Robot-assisted endovascular treatment of hepatic artery aneurysm: A case report.

OBJECTIVE: Robot-assisted endovascular surgery has emerged as a new alternative to interventional procedures, with its application expanding to peripheral and visceral approaches. The objective of this paper is to describe a robot-assisted endovascular treatment in splanchnic arteries. METHODS: A case report of an asymptomatic male patient with an incidental finding of a saccular aneurysm of the proper hepatic artery measuring 3.7 × 2.7 cm and distant 0.6 cm from the origin of the gastroduodenal artery. RESULTS: Using a robot-assisted endovascular technique (CorPath GRX platform - Siemens), 2 guidewires were advanced in parallel: the first one was placed inside the aneurysm sac, while the second one was placed in the proper hepatic artery distal to the aneurysm; through the first guidewire, a balloon was advanced, positioned distally to the aneurysm, and through the second one, a microcatheter was advanced. Embolization of the aneurysm was performed with the use of coils and Onyx. Control exam performed 120 days after embolization revealed treated aneurysm and preserved distal arterial flow. CONCLUSION: Using a robotic platform for navigation in splanchnic territory is safe and effective.

Polidocanol-foam treatment of varicose veins: Quality-of-life impact compared to conventional surgery.

BACKGROUND AND OBJECTIVE: Lower limb varicose veins are a prevalent disease associated with several available treatment options, including conventional surgery and polidocanol foam sclerotherapy. However, few studies have analyzed therapeutic modality outcomes based on Patient-Reported Outcome Measures (PROMs). This large sample-size study was designed to evaluate the outcomes of polidocanol foam sclerotherapy compared to conventional surgery based on an analysis of PROMs. METHODS: This was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with either polidocanol foam sclerotherapy (57 patients, 90 legs) or conventional surgery (148 patients, 236 legs). Patients were preoperatively assessed and re-evaluated 30 days after the procedure using the Venous Disease Severity Score (VCSS) and specific venous disease quality-of-life questionnaires (VEINES-QoL/Sym). RESULTS: Both treatments significantly improved VCSS and VEINES results 30 days after the procedure (p < 0.05). However, surgery promoted greater improvements in VCSS (on average 4.02-points improvement, p < 0.001), VEINES-QoL (average 8-points improvement, p < 0.001), and VEINES-Sym (average 11.66 points improvement, p < 0.001) than did sclerotherapy. Postoperative pain and aesthetic concerns about the legs were the domains of the questionnaires in which the results varied the most between the treatment modalities, with worse results for sclerotherapy. CONCLUSION: Both polidocanol foam sclerotherapy and conventional surgery positively impact patients' quality of life after 30 days, but the improvement is more significant for patients who undergo conventional surgery.

Proposed public policies to improve outcomes in vascular surgery: an experts' forum.

OBJECTIVE: To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. METHODS: This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. RESULTS: There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. CONCLUSION: After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery. Notification of complications of arterial surgeries is essential in identifying strategies to improve surgical outcomes. Screening of prevalent and/or morbid diseases allows early intervention and prevention of complications. Use of telemedicine in vascular follow-up allows optimizing the use of resources and reducing the burden on health services. Concentrating complex cases in reference hospitals leads to improved surgical outcomes.

What are the Main Risk Factors Associated with Erectile Dysfunction in the Elderly? A Cross-Sectional Study of 2436 Brazilian Elderly Men.

Background: Erectile dysfunction (ED) is a multifactorial medical disorder often neglected in clinical practice between elderly men, defined as the inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual intercourse and a common clinical entity among men and associated with impaired quality of life and cardiovascular diseases in elderly men. The aim of this study is to evaluate the association between ED and clinical, demographic and behavioral parameters in elderly men. Methods: A total of 2436 males aged 60 years and over who participated in the health screening between January 2008 and December 2018 were included in this study. Laboratory exams, clinical and behavior profiles were analyzed. Logistic regression models were used. Results: Men with ED were older (65.87±5.49 vs. 63.85±4.05 years old. p<0.001), higher prevalence of physical inactivity (23.8 vs. 19%, p = 0.039) and had a higher body mass index (BMI; 28.36±4.06 vs. 27.72±3.89 kg/m2. p<0.001) than men without ED. The multivariate model shown that hypertension (p = 0.001), diabetes mellitus (p<0.001), lower urinary tract symptoms (LUTS), depressive symptoms (p<0.001) and age (p<0.001), were strongly associated with ED. Conclusion: The main risk factors associated with ED in elderly men were hypertension, diabetes mellitus, LUTS, depressive symptoms and age.

Epidemiology of the use of inferior vena cava filters in Brazil between 2008 and 2019.

OBJECTIVES: The primary objective was to study the totality of inferior vena cava filter placements and their temporal and geographic distribution in the Brazilian Public Health System, which insures more than 160 million Brazilians. The secondary objective was to analyze in-hospital mortality after filter placement and deaths due to pulmonary embolism. METHODS: Public and open data on in-hospital mortality due to pulmonary embolism and on rates of inferior vena cava filters placement, its associated diagnosis, and in-hospital mortality in Brazilian public hospitals between January 2008 and December 2019 were extracted from Ministry of Health databases. RESULTS: A total of 9108 inferior vena cava filters were placed, 98.18% of which was therapeutic. We observed a significant increase in the use of these devices over the years, from 508 inferior vena cava filters placed in 2008 to 965 in 2019. In-hospital mortality rate in patients who received inferior vena cava filters was 6.21%, stable over time, and 96.64% of causes of these causes were attributed to venous thromboembolism. The in-hospital mortality rate due to pulmonary embolism, regardless of the placement of vena cava filters, has increased significantly. CONCLUSION: We observed a low but increasing rate of inferior vena cava filter placements in Brazil between 2008 and 2019, most indications were therapeutic. Our findings were heterogeneous across Brazilian regions and contrasted to those observed in the USA, which is likely due to cultural and socioeconomic factors.

Nationwide Cross-sectional Analysis of Endoscopic Thoracic Sympathectomy to Treat Hyperhidrosis Over 12 years in Brazil: Epidemiology, Costs, and Mortality.

OBJECTIVE: To analyze the number of endoscopic thoracic sympathectomies performed to treat hyperhidrosis in the Universal Public Health System of Brazil, the government reimbursements, and the in-hospital mortality rates. BACKGROUND: Even though endoscopic thoracic sympathectomy has been widely performed for the definitive treatment of hyperhidrosis, no series reported mortality and there are no population-based studies evaluating its costs or its mortality rate. METHODS: Data referring to endoscopic thoracic sympathectomy to treat hyperhidrosis between 2008 and 2019 were extracted from the database of the Brazilian Public Health System, which insures more than 160 million inhabitants. RESULTS: Thirteen thousand two hundred one endoscopic thoracic sympathectomies to treat hyperhidrosis were performed from 2008 to 2019, with a rate of 68.44 procedures per 10 million inhabitants per year. There were 6 in-hospital deaths during the whole period, representing a mortality rate of 0.045%. The total expended throughout the years was U$ 6,767,825.14, with an average of U$ 512.68 per patient. CONCLUSIONS: We observed a rate of 68.44 thoracoscopic sympathectomies for hyperhidrosis' treatment per 10 million inhabitants per year. The inhospital mortality rate was very low, 0.045%, though not nil. To our knowledge, no published series is larger than ours and we are the first authors to formally report deaths after endoscopic thoracic sympathectomies to treat hyperhidrosis. Moreover, there is no other population-based study addressing costs and mortality rates of every endoscopic thoracic sympathectomy for the treatment of any site of hyperhidrosis in a given period.

Proposed public policies to improve outcomes in vascular surgery: an experts' forum

ABSTRACT Objective To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. Methods This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. Results There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. Conclusion After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery.

Population-based analysis of the epidemiology of the surgical correction of hyperhidrosis in 1,216 patients over 11 years: a cross-sectional study

Abstract BACKGROUND: Endoscopic thoracic sympathectomy is the definitive surgical treatment for hyperhidrosis and a nationwide study has suggested that cultural and socioeconomic factors play a role in the numbers of operations performed. Thus, there is a need to evaluate local data in order to understand the local epidemiology and trends in hyperhidrosis treatment. OBJECTIVE: To study the epidemiology of sympathectomy for treating hyperhidrosis in São Paulo, the largest city in Brazil. DESIGN AND SETTING: Population-based retrospective cross-sectional study. METHODS: Data on sympathectomies for treating hyperhidrosis between 2008 and 2018 were assessed from the database of the Municipal Health Department of São Paulo, Brazil. RESULTS: 65.29% of the patients were female, 66.2% were aged between 20 and 39 years and 37.59% had registered with addresses outside São Paulo. 1,216 procedures were performed in the city of São Paulo from 2008 to 2018, and 78.45% of them were in only two public hospitals. The number of procedures significantly declined over the years (P = 0.001). 71.63% of the procedures were associated with 2-3 days of hospital stay, only 78 intensive care unit days were billed and we did not observe any intra-hospital death. CONCLUSION: The profile of patients operated on in São Paulo (young women) is similar to that described in other populations. Sympathectomy is a very safe procedure, with no mortality in our series. There was a decreasing trend in the number of surgeries over the years.

The association between physical activity and erectile dysfunction: A cross-sectional study in 20,789 Brazilian men.

INTRODUCTION: Erectile dysfunction, defined as the inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual intercourse is associated with impaired quality of life and cardiovascular diseases in men older than 40 years. OBJECTIVE: To evaluate the association between erectile dysfunction and physical activity levels in a large cohort of men. METHODS: Data from 20,789 males aged 40 years and over who participated in the check-up screening between January of 2008 and December of 2018 were included in this study. In this sample, data about erectile dysfunction, physical activity levels, clinical profile and laboratory exams were obtained. Logistic regression models were performed. RESULTS: Individuals with erectile dysfunction were older (49.1 ±6.9 vs. 54.8±8.8 years old, p<0.001), had a higher body mass index (27.6 ±3.9 vs. 28.5 ± 4.3 kg/m2, p<0,001), and presented with a higher prevalence of physical inactivity (25 vs. 19%, p<0.001) than individuals without erectile dysfunction. The multivariate model revealed that age (p<0.001), hypertension (p = 0.001), diabetes mellitus (p<0.001), high body mass index (p<0.001), lower urinary tract symptoms and depressive symptoms (p<0.001) were independent risk factors for erectile dysfunction. Low or high physical activity levels (OR = 0.77; CI95%: 0.68-0.87, p<0.001 and OR = 0.85; CI95%: 0.72-0.99, p = 0.04 respectively) were protective factors against erectile dysfunction. CONCLUSION: Low and high physical activity levels were associated with more than 20% reduction in the risk of erectile dysfunction in men aged 40 years or older.

Varicose Vein Stripping in 66,577 patients in 11 years in public hospitals in São Paulo.

OBJECTIVES: The aim of this study was to evaluate the epidemiology of varicose vein stripping in Brazil's largest city, São Paulo. METHODS: Open and anonymous data regarding varicose vein surgeries between 2008 and 2018 were evaluated from the TabNet platform of the Municipal Health Secretary of São Paulo, Brazil. RESULTS: Most patients were female and adults. A total of 66,577 varicose vein surgeries were performed in public hospitals and outpatient clinics in São Paulo, with a statistically significant increase for both unilateral (p=0.003) and bilateral (p<0.001) procedures. Since 2016, unilateral procedures have been performed more frequently than bilateral procedures. Most procedures were associated with same-day (54.8%) or next-day (32%) discharge. The in-hospital mortality rate was 0.0045%. The total amount reimbursed was $20,693,437.94, corresponding to a mean value of $310.82 per procedure. CONCLUSION: Surgeries to treat chronic vein disease totaled 66,577 in 11 years, demanding $20,693,437.94 from the public health system. The majority of treated patients were female, over 40 years of age, and local residents. Procedure rates have increased over the years. The in-hospital mortality rate was very low (0.0045%).

Population-based analysis of the epidemiology of the surgical correction of hyperhidrosis in 1,216 patients over 11 years: a cross-sectional study.

BACKGROUND: Endoscopic thoracic sympathectomy is the definitive surgical treatment for hyperhidrosis and a nationwide study has suggested that cultural and socioeconomic factors play a role in the numbers of operations performed. Thus, there is a need to evaluate local data in order to understand the local epidemiology and trends in hyperhidrosis treatment. OBJECTIVE: To study the epidemiology of sympathectomy for treating hyperhidrosis in São Paulo, the largest city in Brazil. DESIGN AND SETTING: Population-based retrospective cross-sectional study. METHODS: Data on sympathectomies for treating hyperhidrosis between 2008 and 2018 were assessed from the database of the Municipal Health Department of São Paulo, Brazil. RESULTS: 65.29% of the patients were female, 66.2% were aged between 20 and 39 years and 37.59% had registered with addresses outside São Paulo. 1,216 procedures were performed in the city of São Paulo from 2008 to 2018, and 78.45% of them were in only two public hospitals. The number of procedures significantly declined over the years (P = 0.001). 71.63% of the procedures were associated with 2-3 days of hospital stay, only 78 intensive care unit days were billed and we did not observe any intra-hospital death. CONCLUSION: The profile of patients operated on in São Paulo (young women) is similar to that described in other populations. Sympathectomy is a very safe procedure, with no mortality in our series. There was a decreasing trend in the number of surgeries over the years.

Cross-Sectional Analysis of 180,595 Lower Limb Amputations in the State of Sao Paulo Over 12 Years.

BACKGROUND: Lower limb amputations represent a high social, economic and health burden. Most of them are preventable and reflect areas for improvement in health care, making it essential to know their epidemiology. MATERIALS AND METHODS: This is a retrospective population-based cross-sectional analysis on all lower limb amputations performed in public hospitals in Sao Paulo between 2009 and 2020, the most populous Brazilian state, with 46 million inhabitants. Using a public database, we evaluated types, rates and trends of the amputations performed, main etiologies leading to the indication for amputation, hospital length of stay and in-hospital mortality rates, demographics of the amputees and procedure costs. RESULTS: In total, 180,595 lower limb amputations and surgical revision of amputations were performed, with toe amputations (45%) and major amputations (33%) being the most frequent types of surgeries, with a recent significant increase in the rates for both these procedures. Peripheral artery disease was the most frequent etiology, followed by diabetes mellitus, with both showing an upward trend over the years. Most patients were male (69.3%), Caucasians (55.6%) and elderly. August was the month with the highest number of amputations in all years. Overall in-hospital mortality after lower limb amputations was 6.6%. Total reimbursed by the government was US$ 67,675,875.55. CONCLUSIONS: Peripheral artery disease is the most frequent underlying diagnosis for lower limb amputations, followed by diabetes mellitus, with both showing an upward trend over the years. We observed seasonality in procedure rates, with peaks in August in all years.

Nationwide Cross-Sectional Epidemiological Analysis of 3,306 Lower Limb Peripheral Aneurysm Repairs in Brazilian Public Hospitals Between 2008 and 2019: Trends, Mortality and Costs.

BACKGROUND: Although peripheral aneurysms can be limb- or life-threatening, the literature is scarce and there are only two large population-based epidemiological studies on peripheral aneurysm repair, comprising data from high-income countries only. METHODS: This is a retrospective cross-sectional analysis on open and endovascular peripheral aneurysm repairs performed between 2008 and 2019 in the Brazilian Public Health System, which exclusively insures more than 160 million Brazilians. RESULTS: A total of 3,306 peripheral aneurysm repairs were observed. Most patients were elderly (57.74%) and male (72.66%), and patients treated with endovascular repair were older (P = 0.008). Most repairs were emergency (59.56%) and open (93.8%), and there was an overall downward trend in procedure rates. We observed a decreasing predominance of emergency open repair over elective open repair (P < 0.001), but open repairs prevailed over endovascular procedures, with no tendency to change this predominance. Mortality rates were 3.12% and 3.67% after elective and emergency open repair, respectively, with no difference, and 0 and 4.24% for elective and emergency endovascular repair, respectively. The government reimbursed an average of $1170.05 for open PA repair and $1802.01 for endovascular repair. CONCLUSIONS: We presented the largest series of the literature analyzing all 3,306 lower limb peripheral aneurysm repairs performed in public hospitals in a middle-income country. Procedure rates tended to decrease. Open repair predominated. Mortality rates ranged from 0 to 4%. Most procedures were emergency, but there was a relative increase of elective treatments over the years.

Epidemiology of Abdominal Aortic Aneurysm Repair in Brazil from 2008 to 2019 and Comprehensive Review of Nationwide Statistics Across the World.

INTRODUCTION: Studying epidemiology of abdominal aortic aneurysms repairs is essential to prevent related deaths. Although outcomes are influenced by socioeconomic factors, there are no nationwide studies on these statistics in low-and-middle income countries. Therefore, we designed this study to evaluate abdominal aortic aneurysms repair rates, trends, costs, and in-hospital mortality in the Brazilian Public Health System, which exclusively insures over 160 million Brazilians. MATERIAL AND METHODS: Retrospective cross-sectional population-based analysis of publicly available data referring to all abdominal aortic aneurysm repairs performed between 2008 and 2019 in Brazilian public hospitals. RESULTS: We observed a total of 13,506 abdominal aortic aneurysm repairs, of which 32% were emergency endovascular repairs, 20% emergency open repairs, 32% elective endovascular repairs and 16% elective open repairs. There has been a downward trend in total abdominal aortic aneurysms repairs and an increasing predominance of endovascular repair. Elective and endovascular repairs were significantly associated with lower in-hospital mortality. For ruptured abdominal aortic aneurysms, we observed mortality rates of 13.8% after endovascular repair and 52.1% after open repair. For intact abdominal aortic aneurysms, we observed mortalities of 3.8% after endovascular repair and 18.6% after open repair. Procedure and mortality rates varied significantly among the Brazilian regions. CONCLUSIONS: We observed a low and decreasing rate of abdominal aortic aneurysm repair. Most repairs were emergency and endovascular and there was an increasing predominance of endovascular repair. Endovascular and elective repairs were associated with lower mortality.

Epidemiology of 869,220 varicose vein surgeries over 12 years in Brazil: trends, costs and mortality rate.

BACKGROUND: Varicose vein surgeries are the most commonly performed vascular procedure to treat the most prevalent vascular disease, chronic venous disease. However, nationwide studies on the epidemiology of varicose vein surgeries are scarce, none in developing countries. Therefore, we designed this study to assess the total number of varicose vein surgeries performed between 2008 and 2019 in the Public Health System, which exclusively insures more than 160 million Brazilians, their trends, costs and mortality rates. METHODS: Public and open data referring to all surgeries to treat chronic venous disease between 2008 and 2019 were extracted from the Brazilian Ministry of Health database. RESULTS: A total of 869,220 surgeries were performed to treat chronic venous disease in Brazilian public hospitals and outpatient clinics, with an average rate of 4.5 surgeries per 10,000 inhabitants per year. Starting in 2015, we observed a slight non-significant downward trend in the total number of procedures. The total amount reimbursed by the government was US$ 232,775,518.11. A total of 49 deaths were reported after varicose vein surgery, corresponding to a mortality rate of 0.0056%. CONCLUSIONS: A total of 869,220 surgeries were performed to treat chronic venous disease over twelve years, with an overall rate of 4.52 procedures per 10,000 population per year. The mortality rate was very low, 0.0056%.

Varicose Vein Stripping in 66,577 patients in 11 years in public hospitals in São Paulo

SUMMARY OBJECTIVES: The aim of this study was to evaluate the epidemiology of varicose vein stripping in Brazil's largest city, São Paulo. METHODS: Open and anonymous data regarding varicose vein surgeries between 2008 and 2018 were evaluated from the TabNet platform of the Municipal Health Secretary of São Paulo, Brazil. RESULTS: Most patients were female and adults. A total of 66,577 varicose vein surgeries were performed in public hospitals and outpatient clinics in São Paulo, with a statistically significant increase for both unilateral (p=0.003) and bilateral (p<0.001) procedures. Since 2016, unilateral procedures have been performed more frequently than bilateral procedures. Most procedures were associated with same-day (54.8%) or next-day (32%) discharge. The in-hospital mortality rate was 0.0045%. The total amount reimbursed was $20,693,437.94, corresponding to a mean value of $310.82 per procedure. CONCLUSION: Surgeries to treat chronic vein disease totaled 66,577 in 11 years, demanding $20,693,437.94 from the public health system. The majority of treated patients were female, over 40 years of age, and local residents. Procedure rates have increased over the years. The in-hospital mortality rate was very low (0.0045%).

Cell-free therapy with the secretome of adipose tissue-derived stem cells in rats' frozen-thawed ovarian grafts.

The use of secretome may be a new strand of cell therapy, which is equal to or even superior to the injection of live cells, called cell-free therapy. In ovarian transplantation, this approach may be a therapeutic possibility for the ovarian graft in hypoxia. We designed the present study to evaluate whether the cell-free therapy with the secretome of adipose tissue-derived stem cells (ASCs) in rat frozen-thawed ovarian grafts could protect a graft against ischemic injury. A single dose of rat ASCs secretome or vehicle was injected into the bilateral frozen-thawed ovaries of 18 adult female rats immediately after an autologous transplant. Nine animals were used to control the cryopreservation protocol and were evaluated before and after the cryopreservation process. Daily vaginal smears were performed for estrous cycle evaluation until euthanasia on postoperative day 30. Follicle viability by trypan blue, graft morphology by HE, and apoptosis by TUNEL and cleaved-caspase-3 were assessed. No differences were found with respect to estrous cycle resumption and follicle viability (p > 0.05). However, compared with the vehicle-treated grafts, the morphology of the secretome-treated grafts was impaired, showing reduced follicular population and increased apoptosis (p < 0.05). ASC secretome impaired the rat frozen-thawed ovarian graft from ischemic injury. However, more studies are needed to evaluate the factors involved and the possibility of applying the secretome in scaffolds to optimize its use.

Biometric measurements involving the terminal portion of the thoracic duct on left cervical level IV: an anatomic study.

To determine the point of entrance of the thoracic duct in the venous system, as well as to evaluate some biometric measurements concerning its terminal portion, we conducted an anatomic study on 25 non-preserved cadavers. The termination of the thoracic duct occurred on the confluence between the left internal jugular vein and the left subclavian vein in 60 % of the individuals. The average results for the biometric measurements were: distance between the end of left internal jugular vein and omohyoid muscle 31.2 ± 2.7 mm; distance between the end of thoracic duct and the left internal jugular vein 0.0 ± 0.0 mm; distance between the end of thoracic duct and the left subclavian vein 3.6 ± 1.0 mm; distance between the end of thoracic duct and the left brachiocephalic vein 10.7 ± 3.1 mm. Moreover, it was identified that the left internal jugular vein length in level IV, measured between its entrance in the left subclavian vein and the omohyoid muscle, was able to predict the termination of the thoracic duct on the junction between the left internal jugular vein and the left subclavian vein (OR = 2.99) with high accuracy (79.3 %). In addition, the left internal jugular vein length at level IV was able to predict the localization of thoracic duct termination. Thus, this finding has practical value in minimizing the risk for a potential chyle leak during or after a left-sided neck dissection.