RESUMO
OBJECTIVES: Stenting of central venous stenosis to preserve upper extremity hemodialysis access is well-described, though upper extremity complications secondary to these stents are less frequently discussed. METHODS: We present the case of a 43-year-old male with a right brachiocephalic fistula who developed symptoms of venous hypertension following placement of a Wallstent for central venous stenosis. Workup demonstrated venous outflow obstruction secondary to stent foreshortening into the right subclavian vein. RESULTS: The Wallstent was removed in a piecemeal fashion using an open surgical technique and a HeRO graft was placed for dedicated fistula outflow with complete relief of the patient's symptoms. CONCLUSION: In situations where a stent has migrated and endovascular removal is not possible, individual Wallstent fibers can be removed through a limited venotomy.
Assuntos
Derivação Arteriovenosa Cirúrgica , Hipertensão , Masculino , Humanos , Adulto , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Constrição Patológica , Grau de Desobstrução Vascular , Veia Subclávia/diagnóstico por imagem , Veia Subclávia/cirurgia , Stents , Diálise Renal , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Resultado do TratamentoRESUMO
A 16-year-old male was brought to our hospital presenting with acute onset of a painful protruding left neck mass within a day, associated with left upper-arm tenderness. Chest computed tomography revealed high attenuation masses at the left supraclavicular and mediastinal regions, suspected of being venous vascular tumors. Surgery was arranged and then ruptured venous tumor was noted, with pathology results determining a venous malformation.
Assuntos
Implante de Prótese Vascular , Veias Braquiocefálicas/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Hemangioma/cirurgia , Veias Jugulares/cirurgia , Cervicalgia/etiologia , Adolescente , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/patologia , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Hemangioma/complicações , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/patologia , Ligadura , Masculino , Cervicalgia/diagnóstico , Ruptura Espontânea , Resultado do TratamentoRESUMO
Brachiocephalic venous aneurysm is an extremely rare condition, with <20 cases reported in the literature. We present a case of a 72-year-old man who was referred to our department owing to a large aneurysm of the left brachiocephalic vein that was incidentally discovered on computed tomography. Further workup confirmed an isolated saccular aneurysm of the left brachiocephalic vein. The patient underwent aneurysmectomy via sternotomy with no requirement for a vascular graft or cardiopulmonary bypass. The postoperative course and follow-up were uneventful.
Assuntos
Aneurisma , Veias Braquiocefálicas , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Achados Incidentais , Masculino , Flebografia/métodos , Esternotomia , Resultado do Tratamento , Procedimentos Cirúrgicos VascularesRESUMO
BACKGROUND: Arteriovenous fistula (AVF) formation for long-term haemodialysis in children is a niche discipline with little data for guidance. We developed a dedicated Vascular Access Clinic that is run jointly by a transplant surgeon, paediatric nephrologist, dialysis nurse and a clinical vascular scientist specialised in vascular sonography for the assessment and surveillance of AVFs. We report the experience and 2-year outcomes of this clinic. METHODS: Twelve new AVFs were formed and 11 existing AVFs were followed up for 2 years. All children were assessed by clinical and ultrasound examination. RESULTS: During the study period 12 brachiocephalic, nine basilic vein transpositions and two radiocephalic AVFs were followed up. The median age (interquartile range) and weight of those children undergoing new AVF creation were 9.4 (interquartile 3-17) years and 26.9 (14-67) kg, respectively. Pre-operative ultrasound vascular mapping showed maximum median vein and artery diameters of 3.0 (2-5) and 2.7 (2.0-5.3) mm, respectively. Maturation scans 6 weeks after AVF formation showed a median flow of 1277 (432-2880) ml/min. Primary maturation rate was 83 % (10/12). Assisted maturation was 100 %, with two patients requiring a single angioplasty. For the 11 children with an existing AVF the maximum median vein diameter was 14.0 (8.0-26.0) mm, and the median flow rate was 1781 (800-2971) ml/min at a median of 153 weeks after AVF formation. Twenty-two AVFs were used successfully for dialysis, a median kt/V of 1.97 (1.8-2.9), and urea reduction ratio of 80.7 % (79.3-86 %) was observed. One child was transplanted before the AVF was used. CONCLUSIONS: A multidisciplinary vascular clinic incorporating ultrasound assessment is key to maintaining young children on chronic haemodialysis via an AVF.
Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Ambulatório Hospitalar/organização & administração , Diálise Renal/instrumentação , Diálise Renal/métodos , Dispositivos de Acesso Vascular , Adolescente , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Vasos Sanguíneos/diagnóstico por imagem , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Cultura Organizacional , Resultado do Tratamento , Ultrassonografia , Ultrassonografia Doppler , Dispositivos de Acesso Vascular/efeitos adversos , Recursos HumanosRESUMO
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.
Assuntos
Lipoma , Veia Cava Superior , Feminino , Humanos , Pessoa de Meia-Idade , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/cirurgia , Resultado do Tratamento , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Veias Braquiocefálicas/patologia , Veia Subclávia , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Lipoma/patologiaRESUMO
OBJECTIVE: Arteriovenous fistulas are a principal mainstay of long-term dialysis access for patients with end stage renal failure. However, the patency of arteriovenous fistulas is limited, often requiring percutaneous transluminal angioplasty as a salvage procedure. We report a case of percutaneous method of arteriovenous fistula salvage. METHODS: A gentleman with brachiocephalic arteriovenous fistula created in 2015 was admitted under us for dialysis access issue. His fistula history was notable for recurrent and refractory venous outflow stenosis of the cephalic vein and the cephalic arch with multiple previous interventions. Ultrasound showed cephalic arch occlusion with high venous pressures. He underwent left brachicephalic fistula percutaneous bypass. We describe the percutaneous creation of a brachial-subclavian arteriovenous fistula via a bypass graft from a worsening brachial-cephalic fistula with cephalic arch occlusion that is not amendable to angioplasty. RESULTS: Final angiogram showed smooth flow to central vein. He is 2 years post procedure, and his fistula remained patent with no interventions required. CONCLUSION: Percutaneously created jump bypass grafts can reliably produce sustained long-term patency.
Assuntos
Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/cirurgia , Humanos , Masculino , Diálise Renal , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
INTRODUCTION: Knowledge about variations of the venous arm anatomy is limited despite its importance for a successful arteriovenous fistula creation. REPORT: We describe a complication of a basilic vein transposition (BVT) resulting from failure to recognize aberrant anatomy. The brachial-basilic junction was located in an unusual position near the antecubital fossa leading to inadvertent distal brachial vein ligation and transposition of basilic and the proximal and unusually unpaired brachial vein. DISCUSSION: This case highlights the prevalence of anomalies of upper extremity veins and the need for thorough Duplex vein mapping before surgery for the preservation and planning of future access.
Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Veias Braquiocefálicas/cirurgia , Diálise Renal , Extremidade Superior/irrigação sanguínea , Adulto , Veias Braquiocefálicas/anormalidades , Veias Braquiocefálicas/diagnóstico por imagem , Circulação Colateral , Feminino , Humanos , Ligadura , Flebografia , Resultado do Tratamento , Ultrassonografia Doppler DuplaRESUMO
Aneurysms of thoracic veins are rare lesions and their therapeutic management is not clearly determined. We present a 60-year old man with an asymptomatic right innominate vein aneurysm. The patient had been operated on 10 years ago for coronary artery bypass and was under antiplatelet treatment. In a retrospective inspection of his chest X-rays, we found that the aneurysm had been existent for at least 10 years. We suggested conservative treatment and over a 5-year follow-up, the patient has remained asymptomatic. Our patient is alive 15 years with thoracic vein aneurysm and antiplatelet treatment.
Assuntos
Aneurisma/tratamento farmacológico , Veias Braquiocefálicas/patologia , Inibidores da Agregação Plaquetária/administração & dosagem , Aneurisma/diagnóstico por imagem , Aneurisma/patologia , Veias Braquiocefálicas/diagnóstico por imagem , Dilatação Patológica , Esquema de Medicação , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
RATIONALE: Epithelioid hemangioendothelioma is a rare endothelial tumor with a low-grade malignancy. This tumor can be treated with complete resection. PATIENT CONCERNS: A 20-year-old Korean man visited our hospital due to an abnormal finding on standing chest PA X-ray. He did not have any past medical history. DIAGNOSIS: Chest computed tomography shows a well-defined, oval-shaped tumor invading the brachiocephalic vein and superior vena cava. A malignant tumor of vascular origin was diagnosed by a percutaneous needle biopsy. INTERVENTIONS: We performed en-bloc resection including the great vessels for complete resection of the tumor. Histologic evaluation confirmed the lesion to be a hemangioendothelioma and the surgical margins were free from tumor invasion. OUTCOMES: Fourteen days later, the patient was discharged without any complication. Thirty months after surgery, recurrences, or metastasis were not detected. LESSONS: Epithelioid hemangioendothelioma is a rare malignant endothelial tumor in the central vein. Surgery is the treatment of choice and shows good results. We introduce and appropriate surgical method to ensure successful treatment for rare disease.
Assuntos
Hemangioendotelioma Epitelioide/patologia , Hemangioendotelioma Epitelioide/cirurgia , Veia Cava Superior/patologia , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/patologia , Hemangioendotelioma Epitelioide/diagnóstico por imagem , Humanos , Masculino , Margens de Excisão , República da Coreia/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Veia Cava Superior/diagnóstico por imagem , Adulto JovemRESUMO
We present a patient with left cervical aortic arch who had a complex aortic arch aneurysm consisting of multiple saccular aneurysmatic excavations, proximal aortic arch narrowing, a right subclavian artery aneurysm and subaortic left innominate vein diagnosed by computed tomographic angiography.
Assuntos
Aneurisma/complicações , Aorta Torácica/anormalidades , Aneurisma da Aorta Torácica/complicações , Veias Braquiocefálicas/anormalidades , Artéria Subclávia , Adulto , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Veias Braquiocefálicas/diagnóstico por imagem , Feminino , Humanos , Flebografia/métodos , Artéria Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 45-year-old man complained of swelling of the left side of his neck and left upper limb. Ultrasonography and enhanced computed tomography (CT) revealed thrombosis of the left internal jugular, subclavian, and brachiocephalic vein. Based on various examinations, the patient was diagnosed with idiopathic venous thrombosis early in his clinical course. There were no findings to suggest malignancy or abnormal coagulability. However, two months after the start of treatment, the patient was diagnosed with gastric cancer. Despite the presence of Trousseau syndrome, treatment with edoxaban (an oral anticoagulant), reduced the swelling dramatically without any bleeding complications.
Assuntos
Veias Braquiocefálicas/fisiopatologia , Inibidores do Fator Xa/uso terapêutico , Veias Jugulares/fisiopatologia , Piridinas/uso terapêutico , Veia Subclávia/fisiopatologia , Tiazóis/uso terapêutico , Trombose/diagnóstico , Trombose/tratamento farmacológico , Extremidade Superior/fisiopatologia , Veias Braquiocefálicas/diagnóstico por imagem , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Veia Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Extremidade Superior/diagnóstico por imagemRESUMO
A 71-year-old man presented with a thymic mass involving the superior vena cava. A mediastinoscopical biopsy initially suggested a diagnosis of type A thymoma. After neoadjuvant chemotherapy, the patient underwent en-bloc thymectomy and vascular resection for a pathology-confirmed type B3 thymoma involving the superior vena cava, the left brachiocephalic vein and the distal part of the right brachiocephalic vein. Adjuvant radiotherapy was administered. Two years after the primary surgery, abdominal computed tomography (CT) and whole body fluorodeoxyglucose (18-FDG) positron emission tomography (PET) scans showed a single hepatic lesion that was treated with wedge liver resection. Pathological examination confirmed metastatic type B3 thymoma. Almost 4 years later, abdominal CT and 18-FDG PET revealed a 2.9-cm solid mass involving the body of the pancreas. Distal pancreatectomy with lymph node dissection was performed. Pathological examination showed a pancreatic metastasis from a type B3 thymoma, without lymph node involvement. The patient is alive and free of disease 6 months after the pancreatectomy (68 months after the initial thymectomy surgery). Intra-abdominal recurrence and pancreatic metastases are very uncommon manifestations of thymoma, but this event should be kept in mind when an abdominal mass is seen during follow-up.
Assuntos
Hepatectomia , Neoplasias Hepáticas/secundário , Pancreatectomia , Neoplasias Pancreáticas/secundário , Timectomia , Neoplasias do Timo/patologia , Idoso , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/patologia , Veias Braquiocefálicas/cirurgia , Fluordesoxiglucose F18/administração & dosagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/terapia , Masculino , Terapia Neoadjuvante , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/terapia , Tomografia por Emissão de Pósitrons , Radioterapia Adjuvante , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgia , Neoplasias do Timo/terapia , Resultado do Tratamento , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/patologia , Veia Cava Superior/cirurgiaRESUMO
Papillary thyroid carcinoma with massive invasion into the great veins of the neck and mediastinum has rarely been reported and is thought to have a poor prognosis. Here we report successful management of a case of papillary thyroid carcinoma with extensive invasion into the left internal jugular vein, left brachiocephalic vein, and superior vena cava, followed by reconstruction of the superior vena cava using an artificial graft. The operation was conducted to prevent sudden death due to complete obstruction of venous flow, improve the patient's quality of life, and prolong survival. The patient has survived for more than two years after surgery, with good general condition.
Assuntos
Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/patologia , Veias Braquiocefálicas/cirurgia , Carcinoma Papilar/diagnóstico por imagem , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/patologia , Veias Jugulares/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Procedimentos de Cirurgia Plástica , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/patologia , Veia Cava Superior/cirurgiaRESUMO
The significance of upper extremity deep venous thrombosis (DVT) has been minimized in comparison to iliofemoral thrombosis, likely due to the erroneous belief that subsequent pulmonary thromboembolism is rare. The possibility of pulmonary thromboembolism originating in the upper extremity veins must now be seriously considered with catheters and medical instrumentation being performed more commonly in accessing the central venous system. It has been incorrectly assumed that the risk of pulmonary embolism was low due to the abundant collateral flow, and thus lack of stasis around an upper extremity even with venous occlusion. However, several studies, including a recent prospective trial, concluded that pulmonary embolism is not a rare complication in upper extremity DVT. Significantly, when comparing all sources of secondary upper extremity DVT, catheter-related upper extremity DVT is at greatest risk of subsequent pulmonary thromboembolism. We present an illustrative case documenting extensive pulmonary embolization that occurred following insertion of a central venous catheter and subsequent thrombosis of the right subclavian and innominate veins. With absolute contraindications to thrombolytic and anticoagulation therapy, prevention of further embolization was achieved by percutaneous insertion of a superior vena cava filter.
Assuntos
Veias Braquiocefálicas , Veia Subclávia , Tromboflebite/diagnóstico por imagem , Idoso , Veias Braquiocefálicas/diagnóstico por imagem , Humanos , Masculino , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Radiografia , Veia Subclávia/diagnóstico por imagem , Tromboflebite/etiologia , Filtros de Veia CavaRESUMO
We report a case of migration of a Steinman pin to the innominate vein. A pin was used to fix a shoulder separation but a broken piece was left unattended at the time of removal of the pin. How this piece made its way in to innominate vein is puzzling. To our knowledge migration of fixation wires to the innominate vein has not been reported previously.
Assuntos
Pinos Ortopédicos/efeitos adversos , Veias Braquiocefálicas , Migração de Corpo Estranho/etiologia , Fixação de Fratura/efeitos adversos , Fraturas das Costelas/cirurgia , Luxação do Ombro/cirurgia , Adulto , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Remoção de Dispositivo , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Fixação de Fratura/instrumentação , Humanos , Masculino , Esternotomia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Injuries to the branches of the aortic arch are rare and may be caused by blunt, penetrating, blast or iatrogenic trauma. Innominate vascular injury is a rare entity, particularly in blunt trauma. It is estimated that 71% of patients with innominate injuries die before arrival at the hospital. We report here a successfully managed case of a combined blunt trauma of the innominate artery and transection of the left innominate vein after blunt injury to the chest.
Assuntos
Acidentes de Trânsito , Tronco Braquiocefálico/lesões , Veias Braquiocefálicas/lesões , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/etiologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgiaRESUMO
We report the surgical case of an eight-year-old girl who had a very rare combination of ventricular septal defect and abnormal aortic arch anatomy: right cervical aortic arch, left descending aorta and Kommerell's diverticulum from which the left subclavian artery arose with anomalous subaortic left brachiocephalic vein. She was confirmed the chromosomal 22q11.2 deletion.