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1.
J Vasc Access ; 21(1): 39-44, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31165669

RESUMO

BACKGROUND: Arm abduction influences cross-sectional area of the infraclavicular axillary vein, yet the effect of arm abduction on collapsibility of the vein has not been quantified. Decrease in collapsibility of the axillary vein can enable successful cannulation and can decrease injury to underlying vital structures. METHODS: The infraclavicular axillary vein was scanned in 70 patients close to the clavicle with a high-frequency linear transducer in arm adducted position (Point A), after arm abduction at the initial probe position (Point A') and after tracing the vein medially close to clavicle (Point B). Maximum and minimum cross-sectional area and circumference during tidal breathing and collapsibility indices during tidal and deep breathing were measured at three probe positions. RESULTS: The percentage change with respiration in cross-sectional area, circumference and the collapsibility indices computed from the above measurements were lesser in arm abducted position (p < 0.001). There was decrease in collapsibility index during tidal breathing from 25 at Point A to 7 at Point A' and 3 at Point B. Collapsibility index reduced from 91 at Point A to 30 at Point A' and 35 at Point B during deep breathing. CONCLUSION: We conclude that the collapsibility of the infraclavicular axillary vein could be reduced by arm abduction, and hence, abduction could be proposed as the ideal arm position for ultrasound-guided infraclavicular axillary vein cannulation.


Assuntos
Braço/irrigação sanguínea , Veia Axilar/diagnóstico por imagem , Posicionamento do Paciente , Respiração , Ultrassonografia , Adulto , Pontos de Referência Anatômicos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
2.
J Vasc Access ; 21(1): 66-72, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31204560

RESUMO

INTRODUCTION: The ultrasound-guided axillary vein is becoming a compulsory alternative vessel for central venous catheterization and the anatomical position offers several potential advantages over blind, subclavian vein techniques. OBJECTIVE: To determine the degree of dynamic variation of the axillary vein size measured by ultrasound prior to the induction of general anesthesia and after starting controlled mechanical ventilation. DESIGN: Prospective, observational study. METHODS: One hundred ten patients undergoing elective surgery were enrolled and classified according to sex, age, and body mass index. Two-dimensional cross-sectional vein diameter, area, and mean flow velocity were performed using ultrasound on both the left and right axillary veins of each subject before and after induction of anesthesia. RESULTS: There was statistically significant evidence showing that the axillary vein area increases when patients are mechanically ventilated. When considering venous flow velocity as a primary outcome, velocity decreased after patients moved from spontaneous to mechanical ventilation (coefficient = -0.267), but this relationship failed to achieve statistical significance (t = -1.355, p = 0.179). CONCLUSIONS: Anatomical variations in depth and diameter as well as the collapsibility due to intrathoracic pressures changes represent common challenges that face clinicians during central venous catheterization of the axillary vein. A noteworthy increase in vessel size as patients transition from spontaneous to mechanical ventilation may theoretically improve first-pass cannulation success with practitioners skilled in both ultrasound and procedure. As a result, placing a centrally inserted central catheter after the induction of anesthesia may be beneficial.


Assuntos
Veia Axilar/diagnóstico por imagem , Respiração Artificial , Ultrassonografia , Adolescente , Adulto , Idoso , Anestesia Geral , Veia Axilar/fisiologia , Velocidade do Fluxo Sanguíneo , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Pressão , Estudos Prospectivos , Fluxo Sanguíneo Regional , Fatores de Tempo , Adulto Jovem
3.
J Vasc Access ; 20(6): 630-635, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30919718

RESUMO

BACKGROUND: Catheterization of the axillary vein in the infraclavicular area has important advantages in patients with long-term, indwelling central venous catheters. The two most commonly used ultrasound-guided approaches for catheterization of the axillary vein include the long-axis/in-plane approach and the short-axis/out-of-plane approach, but there are certain drawbacks to both approaches. We have modified a new approach for axillary vein catheterization: the oblique-axis/in-plane approach. METHODS: This observational study retrospectively collected data from patients who underwent ultrasound-guided placement of an axillary vein infusion port in the infraclavicular area at the Central Venous Access Clinics of Zhongshan Hospital at Fudan University between March 2014 and May 2017. The patients' demographic data, success rate of catheterization, venous catheterization site, and immediate complications associated with catheterization were recorded. RESULTS: Between March 2014 and May 2017, a total of 858 patients underwent placement of an axillary vein infusion port in the infraclavicular area at our center. The ultrasound-guided oblique-axis/in-plane approach was used for all patients, and the venipuncture success rate was 100%. Two cases of accidental arterial puncture and one case of local hematoma formation were reported, and no other complications, such as pneumothorax or nerve damage, were reported. CONCLUSION: The ultrasound-guided oblique-axis/in-plane approach is a safe and reliable alternative to the routine ultrasound-guided approach for axillary venous catheterization.


Assuntos
Veia Axilar/diagnóstico por imagem , Cateterismo Venoso Central/métodos , Ultrassonografia de Intervenção , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres Venosos Centrais , Feminino , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
4.
J Vasc Access ; 20(6): 763-768, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30704348

RESUMO

INTRODUCTION: Ultrasound-guided cannulation of the axillary vein in the infraclavicular area has several potential advantages for both short-term and long-term venous access devices. Currently, there are two techniques to approach axillary vein for ultrasound-guided cannulation: out-of-plane puncture in the short-axis view and the in-plane puncture in the long-axis view. We propose a novel ultrasound-guided puncture technique of axillary vein for centrally inserted central catheter placement, which consists in the oblique-axis view of the axillary vein coupled with the in-plane puncture. The main objectives of this study were feasibility and safety of this approach. The primary endpoints were the success rate and early complications; the secondary endpoints were late complications. METHODS: We analyzed data from a retrospective cohort of 80 ultrasound-guided cannulation of axillary vein performed with the oblique axis-in-plane technique in 80 cancer patients requiring a totally implantable central venous access, at CRO Aviano National Cancer Institute, during the period from January 2016 up to October 2017. We focused on the percentage of successful venous cannulation at the first attempt and on the cumulative incidence of early and late complications. RESULTS: Axillary vein cannulation was successful at the first attempt in 77 out of 80 patients (96%). We had no significant complications during placement or in the first 48 h. The total number of catheter days was 27,432. The cumulative incidence of catheter-related bloodstream infection was of 0.036 per 1000 catheter days (only one case). We had no infection of the pocket of the reservoir, no symptomatic venous thrombosis, and no catheter migration. CONCLUSION: Our data show that the oblique axis-in-plane technique of the ultrasound approach to the axillary vein is feasible and safe.


Assuntos
Antineoplásicos/administração & dosagem , Veia Axilar/diagnóstico por imagem , Cateterismo Venoso Central/métodos , Neoplasias/tratamento farmacológico , Ultrassonografia de Intervenção , Administração Intravenosa , Adulto , Idoso , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
6.
Microsurgery ; 39(3): 228-233, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30666705

RESUMO

BACKGROUND: Thoracoacromial vein (TAv) is seldomly considered as a secondary outflow recipient option when venous congestion of deep inferior epigastric artery perforator (DIEP) flap is encountered. The purpose of this study was to present a computed tomography (CT)-based anatomy and a method of approaching TAv in performing superdrainage using superficial inferior epigastric vein (SIEV) in DIEP flap breast reconstruction. METHODS: For CT-based anatomical study, 42 thoracoacromial vessels (TAV) of 21 patients who underwent DIEP flap breast reconstruction were analyzed. From November 2016 to May 2018, pectoralis major (PM) muscle splitting approach to TAv in the first intercostal space was applied to 7 patients who required superdrainage via SIEV. RESULTS: TAVs at mid-first intercostal space (ICS) were located 83.5 ± 9.8 mm lateral to the sternal border (H), 41.5 ± 12.9 mm below the clavicle (V), and 11.7 ± 3.2 mm deep to the outer surface of PM muscle (D). Mean oblique distances from TAV to internal mammary vessels in the 2nd and 3rd ICS were 75.7 ± 9.7 mm and 98.2 ± 10.9 mm, respectively. Seven DIEP flaps presenting intraoperative venous congestion were successfully salvaged intraoperatively with superdrainge procedure. TAvs were harvested without cutting the PM muscle in any patient. Their mean size at anastomosis was 1.61 ± 3.2 mm (range, 0.9-2.5 mm). All flaps survived without perfusion-related complications including fat necrosis. CONCLUSIONS: Harvest of TAv by muscle-splitting approach is an alternative option when additional venous anastomosis using SIEV is mandated for managing venous congestion of DIEP flap.


Assuntos
Anastomose Cirúrgica/métodos , Veia Axilar/cirurgia , Artérias Epigástricas/cirurgia , Mamoplastia/métodos , Microcirurgia/métodos , Retalho Perfurante/efeitos adversos , Retalho Perfurante/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Veia Axilar/diagnóstico por imagem , Feminino , Humanos , Hiperemia/etiologia , Pessoa de Meia-Idade , Retalho Perfurante/transplante , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Tomógrafos Computadorizados , Resultado do Tratamento
7.
J Vasc Access ; 20(5): 553-556, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30618343

RESUMO

Increased blood flow in the subclavian artery feeding a vascular access for hemodialysis can rarely induce steal phenomena in the vertebral and internal mammary artery leading to potentially life-threatening conditions. On the contrary, transient interruption of blood flow in the subclavian artery feeding a dialysis arteriovenous fistula can theoretically induce access thrombosis. Here, we describe a technical maneuver preserving continuous ipsilateral upper arm access flow when constructing a unilateral axillo-femoral polytetrafluoroethylene bypass operation for critical limb ischemia in a hemodialysis patient.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Artéria Axilar/cirurgia , Veia Axilar/cirurgia , Implante de Prótese Vascular/métodos , Artéria Braquial/cirurgia , Artéria Femoral/cirurgia , Isquemia/cirurgia , Falência Renal Crônica/terapia , Doença Arterial Periférica/cirurgia , Diálise Renal , Grau de Desobstrução Vascular , Idoso , Artéria Axilar/diagnóstico por imagem , Artéria Axilar/fisiopatologia , Veia Axilar/diagnóstico por imagem , Veia Axilar/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Estado Terminal , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Politetrafluoretileno , Desenho de Prótese , Fluxo Sanguíneo Regional , Resultado do Tratamento
9.
Ann Vasc Surg ; 55: 210-215, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30217711

RESUMO

BACKGROUND: To evaluate outcomes and patency of arteriovenous grafts (AVGs) created using Gore hybrid vascular grafts in hemodialysis patients with limited venous outflow or challenging anatomy. MATERIALS AND METHODS: A retrospective review was performed in two academic centers of all patients between July 2013 and December 2016 who underwent surgical AVG creation using a Gore hybrid vascular graft in a brachial artery to axillary configuration. Patient characteristics and comorbidities as well as graft patency, function, and subsequent need for percutaneous interventions were recorded. RESULTS: Forty-six patients including 30 females (65.2%) and 16 males (34.8%) with a mean age of 63 ± 13 years were identified. The most common indications for a hybrid vascular graft were limited surgical accessibility and/or revision of existing AVG due to severe stenotic lesions at the venous outflow in 33 patients (72%). One-year primary unassisted and assisted patency rates were 44 ± 8% and 54 ± 8%, respectively, compared with 1-year secondary patency rate of 66 ± 8%. The rate of percutaneous interventions to maintain graft function and patency was approximately one intervention per graft per year. CONCLUSIONS: Access created with the hybrid vascular graft in a brachial-axillary (brachial artery to axillary vein) configuration is an acceptable option for patients with limited venous outflow reserve and challenging anatomy. Twelve-month primary and secondary patency rates and need for percutaneous interventions were comparable to traditional AVGs.


Assuntos
Ligas , Derivação Arteriovenosa Cirúrgica/instrumentação , Veia Axilar/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Artéria Braquial/cirurgia , Politetrafluoretileno , Diálise Renal , Stents , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Veia Axilar/diagnóstico por imagem , Veia Axilar/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Grau de Desobstrução Vascular
10.
Ann Vasc Surg ; 54: 118-122, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30217714

RESUMO

BACKGROUND: Venous thoracic outlet syndrome (vTOS) is a rare disease with no defined guidelines regarding treatment. Patients with first rib resection with anterior scalenectomy (FRRS) often have residual subclavian vein stenosis. The aim of this study was to evaluate the use of intravascular ultrasound (IVUS) in the treatment of vTOS patients who have been surgically decompressed with FRRS. METHODS: Patients treated with venography after FRRS for vTOS during 2015-2017 were retrospectively reviewed. Patients were included if they received a venogram with IVUS after FRRS. The axillosubclavian vein at the site of the thoracic outlet was imaged using single-plane venography and IVUS. A greater than 50% diameter stenosis on venography or 50% cross-sectional area reduction on IVUS was considered significant and treated with balloon venoplasty. RESULTS: During the 2-year period, 14 patients underwent 24 upper extremity venograms performed after surgical decompression for vTOS, 18 of which included IVUS. Of the 18 cases with IVUS, 5 (27.8%) stenoses >50% were detected by IVUS, which were not apparent on venography, leading to intervention. IVUS detected a greater degree of stenosis than venography. Seven patients required repeat venograms. Overall, IVUS detected significant venous stenosis in 94.4% of patients compared with 66.7% of patients with venography after FRRS for vTOS. CONCLUSIONS: These results suggest that IVUS detected greater levels of stenosis than venography, leading to more interventions. Just as IVUS being ideal for identifying occult iliac venous lesions, it may have a similar role in identifying venous lesions not evident on single-plane venography for postsurgical decompression in vTOS patients. Further studies may show this technique to increase the number of stenoses identified and improve long-term symptom relief.


Assuntos
Veia Axilar/diagnóstico por imagem , Veia Subclávia/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Ultrassonografia de Intervenção , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Adolescente , Adulto , Angioplastia com Balão , Veia Axilar/cirurgia , Constrição Patológica , Bases de Dados Factuais , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Osteotomia , Flebografia , Valor Preditivo dos Testes , Estudos Retrospectivos , Costelas/cirurgia , Veia Subclávia/cirurgia , Síndrome do Desfiladeiro Torácico/etiologia , Síndrome do Desfiladeiro Torácico/cirurgia , Resultado do Tratamento , Trombose Venosa Profunda de Membros Superiores/etiologia , Trombose Venosa Profunda de Membros Superiores/cirurgia , Adulto Jovem
12.
J Vasc Access ; 20(2): 134-139, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29923460

RESUMO

PURPOSE:: To evaluate the clinical outcomes and complications of totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy. MATERIALS AND METHODS:: A total of 176 totally implantable venous access ports were placed via the axillary vein in 171 patients with head and neck malignancy between May 2012 and June 2015. The patients included 133 men and 38 women, and the mean age was 58.8 years (range: 19-84 years). Medical records were retrospectively reviewed. RESULTS:: This study included a total of 93,237 totally implantable venous access port catheter-days (median 478 catheter-days, range: 13-1380 catheter-days). Of the 176 implanted totally implantable venous access port, complications developed in nine cases (5.1%), with the overall incidence of 0.097 events/1000 catheter-days. The complications were three central line-associated blood-stream infection cases, one case of keloid scar at the needling access site, and five cases of central vein stenosis or thrombosis on neck computed tomography images. The 133 cases for which neck computed tomography images were available had a total of 59,777 totally implantable venous access port catheter-days (median 399 catheter-days, range: 38-1207 catheter-days). On neck computed tomography evaluation, the incidence of central vein stenosis or thrombosis was 0.083 events/1000 catheter-days. Thrombosis developed in four cases, yielding an incidence of 0.067 events/1000 catheter-days. All four patients presented with thrombus in the axillary or subclavian vein. Stenosis occurred in one case yielding an incidence of 0.017 events/1000 catheter-days. One case was catheter-related brachiocephalic vein stenosis, and the other case was subclavian vein stenosis due to extrinsic compression by tumor progression. Of the nine complication cases, six underwent port removal. CONCLUSION:: These data indicate that totally implantable venous access port implantation via the axillary vein in patients with head and neck malignancy is safe and feasible, with a low axillary vein access-related complication rate.


Assuntos
Veia Axilar , Cateterismo/instrumentação , Cateteres Venosos Centrais , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Veia Axilar/diagnóstico por imagem , Obstrução do Cateter/etiologia , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/microbiologia , Cateterismo/efeitos adversos , Cateterismo/métodos , Angiografia por Tomografia Computadorizada , Remoção de Dispositivo , Estudos de Viabilidade , Feminino , Humanos , Queloide/diagnóstico por imagem , Queloide/etiologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Flebografia/métodos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Trombose Venosa Profunda de Membros Superiores/diagnóstico por imagem , Trombose Venosa Profunda de Membros Superiores/etiologia , Adulto Jovem
13.
Medicina (B Aires) ; 78(5): 372-375, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30285932

RESUMO

Deep vein thrombosis (DVT) of the upper limb is a rare entity, estimated to account for 10% of all cases of DVT. Classically, they are classified into primary (idiopathic, due to subclavian vein compression or exercise related) and secondary (cancer, thrombophilia, trauma, shoulder surgery, associated to venous catheters or due to hormonal causes). The Paget- Schrötter syndrome is a primary thrombosis of the subclavian vein in the subclavian-axillary junction, related either to repetitive movements or to exercise; leading to microtrauma in the endothelium with consequent activation of the coagulation cascade. Clinically, it presents abruptly with pain, edema and feeling of heaviness in the affected limb. The treatment varies from thrombolytics and anticoagulation to surgical intervention, depending on the time of evolution. We present four cases of exercise-related subclavian vein thrombosis.


Assuntos
Veia Axilar/patologia , Veia Subclávia/patologia , Trombose Venosa Profunda de Membros Superiores/patologia , Adolescente , Adulto , Anticoagulantes/uso terapêutico , Veia Axilar/diagnóstico por imagem , Edema , Feminino , Humanos , Masculino , Flebografia , Veia Subclávia/diagnóstico por imagem , Ultrassonografia Doppler , Trombose Venosa Profunda de Membros Superiores/diagnóstico , Trombose Venosa Profunda de Membros Superiores/tratamento farmacológico
15.
JBJS Case Connect ; 8(2): e33, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29794488

RESUMO

CASE: A 57-year-old man presented with bilateral proximal humeral fracture-dislocation and an associated axillary artery injury. He was treated urgently with reduction, arterial repair, fasciotomies, and skeletal stabilization. The patient sustained a massive intraoperative hemorrhage from an unrecognized axillary vein injury after the arterial repair. CONCLUSION: An unrecognized axillary vein injury led to substantial blood loss that required a massive transfusion protocol. Although an axillary arterial injury is readily identified with computed tomography angiography, concomitant venous injuries may go unrecognized. The surgical team, including the vascular and orthopaedic surgeons and the anesthesiologists, should be prepared to manage a life-threatening hemorrhage.


Assuntos
Veia Axilar , Perda Sanguínea Cirúrgica , Luxação do Ombro , Fraturas do Ombro , Lesões do Sistema Vascular , Acidentes , Veia Axilar/diagnóstico por imagem , Veia Axilar/lesões , Angiografia por Tomografia Computadorizada , Fasciotomia , Humanos , Masculino , Pessoa de Meia-Idade , Luxação do Ombro/complicações , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/cirurgia , Fraturas do Ombro/complicações , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Lesões do Sistema Vascular/complicações , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia
16.
J Vasc Access ; 19(6): 667-671, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29642728

RESUMO

INTRODUCTION:: A safe, largely used practice for difficult venous access patients is positioning a catheter in deeper veins under ultrasound guide. However, the risk of complications is increased when there is a high catheter-to-vein ratio or when the insertion site is in a zone with particular anatomical/physiological characteristics. CASE DESCRIPTION:: A 60-year-old woman admitted to a post-operative intensive care unit after cardiac surgery had a complicated post-operative course. After the removal of a central venous catheter, it was necessary to insert a midline catheter. A complete ultrasound evaluation showed that only the axillary vein was suitable for direct cannulation. To avoid creating an exit site in the axillary cavity, the decision was made to tunnel the catheter to locate an exit site in a safer position. A guidewire was introduced through a needle in the axillary vein. A tunnel was created using a subcutaneous injection of lidocaine. A 14 G/13.3 cm peripheral venous catheter was inserted in the subcutaneous tract. A 4 Fr/20 cm catheter was introduced through the peripheral venous catheter and moved to the axillary vein through the previously inserted sheath. No acute complications occurred. The catheter was accessed several times a day during the period following its insertion to infuse drugs and take blood samples. It was removed 50 days after its placement because it was no longer needed. No symptomatic thrombosis or infections occurred. CONCLUSION:: The placement of the tunnelled midline catheter is shown to be a safe and effective way to ensure vascular access for almost 2 months.


Assuntos
Veia Axilar , Cateterismo Periférico/instrumentação , Cateteres de Demora , Dispositivos de Acesso Vascular , Veia Axilar/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
17.
J Vasc Access ; 19(4): 396-397, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29529963

RESUMO

INTRODUCTION: We report a case of vein rupture by Arrow-Trerotola percutaneous thrombolytic device (Trerotola PTD) during a treatment of thrombosed arteriovenous graft (AVG). CASE DESCRIPTION: A 77-year-old woman with a problem of thrombosed AVG underwent an endovascular treatment including a procedure of angioplasty of axillary vein. After angioplasty of axillary vein, we found a newly developed thrombus in axillary vein and performed thrombolysis using an over-the-wire 7F Trerotola PTD. When the rotating cage of the device arrived at axillary vein, it suddenly stopped, fixed at the angioplasty site, and didn't move at all. Venogram showed an extravasation of contrast media at axillary vein, suggesting vein rupture. The patient underwent an emergency operation. CONCLUSIONS: It could be dangerous to use Trerotola PTD in a native vein immediately after angioplasty.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Veia Axilar/lesões , Oclusão de Enxerto Vascular/terapia , Diálise Renal , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/instrumentação , Lesões do Sistema Vascular/etiologia , Trombose Venosa/terapia , Idoso , Angioplastia com Balão , Veia Axilar/diagnóstico por imagem , Veia Axilar/fisiopatologia , Veia Axilar/cirurgia , Desenho de Equipamento , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Flebografia , Ruptura , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/cirurgia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/fisiopatologia
18.
J Vasc Access ; 19(3): 311-315, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29592529

RESUMO

PURPOSE: Peripherally inserted central venous catheters are some of the most useful devices for vascular access used globally. Peripherally inserted central venous catheters have a low rate of fatal mechanical complications when compared to non-tunnel central venous catheters. However, as peripherally inserted central venous catheter access requires a smaller vein, there is a high risk of thrombosis. The axillary vein (confluence of the basilic and brachial veins) can serve as an access for cannulation. Moreover, as this vein is larger than the basilic or brachial vein, it might be a superior option for preventing thrombosis. The risk of catheter-related bloodstream infection should be considered when the puncture site is at the axillary fossa. The aim of this study was to present our new protocol involving peripherally inserted central venous catheters (non-tunneled/tunneled) and a tunneling technique and assess its feasibility and safety for improving cannulation and preventing thrombosis and infection. METHODS: The study included 20 patients. The axillary vein in the upper arm was used for peripherally inserted central venous catheters in patients with a small-diameter basilic vein (<3 mm). When the puncture site was in the axillary fossa, a subcutaneous tunnel of about 3 cm was constructed easily using a peripheral venous catheter. RESULTS: The observed catheter duration was 645 days (median ± standard deviation, 26 ± 22.22 days). Catheterization was successful in all cases, however, two accidental dislodgements were identified. No fatal or serious complications were observed after catheterization. CONCLUSION: Our new protocol for axillary peripherally inserted central venous catheters/tunneled axillary peripherally inserted central venous catheters use for a small-diameter basilic vein is safe and feasible.


Assuntos
Veia Axilar , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Idoso , Idoso de 80 Anos ou mais , Veia Axilar/diagnóstico por imagem , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Punções , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Ultrassonografia de Intervenção
19.
Ann Vasc Surg ; 48: 253.e11-253.e16, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29421426

RESUMO

BACKGROUND: Cephalic arch problems, mainly stenosis, are a common cause of arteriovenous fistulas (AVFs) failure, and the most effective treatment is yet to be clearly defined. Restenosis usually occurs soon, and multiple interventions become necessary to maintain patency and functionality. The authors present the experience of their center with cephalic vein transposition in a group of patients with different problems involving the cephalic arch. METHODS: After consultation of the medical records, an observational retrospective analysis was performed to evaluate the outcomes of surgical treatment in cephalic arch problems of AVFs treated at the author's center between January 2013 and December 2015. The considered outcomes were endovascular intervention rate, thrombosis rate, and primary and secondary patencies. RESULTS: Seven patients were treated by venovenostomy with transposition of the cephalic arch and anastomosis to the axillary vein. The average patient age was 72 years (59-81), and most patients were female (71%) and diabetic (71%). All accesses were brachiocephalic AVFs with a mean duration of 4 years (1-7). The underlying problems were intrinsic cephalic arch stenosis (n = 5), entrapment of the cephalic vein (n = 1), and clinically significant vein tortuosity at the cephalic arch (n = 1). These last 2 problems conducted to a surgical approach as first-line therapy instead of endovascular intervention, the initial treatment in the other 5 cases (all with high-pressure balloons, with cutting balloon in one case). Previous thrombotic episodes were reported in 57% of the patients. The mean access flow before surgical intervention was 425 mL/min (350-1,500). No complications related with the surgical procedure were reported. One patient underwent surgical thrombectomy after AVF thrombosis, followed by transposition of the vein. In another case, a simultaneous flow reduction was performed. Most of the patients on dialysis (5/6) used the AVF after surgery. After a mean follow-up period of 9 months (1-22), surgical treatment was associated with a reduction in endovascular intervention rate (1.9 interventions per patient-year presurgery versus 0.4 postsurgery; P < 0.05) and thrombosis rate (0.93 thrombotic episodes per patient-year presurgery versus 0.17 postsurgery; P < 0.05). The problems leading to endovascular reintervention were as follows: new venous anastomosis stenosis (57%), axillary vein stenosis (29%), and swing-point stenosis (14%). Primary and secondary patencies at 6 months were 57% and 71%, respectively. CONCLUSIONS: In this group of patients with cephalic arch problems and multiple previous procedures, surgical treatment was associated with a reduction in endovascular intervention and thrombosis rate but did not avoid reintervention. Facing the complexity and multiplicity of the cephalic arch complications, treatment should be individually decided.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Veia Axilar/cirurgia , Veias Braquiocefálicas/cirurgia , Oclusão de Enxerto Vascular/cirurgia , Extremidade Superior/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Veia Axilar/diagnóstico por imagem , Veia Axilar/fisiopatologia , Velocidade do Fluxo Sanguíneo , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/fisiopatologia , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
20.
Folia Morphol (Warsz) ; 77(3): 464-470, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29345717

RESUMO

BACKGROUND: During cardiac implantable electronic device (CIED) implantation procedures cardiac leads have been mostly introduced transvenously. The associated injury to the selected vessel and adjacent tissues may induce reflex vasoconstriction. The aim of the study was to assess the incidence of cephalic vein (CV) vasoconstriction during first-time CIED implantation. MATERIALS AND METHODS: Of the 146 evaluated first-time CIED implantation procedures conducted in our centre in 2016, we selected those during which CV vasoconstriction was recorded. We focused on the stage of the procedure involving CV cutdown and/or axillary vein (AV)/subclavian vein (SV) puncture for lead insertion. Only cases documented via venography were considered. RESULTS: Vasoconstriction was observed in 11 patients (5 females and 6 males, mean age 59.0 ± 21.2 years). The presence of this phenomenon affected the stage of CIED implantation involving cardiac lead insertion to the venous system, in severe cases, requiring a change of approach from CV cutdown to AV/SV puncture. The extent of vasoconstriction front propagation was limited to the nearest valves. Histological examinations of collected CV samples revealed an altered spatial arrangement of myocytes in the tunica media at the level of leaflet attachment. CONCLUSIONS: Cephalic vein vasoconstriction is a rare phenomenon associated with accessing the venous system during first-time CIED implantation. The propagation of CV constriction was limited by the location of the nearest valves.


Assuntos
Veia Axilar , Desfibriladores Implantáveis , Flebografia , Veia Subclávia , Vasoconstrição , Idoso , Idoso de 80 Anos ou mais , Veia Axilar/diagnóstico por imagem , Veia Axilar/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veia Subclávia/diagnóstico por imagem , Veia Subclávia/fisiopatologia
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