Search

Thymic squamous cell carcinoma (TSCC) is a rare yet aggressive tumor associated with a dismal prognosis. The patient, a 76-year-old male, presented with symptoms of fatigue, bloody sputum and dyspnea. Computed tomography (CT) and positron emission tomography/computed tomography (PET/CT) scans demonstrated a significant mass in the chest, accompanied by metastasis to adjacent lymph nodes. Vascular ultrasound and CT angiography both indicated thrombosis in the jugular, innominate, and left subclavian veins. A CT-guided needle biopsy subsequently confirmed the diagnosis of TSCC. The patient had an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) score of 4 and exhibited high PD-L1 expression. The treatment plan entailed multiple administrations of low-dose carboplatin via intrapleural injection, infusions of albumin-bound paclitaxel (ABP), and pembrolizumab. Concurrent anticoagulation and nutritional therapy were also provided. A combination of carboplatin and ABP was administered for six cycles, followed by a single cycle of ABP alone. Subsequently, pembrolizumab was administered for ten cycles. After this, pembrolizumab was temporarily discontinued, and radiation therapy was administered to the primary tumor site and mediastinal lymph nodes. Five weeks later, pembrolizumab therapy was resumed. The patient's PS has recovered to 0, and have survived for 23 months with a good quality of life. This experience suggests that combining pembrolizumab with low-dose chemotherapy drugs could be a beneficial treatment option for patients with advanced TSCC, poor PS, and high PD-L1 expression. [ABSTRACT FROM AUTHOR]

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]

Introduction: Men are generally more susceptible to bacterial infections than women. Central venous catheters (CVCs), often used to administer systemic treatment in patients with cancer, are an important source of infection. However, little is known about sex-specific differences of CVC-related bloodstream infections (CRBSIs) in patients with cancer. This study aimed to compare CRBSIs in men versus women in a large cohort of patients with cancer. Methods: Data were derived from the SECRECY registry including nonselected patients with centrally inserted non-tunneled internal jugular or subclavian vein CVCs in 10 hematology and oncology sites in Germany. Only CRBSIs classified as definite CRBSI (dCRBSI) or probable CRBSI were included, and the combination of both was summarized as dpCRBSI. CVCs were matched 1:1 for underlying disease, anatomic site of CVC insertion, type of CVC dressing, antimicrobial coated CVC, complicated CVC insertion, and CVC in situ time by propensity score matching (PSM). Endpoints were CRBSI rates and incidences in CVCs inserted in men versus women. Results: A total of 5,075 CVCs registered from March 2013 to March 2024 were included in the analysis, of which 3,024 comprise the PSM cohort. A total of 1,512 (50.0%) CVCs were inserted in men. Underlying diseases mainly were hematological malignancies (96.4%). While there was no statistically significant difference between men and women in the dCRBSI rate (5.4% vs. 4.1%; p = 0.12) and the dCRBSI incidence (3.8 vs. 2.9/1,000 CVC days; p = 0.11), the rate of dpCRBSI (9.9% vs. 6.7%; p = 0.002) and the dpCRBSI incidence (7.0 vs. 4.7/1,000 CVC days; p = 0.002) were significantly higher in men versus women. The proportion of coagulase-negative staphylococci as causative agent of both dCRBSI and dpCRBSI was higher in men than in women (58.8% vs. 41.2%; p = 0.07 and 61.5% vs. 38.5%; p = 0.002, respectively). A multivariable regression revealed neutropenia as an independent risk factor for dCRBSI and male sex as risk factor for dCRBSI and dpCRBSI. Conclusion: In patients with hematological malignancies, men have a higher risk of CRBSI than women. This finding may be attributed to the high number of jugular vein-inserted CVCs, which in men may be associated with higher rates of skin colonization than in women. Special preventive measures such as earlier removal of CVCs in men may be studied in future. Introduction: Men are generally more susceptible to bacterial infections than women. Central venous catheters (CVCs), often used to administer systemic treatment in patients with cancer, are an important source of infection. However, little is known about sex-specific differences of CVC-related bloodstream infections (CRBSIs) in patients with cancer. This study aimed to compare CRBSIs in men versus women in a large cohort of patients with cancer. Methods: Data were derived from the SECRECY registry including nonselected patients with centrally inserted non-tunneled internal jugular or subclavian vein CVCs in 10 hematology and oncology sites in Germany. Only CRBSIs classified as definite CRBSI (dCRBSI) or probable CRBSI were included, and the combination of both was summarized as dpCRBSI. CVCs were matched 1:1 for underlying disease, anatomic site of CVC insertion, type of CVC dressing, antimicrobial coated CVC, complicated CVC insertion, and CVC in situ time by propensity score matching (PSM). Endpoints were CRBSI rates and incidences in CVCs inserted in men versus women. Results: A total of 5,075 CVCs registered from March 2013 to March 2024 were included in the analysis, of which 3,024 comprise the PSM cohort. A total of 1,512 (50.0%) CVCs were inserted in men. Underlying diseases mainly were hematological malignancies (96.4%). While there was no statistically significant difference between men and women in the dCRBSI rate (5.4% vs. 4.1%; p = 0.12) and the dCRBSI incidence (3.8 vs. 2.9/1,000 CVC days; p = 0.11), the rate of dpCRBSI (9.9% vs. 6.7%; p = 0.002) and the dpCRBSI incidence (7.0 vs. 4.7/1,000 CVC days; p = 0.002) were significantly higher in men versus women. The proportion of coagulase-negative staphylococci as causative agent of both dCRBSI and dpCRBSI was higher in men than in women (58.8% vs. 41.2%; p = 0.07 and 61.5% vs. 38.5%; p = 0.002, respectively). A multivariable regression revealed neutropenia as an independent risk factor for dCRBSI and male sex as risk factor for dCRBSI and dpCRBSI. Conclusion: In patients with hematological malignancies, men have a higher risk of CRBSI than women. This finding may be attributed to the high number of jugular vein-inserted CVCs, which in men may be associated with higher rates of skin colonization than in women. Special preventive measures such as earlier removal of CVCs in men may be studied in future. [ABSTRACT FROM AUTHOR]

The article in CVIR Endovascular discusses the use of direct percutaneous puncture of occluded venous stents as an adjunctive technique to restore patency in patients with chronic venous diseases. The study involved four patients who underwent this procedure after conventional endovascular techniques failed. The technique was successful in all patients, with no adverse events reported, demonstrating its feasibility and usefulness as an escalation technique in recanalizing chronically occluded venous stents. [Extracted from the article]

ABSTRACT Introduction Purpose Methods Results Conclusions Ultrasound (US)‐guided axillary vein puncture is a safe and effective approach for cardiac implantable electronic device (CIED) implantation, and it is highly recommended by the current consensus document. However, only reports on small populations are available in the current literature regarding the comparison of this technique with other traditional approaches (subclavian vein blind puncture and cephalic vein surgical cutdown).We aimed to assess the effectiveness and safety of US‐ guided axillary vein puncture using a microintroducer kit for CIED implantation as compared to the aforementioned traditional approaches.All consecutive patients with an indication to CIED implantation were prospectively enrolled in our observational study from March 2021 to July 2023. Patients were divided into three groups based on venous access route, according to the operator's preference: cephalic vein surgical cutdown (G1), US‐guided axillary vein puncture (G2), and subclavian vein blind puncture (G3). Clinical and procedural characteristics, success and complication rates were considered for analysis.A total of 1000 patients (65.2% male, mean age 75.5 ± 10.8 years) were enrolled. Cephalic vein surgical cutdown was chosen in 172 (G1, 17.2%), US‐guided axillary access in 433 patients (G2, 43.3%), and subclavian vein in 395 (G3, 39.5%). Success rate was 77.6% in G1, 96.3% in G2, and 97.2% in G3 (G2 vs. G3, p = 0.5; G1 vs. G2, p < 0.0001; G1 vs. G2. vs. G3, p < 0.0001). Compared to subclavian and cephalic groups, in the US‐guided axillary group, a successful access was obtained with a reduced mean number of puncture attempts (G2 vs. G3: 1.3 ± 0.9 vs. 1.8 ± 1, p < 0.0001) and needed reduced times to get access (G2 vs. G3: 15 s [10–30 s] vs. 40 [20–65 s]; p < 0.0001, G1 vs. G2: 210 s [180–247 s] vs. 15 s [10–30 s]; p < 0.0001) and to reach the superior vena cava, without differences in total procedural times (72.9 ± 30.4 vs. 75.7 ± 34.8 min, p = 0.24). Bailout fluoroscopy times [1 (0–8) s vs. 20 (10–58) s, p < 0.0001] and usage of vein angiography (11.9% vs. 51.3%, p < 0.0001) were lower in G2 as compared to G3. Complication rate did not differ among the three study groups (early complications: 2.9% in G1, 2.5% in G2, and 2.5% in G3, p = 0.96; late complications: 2.9% in G1, 1.6% in G2, and 0.8% in G3, p = 0.15).US‐guided axillary vein puncture for CIED implantation using a microintroducer kit is a safe technique with a very high success rate. Compared to other traditional approaches, it allows to get access with a lower number of puncture attempts and with reduced times, without prolonging the total procedural time. Moreover, x‐ray use and need for contrast medium are very rare in US‐guided axillary approach. Hence, it should be considered the strategy of choice for most patients undergoing CIED implantation. [ABSTRACT FROM AUTHOR]

Background: Central venous catheterization by anesthesiologists carries risks such as accidental arterial puncture. This case report highlights a rare subclavian artery aneurysm (SAA) detected during ultrasound-guided internal jugular vein (IJV) access, emphasizing the importance of recognizing anatomical variations. Case: An 88-year-old female with hypertension and atrial fibrillation was scheduled for lumbar laminectomy and posterior fusion. Preoperative evaluation revealed right lower lobe atelectasis and mild aortic sclerosis. During ultrasonography for right IJV catheterization, two vessels of different diameters were observed on the common carotid artery's lateral side. The larger vessel disappeared at the upper neck level, showing arterial pulsation on Color Doppler. Postoperative neck computed tomography confirmed a right SAA and a 5-mm saccular aneurysm in the left intracranial artery. The patient had no vascular disease, trauma, or relevant family histories. Conclusions: Anesthesiologists should be aware of anatomical variations during IJV catheterization. Ultrasound with Doppler is crucial for accurate artery identification. [ABSTRACT FROM AUTHOR]

The article discusses a case of effort-induced upper extremity deep vein thrombosis in a healthy painter, highlighting the importance of recognizing this uncommon condition. The patient presented with pain and swelling in the right upper limb, which was diagnosed through venous ultrasound. Treatment involved early anticoagulation, with catheter-directed thrombolysis and first rib resection being common therapeutic approaches. The case underscores the need for suspicion of primary UEDVT in young individuals engaged in repetitive upper extremity movements, emphasizing the importance of prompt diagnosis and appropriate management to prevent complications. [Extracted from the article]

Pupose: This study aims to reveal the relationship of the phrenic nerve (PhN) with its neighboring structures in the lower neck region more comprehensively than previous studies and to minimize nerve damage by enabling invasive procedures in this region to be performed with high accuracy. Methods: Forty-one heminecks were evaluated. The relationship between the PhN and the anterior scalene muscle (ASM), internal thoracic artery (ITA), branches of subclavian artery (SA) and subclavian vein (SV) was examined. Results: It was observed that the PhN was located medial to the ASM in all cases. The distances were higher in male cadavers. The PhN was found to enter the thorax lateral to the ITA in 15/41 and medial to it in 25/41 sides. In 17/41 cases, the closest SA branch to the PhN was the thyrocervical trunk (TT) and in 24 cases the ITA. The PhN was located behind the SV in 38 cases and in front of it in 2 cases.The accessory PhN was found in 4/41 sides. There was no significant difference in morphometric findings between genders (p > 0.05). However, significant differences were observed between the parameters (p < 0.05). Conclusion: The anatomy and variations of the PhN are of great importance in surgical interventions and invasive procedures in the neck region. The study provides important information to reduce the risk of damage to the PhN in surgical procedures. In addition, knowledge of the anatomical variations of the nerve may contribute to more successful results in nerve grafting and other surgical applications. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this observational study was to investigate the risk factors of a failed first attempt at pediatric central venous catheter (CVC) placement and its impact on CVC-related morbidity. Materials and Methods: In this prospective observational study, we included 3-month-to 5-year-old children proposed for infraclavicular subclavian vein catheterization consecutively sing the anatomic landmark technique. Patients were divided into two groups: group 1 included single-attempt catheter placements, and Group 2 included failed first attempts at catheter placement. The management protocol was standardized for all patients. After comparing the two groups, univariable logistic regression was used to investigate the risk factors for a failed first attempt and to show the interest of the single-attempt catheter placement. Results: Among 150 pediatric CVC placements, the incidence of failed first attempts was 41.3% and its main risk factors were children with comorbidities (OR=3.11; 95%CI: 1.17–8.21), hematology and oncology patients (OR=5.6; 95%CI: 2.75–11.38), children with aplastic anemia (OR=3.05; 95%CI:1.388–6.705), and anesthesia sedation with I-Gel airway ventilation (OR=9.21; 95%CI: 1.080–78.5). On the other hand, a single-attempt catheter placement was a protective factor against catheter-related complications with OR=0.258 [0.12–0.55]. Conclusion: It seems that a single-attempt CVC placement may reduce the incidence of complications. The knowledge of the main risk factors of failed first attempts is mandatory for taking necessary precautions. [ABSTRACT FROM AUTHOR]

Background/aim: To investigate the possible morbidities associated with the implantation of a totally implantable venous access device (TIVAD) in breast cancer (BC) patients. Materials and methods: Clinical data and developed complications in 546 BC patients with TIVAD between 2017 and 2021 were analyzed retrospectively. Among these, 524 (96%) patients who underwent TIVAD implantation via the right subclavian vein (SCV) route were examined separately. Results: The mean patient age was 56.1 ± 11.4 years, and the mean patient body mass index was 25.3 ± 6.5. The incidence of early complications was 2.3% (12 cases), and the late complication incident rate was 2.6% (14 cases). Among these complications, ten (1.9%) catheter-related infections developed more frequently than others. Early complications increased as the number of puncture attempts rose and decreased with ultrasound guidance in the implantation, but no other predictive factors increased. No correlation existed between the patients' age, body mass index, BC side, puncture method, puncture number, surgical approach, radiotherapy, and late complications. There was no evidence that postoperative effects specific to BC surgery, such as increased pain, decreased functional capacity, and lymphedema, were altered with TIVAD implantation. For catheter-related infections only, adjuvant radiotherapy was a risk factor for patients with various comorbidities. Conclusion: This study concludes that the right SCV approach remains a morbidity-safe route for TIVAD implantation in BC patients, as in other malignancies. The study suggests that clinicians can use other implantation routes to avoid catheter-related infection in patients scheduled for neoadjuvant treatment, who also have morbidity, and who are likely to receive postoperative radiotherapy. [ABSTRACT FROM AUTHOR]

Objectives: This report presents a rare anatomical variation, double fenestration of the External jugular vein on the right side. Materials and methods: During the routine dissection of a male cadaver aged 60 years, we observed a unilateral large double fenestration of the External jugular vein on the right side. Results: After its formation from the posterior division of the retromandibular and posterior auricular veins, External jugular vein descended in the posterior triangle of neck. Here, it divided into medial, intermediate, and lateral veins that united again before draining into the subclavian vein. Lateral vein was the largest (7.2 cm) and intermediate and medial veins were measuring 6.4 cm each. Two large fenestrations, measuring 5.8 cm each, arranged like a "double bubble" were seen in the External jugular vein extending from fourth to sixth cervical (C4 to C6) vertebrae. The medial branch of supraclavicular nerve was seen passing superficial to the distal part of External jugular vein. On the left side, the course of External jugular vein showed a standard pattern. Conclusion: Surgeons must be acquainted with the varied anatomy of the superficial neck veins to prevent major bleeding during operative procedures, including carotid endarterectomy, flap operations, & central venous catheterisation. [ABSTRACT FROM AUTHOR]

The American Institute of Ultrasound in Medicine (AIUM) revised the Practice Parameter for the Performance of Vascular Ultrasound for Postoperative Assessment of Hemodialysis Access in collaboration with other organizations. The document provides recommendations for personnel requirements, documentation, quality assurance, and safety for ultrasound examinations. It addresses the importance of monitoring hemodialysis access to detect complications and ensure proper function, with specific guidelines for evaluating AVFs and grafts. The parameter emphasizes the need for accurate documentation, equipment specifications, and adherence to quality and safety standards in ultrasound practices. [Extracted from the article]

Background: A heart positioned on the right side of the thorax can be more a complex situation than it seems, also the potentially associated congenital cardiopathies are variable. In this regard, patients with dextrocardia presenting with complete atrioventricular block require a thorough anatomical investigation to map the veno-arterial system and potential cardiovascular defects before proceeding with a permanent pacing procedure. Case presentation: A 73-year-old Caucasian woman with no significant medical history presented with syncope. Physical examination showed regular heart sounds with an average heart rate of 35–40 beats per minute and no other relevant physical findings. Chest X-rays revealed a heart positioned in the right hemithorax. A standard electrocardiogram revealed complete atrioventricular block with junctional escape rhythm at nearly 35–40 beats per minute. A transthoracic echocardiogram showed a mirror image dextrocardia without any other remarkable abnormalities. Venogram performed using the left peripheral cephalic vein showed normal venous return into the right atrium positioned on the left side. Surgical intervention consisted of permanent dual chamber pacemaker implantation using the left subclavian vein. Discussion is provided based on the relevant medical literature outlining different potential scenarios with associated cardiac and major vessels abnormalities. Conclusion: This case highlights an atypical presentation of atrioventricular block in a patient with dextrocardia and situs inversus, for whom a successful dual-pacemaker implantation procedure was performed. [ABSTRACT FROM AUTHOR]

Background: Central venous catheterization, crucial for device insertion, monitoring, medication, and fluid resuscitation, commonly uses the subclavian, internal jugular, and femoral veins. Despite its general safety, complications like arterial puncture can be life-threatening, requiring rapid diagnosis and treatment. Case presentation: A 74-year-old woman in the recovery phase of cerebral infarction underwent right subclavian vein catheterization. The catheter was mistakenly placed in the brachiocephalic trunk, with its tip in the ascending aorta, as confirmed by computed tomography (CT) and digital subtraction angiography (DSA). With the high surgical risk and the complexity of endovascular treatment, catheter replacement was chosen. One month after the initial placement, the catheter was replaced with a smaller one, and another month later, it was retracted without complications. Follow-up CT and DSA revealed no leakage, with the patient's vitals remaining stable. A three-month post-discharge phone follow-up confirmed the patient's continued stability. Conclusion: This case demonstrates the effective use of a catheter replacement technique as a minimally invasive repair method when other options are impractical. Ultrasound guidance is also recommended to improve the procedure's accuracy and safety. [ABSTRACT FROM AUTHOR]

Anaplastic thyroid carcinoma (ATC) with retrosternal extension is a very uncommon and extremely aggressive malignancy with an exceptionally poor prognosis. This cancer usually infiltrates the surrounding anatomic structures as well as metastasizes into the neck or upper mediastinal lymph nodes. Multimodal treatment including surgery, chemo-radiotherapy, and targeted and immunotherapies serves for the cure, ameliorates the symptoms, or prolongs the survival. Radical surgery remains the most effective treatment modality, but unfortunately, it is not always applicable. Neoadjuvant therapies may render the tumor into an operable one and give a real chance for healing. In this article, we report a case of a 75-year-old man with loco-regional advanced anaplastic (undifferentiated) high-grade thyroid carcinoma mixed with papillary carcinoma. It was performed a cervicotomy, proximal partial median sternotomy, total thyroidectomy, partial resection of the right prethyroid and sternocleidomastoid muscles, medial part of the right clavicle, upper right corner of manubrium, right sternoclavicular joint, right internal jugular vein, right vagal and phrenic nerves, partial resection of the right subclavian vein, and patch plasty of the latter with pericardium, pericardial fenestration. The patient was referred to adjuvant radiotherapy. [ABSTRACT FROM AUTHOR]

Central venous catheterization (CVC) is crucial in paediatric care but presents unique challenges, including malpositioning. This series discusses four cases highlighting complications and management strategies. An infant with congenital cardiac anomalies required repositioning of a PICC line due to jugular malposition. A preterm neonate's CVC was found extravascular, necessitating removal under surgical supervision. Additional cases involved misplacement in the subclavian vein and overlying the right ventricle, both successfully corrected. These instances underscore the importance of proper technique, monitoring, and the use of diagnostic tools to enhance patient safety and minimize complications associated with CVC insertion in children. [ABSTRACT FROM AUTHOR]

Introduction: Although the subclavian vein offers significant advantages over other approaches for ultrasound-guided central venous access, it is not the first choice in the pediatric population, mainly due to its proximity to the pleura and the subclavian artery. Objective: To assess the sonoanatomical characteristics of the subclavian vein and adjacent structures using the supraclavicular approach in a pediatric population. Materials and methods: Observational, intraoperative, cross-sectional study, between June 2021 and March 2022. The population consisted of ASA I, II and III children taken to non-emergent surgical procedures under general anesthesia. Images were acquired with the patients under general anesthesia, using a high-frequency linear probe to identify the subclavian vein and measure the anatomical landmarks. Results: A total of 67 children were recruited; mean age was 6 years (IQR: 2-12 years), with male sex predominance (61%). Median weight was 22 kg (IQR: 12.2-34 Kg) and median height was 115 cm (IQR: 88-142 cm). Measurements in relation to the vessel showed a mean distance from the skin of 0.70 cm (SD: 0.18 cm), while mean distance from the skin to the pleura was 1.31 cm (SD: 0.28 cm). Mean vein diameter was 0.49 cm (IQR: 0.40-0.63 cm). The mean hypothetical approach angle to the vessel was 22.09 degrees (SD: 4.37 degrees), while the approach angle to the pleura was 39 degrees (SD: 5.31 degrees). No concurrent visualization of the vein and artery was documented in any of the recorded sonoanatomy windows. The tests pointed to an average difference of 0.61 cm in vessel depth in relation to the pleura, and the angle of approach to the vessel was 16.91 degrees smaller when compared with the angle of approach to the pleura (p < 0.001). Conclusions: Using this technique, the supraclavicular approach to the subclavian vein in children is safe and feasible, with an average skin-to-vessel distance of 0.70 cm, minimizing the risk of pleural puncture. Additional studies are required to optimize this technique in the pediatric population. [ABSTRACT FROM AUTHOR]

Background: Hypotension following induction of general anesthesia (GA) is commonly observed. Ultrasound (US) measurement of collapsibility index (CI) of the inferior vena cava (IVC) for predicting postinduction hypotension has been studied. As there is limited data available comparing the diagnostic accuracy of subclavian vein (SCV) versus IVC‑CI, we performed this observational study. Methods: A total of 132 adult patients scheduled for elective surgery under GA were enrolled. US measurements of three readings of maximum and minimum diameters of SCV and IVC were recorded during both quiet and deep breathing, and the mean of three values was calculated. CI was derived using the formula: (dmax – dmin) × 100/dmax. Subsequently, GA was administered using standard technique, irrespective of the findings of SCV and IVC measurements. The administered drugs and dosage were recorded. Hemodynamic parameters were collected at baseline and then at every minute for the first 20 min. The primary objective was to compare the diagnostic accuracies of SCV‑CI and IVC‑CI for prediction of postinduction hypotension during quiet breathing. The secondary objectives were to compare the diagnostic accuracies during deep breathing and find the correlation between IVC‑CI and SC‑CI during quiet and deep breathing, incidence of hypotension, and time required to acquire US images. Results: Fifty‑seven patients developed postinduction hypotension. During quiet breathing, SCV‑CI ≥10% had a sensitivity of 68% and specificity of 56% (area under curve [AUC] [95% confidence interval {CI}] of 0.659 [0.56–0.75]; P = 0.002), while IVC‑CI ≥34% had a sensitivity of 70% and specificity of 59% (AUC [95% CI] of 0.672 [0.58–0.76]; P = 0.001) for prediction of postinduction hypotension. During deep breathing, both SCV‑CI and IVC‑CI had moderate accuracy (P = 0.001 for both). Pearson’s correlation showed a significant positive correlation between SCV‑CI and IVC‑CI with a correlation coefficient (r) of 0.313 during quiet breathing and 0.379 during deep breathing (P < 0.001). The time required for acquiring US images was significantly less for SCV compared to IVC during both quiet and deep breathing (P < 0.001 for both). Conclusion: Both SCV‑CI and IVC‑CI were found to have good and comparable diagnostic accuracy for the prediction of postinduction hypotension. We also found a significant positive correlation between SCV‑CI and IVC‑CI. In comparison to IVC, US scanning of SCV took lesser time to acquire the images. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is number one reason for hospitalization in people over 65 years with nearly 1 million patients hospitalized every year in US and Europe. Objectives: To study the correlation between invasive central venous pressure (CVP) and collapsibility indices of internal jugular veins (IJVs) and inferior vena cava (IVC) utilizing ultrasonography in hospitalized HF patients. Methods: This prospective observational study had been conducted on 55 participants aged from >18 years old with decompensated HF admitted to CCU of Menoufia University hospitals. Clinical evaluation was done by using EVEREST score. CVP catheter was inserted via right (RT) subclavian vein. Ultrasound examination was performed using the GE Vivid S5 diagnostic US system. Results: There was positive correlation between CVP and expiration diameter of (IVC, RT IJV and LT IJV) at admission and discharge. Negative correlation existed between CVP and CI of (IVC, RT IJV and LT IJV) at admission and discharge. CVP, expiration, inspiration diameter of (IVC, RT IJV and LT IJV) and EVEREST score had been significantly lower at discharge contrasted to at admission (P <0.001). CI of (IVC, RT IJV and LT IJV) were significantly greater at discharge compared to at admission. Conclusions: Assessment of diameters of IVC, RT IJV and LT IJV showed strong positive correlation with invasive CVP. CI of IVC, RT IJV and also LT IJV showed strong negative correlation with invasive CVP. LT IJV can be used as an indicator for follow up volume status but less sensitive than RT IJV. [ABSTRACT FROM AUTHOR]

Aim and background: Central lines are an integral part of resuscitation in a collapsing patient in the emergency department (ED). The common sites for insertion of central venous access are the internal jugular vein, femoral vein, and subclavian vein. The most frequently encountered complications in internal jugular access are pneumothorax, carotid artery puncture and cannulation, guidewire entrapment, and hematomas. Case description: We present a case of a 60-year-old female with arch of aorta cannulation leading to brachial artery thrombosis and limb ischemia. Conclusion: Arch of aorta cannulation and acute limb ischemia are vascular emergencies. Proper evaluation of landmarks, positioning of the patient, use of ultrasound-guided approach, correlation of arterial/venous blood gas analysis, proper anatomical acknowledgment on chest radiography and waveform analysis may prevent complications. Clinical significance: The complications associated with aortic cannulation increase the risk of stroke and arterial injury, which can further lead to complications such as hematoma formation, pseudoaneurysm, fistula, and even death. Manipulating the aorta during cannulation can cause a tear in its layers, leading to aortic dissection. We need to remember that accidental arterial puncture occurs in a small percentage of cases during jugular or subclavian approaches for central venous catheter (CVC) placement. While CVCs are essential for various medical purposes, proper technique, vigilance, and awareness of potential complications are crucial for patient safety. [ABSTRACT FROM AUTHOR]

Copyright of Pediatrie pro Praxi is the property of SOLEN sro 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.)

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]

Simple Summary: This research investigates the effectiveness and safety of totally implantable vascular access devices (TIVADs) used for delivering treatments such as chemotherapy. Over a five-year period, 70 patients received TIVADs through a standardized surgical method under local anesthesia. The study found very low complication rates, with only two notable incidents: one device needed adjustment due to a flipped catheter, and one infection occurred after over three years of use. The procedural success rate was 100%, with devices typically lasting around 22 months, and some even up to five years. These findings suggest that TIVADs are a reliable and safe option for long-term venous access, significantly benefiting routine clinical practices. Background: Daily clinical practice requires repeated and prolonged venous access for delivering chemotherapy, antibiotics, antivirals, parenteral nutrition, or blood transfusions. This study aimed to investigate the performance and the safety of totally implantable vascular access devices (TIVADs) over a 5-year follow-up period through a standardized well-trained surgical technique and patient management under local anesthesia. Methods: In a retrospective, observational, and monocentric study, 70 patients receiving POLYSITE® TIVADs for chemotherapy were included. The safety endpoints focused on the rate of perioperative, short-term, and long-term complications. The performance endpoints included vein identification for device insertion and procedural success rate. Results: The study demonstrated no perioperative or short-term complications related to the TIVADs. One (1.4%) complication related to device manipulation was identified as catheter flipping, which led to catheter adjustment 56 days post-placement. Moreover, one (1.4%) infection due to usage conditions was observed, leading to TIVAD removal 3 years and 4 months post-surgery. Catheter placement occurred in cephalic veins (71.4%), subclavian veins (20%), and internal jugular veins (8.6%). The procedural success rate was 100%. Overall, the implantable ports typically remained in place for an average of 22.4 months. Conclusions: This study confirmed the TIVADs' performance and safety, underscored by low complication rates compared to published data, thereby emphasizing its potential and compelling significance for enhancing routine clinical practice using a standardized well-trained surgical technique and patient management. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Venous spasm is an important reason for complicated or failed implantations of cardiac implantable electronic devices. Prevention or risk reduction of venous spasm during cardiac implantable electronic device implantation may be achieved by ultrasound or fluoroscopic imaging prior to puncture, cephalic vein cut‐down, sufficient pre‐ and perioperative hydration, nitroglycerin injection and effective sedation, and analgesia. This case report with literature review focuses on venous spasm as a potential cause for complicated implantations of cardiac implantable electronic devices. The case report is clinically relevant as it describes a progressive spasm affecting the axillary and the subclavian vein. A 66‐year‐old female complained of symptomatic atrial fibrillation (AF) and atypical atrial flutter despite interventional and medical treatment. As an ultimate treatment, she was scheduled for pacemaker implantation and atrioventricular node ablation. Several puncture attempts of the axillary vein failed. Despite venous blood aspiration, no guidewires could be advanced into the axillary vein. We performed a first venogram revealing significant spasm of the axillary vein. Another failed venous puncture occurred after change of access site to the subclavian vein. A second venogram displayed progression of the spasm, now affecting both the axillary and the subclavian veins. Normal saline perfusion was administered as well as intravenous isosorbide. Unfortunately, a repeated venogram after 15 min waiting time showed persistence of the spasm, still affecting both veins. The procedure was discontinued as the patient became uncomfortable. Venous spasm is an important reason for complicated or failed implantations of cardiac implantable electronic devices. Commonly used medical prevention and treatment are intravenous fluids and nitroglycerin. Prevention or risk reduction of venous spasm during cardiac implantable electronic device implantation may be achieved by ultrasound or fluoroscopic imaging prior to puncture, cephalic vein cut‐down, sufficient pre‐ and perioperative hydration, nitroglycerin injection and effective sedation and analgesia. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Multiple methods are used to tackle ipsilateral obstructed venous access in patients undergoing a device upgrade by implanting a new left ventricular lead. One feasible solution to tackle this is implantation of the upgrade lead contralaterally with pre‐sternal tunnelization to the opposite side under conscious sedation. [ABSTRACT FROM AUTHOR]

Introduction: The establishment of venous access is one of the driving factors for complications during implantation of pacemakers and defibrillators (cardiac implantable electronic devices [CIED]). Recently, a novel approach of accessing the cephalic vein for CIED by cephalic vein puncture (CVP) using a modified Seldinger technique has been described, promising high success rates and simplified handling with steeper learning curves. In this single‐center registry, we analyzed the safety and efficiency of CVP to SVP access after defining CVP as the primary access route in our center. Methods: A total of 229 consecutive patients receiving a CIED were included in the registry. Sixty‐one patients were implanted by primary or bail‐out SVP; 168 patients received primary cephalic preparation and CVP was performed when possible, using a hydrophilic transradial sheath. Results: Implantation of at least one lead via CVP was successful in 151 of 168 patients (90%), and implantation of all leads was possible in 122 of 168 patients (72.6%). Total implantation times and fluoroscopy times and doses did not differ between CVP and SVP implantations. Pneumothorax occurred in 0/122 patients implanted via CVP alone, but 8/107 (7.5%) patients received at least one lead via SVP. Conclusion: Our data confirms high success rates of the CVP for CIED implantation. Moreover, this method can be used without significantly prolonging the total procedure time or applying fluoroscopy dose compared to the highly efficient SVP while showing lower overall complication rates. [ABSTRACT FROM AUTHOR]

Intrahepatic interruption of the inferior vena cava (IVC) with continued hemizygous is a very rare abnormality and sometimes it may be accompanied by other cardiovascular abnormalities. Continuation of the hemizygous vein draining into the right atrium through the left superior vena cava (LSVC) is much rarer. In this paper, we have presented a patient who had simultaneous IVC interrupted with persistent LSVC and suffered from Atrioventricular nodal reentrant tachycardia (AVNRT). Finally, radiofrequencies (RF) catheter ablation for AVNRT was successfully performed through a left subclavian vein access. [ABSTRACT FROM AUTHOR]

Background Total anomalous pulmonary venous connection (TAPVC) to left superior vena cava (LSVC) is an extremely rare congenital heart disease, and its surgical management is very challenging. Case summary We report one such case of a 5-year-old south Asian male with double outlet right ventricle and unbalanced atrioventricular canal defect, where all the pulmonary veins were found opening into LSVC, which was then opening into the left side of the common atrium. Intraoperatively, the LSVC was transected just below the left internal jugular vein and left subclavian vein junction and left-sided bidirectional Glenn shunt done using 8 mm Dacron tube graft. Pulmonary veins were left draining through the LSVC into the common atrium. Right-sided Glenn shunt was completed as usual. Currently, the patient is year and half post-surgery and is doing well; school going on par with the peer group maintaining a room air saturation of 87%. Discussion Here, we report a successful surgical correction of TAPVC to LSVC in a child with univentricular physiology, however due to the paucity of data and rarity of such cases, optimal surgical management is yet to be defined. [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]

The editorial discusses the importance of choosing the right insertion site for central venous catheters in preventing infections in intensive care units. The subclavian site is generally preferred for reducing bloodstream infections, but other factors such as mechanical complications and patient conditions should also be considered. A recent French study found similar infection rates across different insertion sites, but limitations in the study design suggest that the choice of insertion site still matters. The editorial provides an algorithm to help clinicians make informed decisions based on individual patient needs and conditions. [Extracted from the article]

Introduction: Paget-Von Schroetter syndrome (PVSS), also known as effort thrombosis or spontaneous subclavian vein thrombosis, is a rare condition characterized by acute upper limb swelling and pain due to thrombotic occlusion of the axillary and/or subclavian veins. This case report describes a 28-year-old male software engineer who presented with acute left arm swelling and pain following strenuous weightlifting, diagnosed with PVSS. The report discusses the clinical presentation, diagnostic approach, management strategies, and outcomes of PVSS, emphasizing the importance of early recognition and treatment to prevent complications such as pulmonary embolism and chronic venous insufficiency. [ABSTRACT FROM AUTHOR]

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]

Varicose veins typically occur in the lower limbs, caused by valvular insufficiency leading to the swelling and tortuosity of subcutaneous veins. Although rare in the upper limbs, they can be successfully diagnosed and treated. Rare causes include congenital vascular anomalies like Klippel-Trenaunay syndrome and Parkes Weber syndrome, characterised by Arteriovenous (AV) fistulae. Subclavian vein thrombosis-induced venous outflow obstruction is another uncommon cause. Diagnosis involves a thorough history taking with clinical examination, often supplemented by investigations. Invasive procedures are rarely necessary but may be used in unique cases to define the pathology further. Treatment for upper limb varicose veins closely mirrors lower limb approaches. The stab-avulsion technique combined with stripping of lengthier sections yields outstanding cosmetic and functional results. Surgical ligation with stripping effectively eliminates varicosities with a low risk of recurrence. Sclerosing agents like Sodium Tetradecyl Sulphate and Polidocanol are substitutes for surgery. In cases of varicosities resulting from upper limb arteriovenous fistulae, surgical intervention involving ligation of the distal venous limb or division of the fistula is the standard approach. In summary, while upper limb varicose veins are exceptionally rare, they can be accurately diagnosed and effectively treated with surgical interventions similar to lower limb varicose veins. [ABSTRACT FROM AUTHOR]

Central venous obstruction following pacemaker implantation is not uncommon and can prove challenging in the case of a system upgrade to a cardiac resynchronization therapy pacemaker (CRT‐P). We describe the case of a patient who underwent a successful upgrading procedure of a pacemaker to a CRT‐P in the presence of an occluded left subclavian vein and superior vena cava, using collateral veins that drained into right atrium. [ABSTRACT FROM AUTHOR]

The subclavian vein is typically used in cardiovascular implantable electronic device (CIED) implantations. External stress on the subclavian vein can lead to lead‐related complications. There are several causes of this stress, such as frequent upper extremity movements or external injury. Venous thoracic outlet syndrome (TOS) can also become the cause of external lead stress. However, the diagnosis of venous TOS can be challenging because subclavian venography can appear normal at first glance. We present a unique case of a device infection in a patient with venous TOS. A careful observation of the imaging studies is vital for diagnosing venous TOS and a leadless pacemaker implantation could be an alternative therapeutic option. [ABSTRACT FROM AUTHOR]

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 malposition of central venous catheters (CVCs) may lead to vascular damage, perforation, and even mediastinal injury. The malposition of CVC from the right subclavian vein into the azygos vein is extremely rare. Here, we report a patient with CVC malposition into the azygos vein via the right subclavian vein. We conduct a comprehensive review of the anatomical structure of the azygos vein and the manifestations associated with azygos vein malposition. Additionally, we explore the resolution of repositioning the catheter into the superior vena cava by carefully withdrawing a specific length of the catheter. Case presentation: A 79-year-old female presented to our department with symptoms of complete intestinal obstruction. A double-lumen CVC was inserted via the right subclavian vein to facilitate total parenteral nutrition. Due to the slow onset of sedative medications during surgery, the anesthetist erroneously believed that the CVC had penetrated the superior vena cava, leading to the premature removal of the CVC. Postoperative contrast-enhanced computed tomography of the chest confirmed that the central venous catheter had not penetrated the superior vena cava but malpositioned into the azygos vein. The patient was discharged 15 days after surgery without any complications. Conclusions: CVC malposition into the azygos vein is extremely rare. Clinical practitioners should be vigilant regarding this form of catheter misplacement. Ensuring the accurate positioning of the CVC before each infusion is crucial. Utilizing chest X-rays in both frontal and lateral views, as well as chest computed tomography, can aid in confirming the presence of catheter misplacement. [ABSTRACT FROM AUTHOR]

Background: Perioperative hypotension is frequently observed following the initiation of general anesthesia administration, often associated with adverse outcomes. This study assessed the effect of subclavian vein (SCV) diameter combined with perioperative fluid therapy on preventing post-induction hypotension (PIH) in patients with lower ASA status. Methods: This two-part study included patients aged 18 to 65 years, classified as ASA physical status I or II, and scheduled for elective surgery. The first part (Part I) included 146 adult patients, where maximum SCV diameter (dSCVmax), minimum SCV diameter (dSCVmin), SCV collapsibility index (SCVCI) and SCV variability (SCVvariability) assessed using ultrasound. PIH was determined by reduction in mean arterial pressure (MAP) exceeding 30% from baseline measurement or any instance of MAP < falling below 65 mmHg for ≥ a duration of at least 1 min during the period from induction to 10 min after intubation. Receiver Operating Characteristic (ROC) curve analysis was employed to determine the predictive values of subclavian vein diameter and other relevant parameters. The second part comprised 124 adult patients, where patients with SCV diameter above the optimal cutoff value, as determined in Part I study, received 6 ml/kg of colloid solution within 20 min before induction. The study evaluated the impact of subclavian vein diameter combined with perioperative fluid therapy by comparing the observed incidence of PIH after induction of anesthesia. Results: The areas under the curves (with 95% confidence intervals) for SCVCI and SCVvariability were both 0.819 (0.744–0.893). The optimal cutoff values were determined to be 45.4% and 14.7% (with sensitivity of 76.1% and specificity of 86.7%), respectively. Logistic regression analysis, after adjusting for confounding factors, demonstrated that both SCVCI and SCVvariability were significant predictors of PIH. A threshold of 45.4% for SCVCI was chosen as the grouping criterion. The incidence of PIH in patients receiving fluid therapy was significantly lower in the SCVCI ≥ 45.4% group compared to the SCVCI < 45.4% group. Conclusions: Both SCVCI and SCVvariability are noninvasive parameters capable of predicting PIH, and their combination with perioperative fluid therapy can reduce the incidence of PIH. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data on the incidence of central venous catheter tip misplacements after the implementation of ultrasound guidance during insertion. The aims of the present study were to determine the incidence of tip misplacements and to identify independent variables associated with tip misplacement. Methods: All jugular and subclavian central venous catheter insertions in patients ≥16 years with a post‐procedural chest radiography at four hospitals were included. Each case was reviewed for relevant catheter data and radiologic evaluations of chest radiographies. Tip misplacements were classified as 'any tip misplacement', 'minor tip misplacement' or 'major tip misplacement'. Multivariable logistic regression analyses were used to investigate associations between predefined independent variables and tip misplacements. Results: A total of 8556 central venous catheter insertions in 5587 patients were included. Real‐time ultrasound guidance was used in 91% of all insertions. Any tip misplacement occurred (95% confidence interval) in 3.7 (3.3–4.1)% of the catheterisations, and 2.1 (1.8–2.4)% were classified as major tip misplacements. The multivariable logistic regression analyses showed that female patient gender, subclavian vein insertions, number of skin punctures and limited operator experience were associated with a higher risk of major tip misplacement, whereas increasing age and height were associated with a lower risk. Conclusions: In this large prospective multicentre cohort study, performed in the ultrasound‐guided era, we demonstrated the incidence of tip misplacements to be 3.7 (3.3–4.1)%. Right internal jugular vein catheterisation had the lowest incidence of both minor and major tip misplacement. [ABSTRACT FROM AUTHOR]

Background and objectives: The subclavian vein is frequently cannulated using ultrasound. There are two techniques of subclavian vein catheterization (SVC): Supraclavicular (SC) and infraclavicular (IC). Though the IC route is often preferred, the SC approach offers several distinct advantages. This study was planned to compare the technique of SVC using SC and IC approaches in terms of catheterization technique and complications in elective surgeries in adults. Methods: Sixty American Society of Anesthesiologists (ASA) 1, 2, or 3 adult patients posted for elective surgeries under general anesthesia were recruited. Patients were divided into SC or IC groups randomly. Right-sided subclavian vein was cannulated in both the groups (n = 30). Visualization time, Likert scale, subclavian vein diameter, skin-to-subclavian vein depth, number of attempts, puncture time, ease of guidewire insertion, catheter insertion time, and total procedural time were observed. A comparison of complications for each approach was noted. Results: Total procedural time, time to visualization of the subclavian vein, and puncture time was lower for group SC and higher for group IC. Catheter insertion time was higher with the IC approach than with the SC approach. Better ultrasound view scores were seen in group SC than in group IC. The first attempt success rate was higher in group SC than in group IC. Comparatively, lower complications both during and after the procedure were noted in the SC approach than the IC approach. Conclusion: Ultrasonography (USG) guidance guided SC approach to access the subclavian vein is quicker, relatively secure, and a better technique than the IC approach. Additionally, the SC approach is associated with comparatively fewer immediate and delayed complications. [ABSTRACT FROM AUTHOR]

Sudden death in young females can have various causes and it is important to investigate the cause thoroughly. In cases with a vague history, postmortem ancillary investigation can also help to establish or rule out potential causes of death, such as underlying medical conditions or environmental factors. These investigations may include various laboratory tests, such as toxicology, histology, microbiology, and genetic analysis, as well as radiological imaging studies. This information not only helps in ascertaining the cause and manner of death but also helps in establishing the legal connotations in any medicolegal case. This is a case of a young woman allegedly 18 years brought for a medicolegal autopsy. She had been feeling unwell for a few days before her death, experiencing vomiting, weakness, and fatigue. Although no underlying disease was diagnosed, she was advised to take a pregnancy test. Fifteen days later, she died at home continuing to feel unwell. Upon autopsy, the young woman was found to be emaciated, and revealed a male fetus, of 4 to 5 months of gestational age, in her uterus. A radiological examination of bones conducted postmortem revealed that the age of woman was approximately 15 years old. Postmortem microbiology analysis revealed the presence of the bacteria Leuconostoc mesenteroides in a blood sample collected from the subclavian vein. The pathogenicity of this bacteria in the cause of death along with the role of ancillary investigation in the light of Indian criminal law and its challenges are being discussed. [ABSTRACT FROM AUTHOR]

Background: Ultrasound-guided percutaneous axillary vein cannulation can reduce cannulation failure and mechanical complications, is as safe and effective as internal jugular vein cannulation, and is superior to subclavian vein cannulation using landmark technique. As far, reports of venovenous extracorporeal membrane oxygenation (VV-ECMO) with percutaneous axillary vein cannulation are rare. Case presentation: A 64-year-old man presenting with dyspnea and chest tightness after aspirating sewage was admitted to the emergency department. Computed tomography (CT) showed diffuse exudation of both lungs and arterial blood gas analysis showed an oxygenation index of 86. He was diagnosed with aspiration pneumonia-induced acute respiratory distress syndrome (ARDS) and intubated for deteriorated oxygenation. Despite the combination therapy of protective mechanical ventilation and prone position, the patient's oxygenation deteriorated further, accompanied with multiple organ dysfunction syndrome, which indicated the requirement of support with VV-ECMO. However, vascular ultrasound detected multiple thrombus within bilateral internal jugular veins. As an alternative, right axillary vein was chosen as the access site of return cannula. Subsequently, femoral-axillary VV-ECMO was successfully implemented under the ultrasound guidance, and the patient's oxygenation was significantly improved. Unfortunately, the patient died of hyperkalemia-induced ventricular fibrillation after 36 h of VV-ECMO running. Despite the poor prognosis, the blood flow during ECMO run was stable, and we observed no bleeding complication, vascular injury, or venous return disorder. Conclusions: Axillary vein is a feasible alternative access site of return cannula for VV-ECMO if internal jugular vein access were unavailable. [ABSTRACT FROM AUTHOR]

Introduction: Femoral-femoral Veno-Venous ExtraCorporeal Life Support (V-V ECLS) has been associated with higher infections rates, vascular site bleeding complications, and restricted patient mobility. Jugular or bicaval dual lumen V-V ECLS conceptually overcomes some of these adverse factors, but experience has shown that jugular vein cannulation still limits mobility and has increased bleeding complications. Technique and outcomes of subclavian vein single-cannulation with Crescent jugular dual-lumen V-V ECLS is described. Method: five patients with COVID-19 related acute respiratory distress syndrome (ARDS) underwent right subclavian vein V-V ECLS placement with the Crescent 32 French jugular dual-lumen V-V ECLS catheter. A standardized percutaneous technique was developed that allowed efficient insertion without need for any specialized imaging (i.e. transesophageal echocardiogram) and outcomes assessed. Results: Mean age of the five patients was 41.2 years, all obese with an average basal mass index of 45.2 kg/m2 and mean days to decannulation of 24.2 days. Outcomes discovered included; improved patient mobility allowing physical rehabilitation, no vascular access site related complications requiring surgery or endovascular intervention, and none had evidence of superior vena cava syndrome. One patient had subclavian/axillary vein thrombosis with resolution after 3 months of direct-acting oral anticoagulants, and one patient had blood cultures positive at day 37, nearing decannulation. Conclusion: Subclavian vein access for crescent jugular dual lumen V-V ECLS catheter appears to be safe and feasible with added benefits of decreased bleeding and increased mobility over jugular or femoral-femoral access site for long term V-V ECLS support in COVID-19 related ARDS patients. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing 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.)

Copyright of Arab Journal for Scientific Publishing is the property of Research & Development of Human Recourses Center (REMAH) 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.)

Background: A previous study on mechanical complications after central venous catheterisation demonstrated differences in complication rates between male and female operators. The objective of this subgroup analysis was to further investigate these differences. The hypothesis was that differences in distribution of predefined variables between operator genders could be identified. Methods: This was a subgroup analysis of a prospective, multicentre, observational cohort study conducted between March 2019 and December 2020 including 8 586 patients ≥ 16 years receiving central venous catheters at four emergency care hospitals. The main outcome measure was major mechanical complications defined as major bleeding, severe cardiac arrhythmia, pneumothorax, arterial catheterisation, and persistent nerve injury. Independent t-test and χ2 test were used to investigate differences in distribution of major mechanical complications and predefined variables between male and female operators. Multivariable logistic regression analysis was used to determine association between operator gender and major mechanical complications. Results: Female operators had a lower rate of major mechanical complications than male operators (0.4% vs 0.8%, P =.02), were less experienced (P <.001), had more patients with invasive positive pressure ventilation (P <.001), more often chose the internal jugular vein (P <.001) and more frequently used ultrasound guidance (P <.001). Male operators more often chose the subclavian vein (P <.001) and inserted more catheters with bore size ≥ 9 Fr (P <.001). Multivariable logistic regression analysis showed that male operator gender was associated with major mechanical complication (OR 2.67 [95% CI: 1.26–5.64]) after correction for other relevant independent variables. Conclusions: The hypothesis was confirmed as differences in distribution of predefined variables between operator genders were found. Despite being less experienced, female operators had a lower rate of major mechanical complications. Furthermore, male operator gender was independently associated with a higher risk of major mechanical complications. Future studies are needed to further investigate differences in risk behaviour between male and female operators. Trial registration: Clinicaltrials.gov identifier: NCT03782324. Date of registration: 20/12/2018. [ABSTRACT FROM AUTHOR]

Upper extremity deep vein thrombosis (DVT) of the axillary/subclavian veins is rare (5–10% of DVT). After clinical suspicion and duplex ultrasound, anticoagulation, surgical decompression and sometimes thrombolysis are mandatory due to complications. We discuss the case of a young healthy orchestra conductor with primary DVT of the left upper extremity and concomitant left shoulder musculo-tendinous traumatic injury. Symptoms of both conditions and subtle signs of upper extremity DVT delayed the diagnosis until full-blown DVT occurred. After successful anticoagulation and surgical TOS (thoracic outlet syndrome) decompression, evolution was favorable, without recurrent thrombosis. [ABSTRACT FROM AUTHOR]