [ABSTRACT FROM AUTHOR]