Search

Background: Axillary vein puncture guided by ultrasound (US-Ax) has emerged as a valid alternative access route to pacemaker and defibrillator lead insertion.Objective: The purpose of this study was to evaluate whether US-Ax compared to cephalic vein dissection (CV) improves success and early complications in pacemaker or defibrillator implant.Methods: This prospective, multicenter clinical trial included 88 adult patients randomized 1:1 to US-Ax (n = 44) or CV (n = 44). All procedures were performed by operators with no previous experience in axillary approach. Primary endpoint was defined as success rate. Secondary endpoints were venous access site change, time to obtain venous access, total procedural time, and early complication rate. Analyses were performed using the intention-to-treat principle.Results: Median age was 70.5 years (58.2-79.7), and 60.2% were male. For the primary outcome, a higher success rate was observed in the axillary group (97.7% vs 54.5%; P <.001), as well as a lower rate of venous access site change (2.3% vs 40.9%; P <.001) and shorter time to obtain venous access (5 vs 15 minutes; P <.001) and procedural time (40 vs 51 minutes; P = .010), with no difference in complication rate (2.3% vs 11.4%; P =.20). In multivariate analysis, US-Ax (P <.001), single-chamber device (P = .015), and body mass index (P = .015) were independent predictors of overall success.Conclusion: This is the first randomized trial comparing self-learned US-Ax to CV in cardiac lead implantation. Our results indicate that the axillary approach was superior in terms of success rate, time to obtain venous access and procedural time, with similar complication rate. [ABSTRACT FROM AUTHOR]

The effect of the direction of cephalic vein mobilization in a deltopectoral approach to the shoulder on limb edema is unknown. The primary objective was to evaluate the effect of the direction of cephalic vein mobilization/ligation on limb edema after elective shoulder arthroplasty. The secondary objectives were to: evaluate the effect of the arthroplasty procedure performed on limb edema; correlate postoperative ultrasonographic patency with intraoperative assessment. A cohort of 62 patients undergoing primary shoulder arthroplasty using the deltopectoral approach were enrolled and prospectively followed. Exclusion criteria included: surgery for fracture and prior open anterior shoulder procedure. Surgeons documented the direction of vein mobilization and if it was ligated. Patency was assessed by doppler ultrasound and standardized limb circumference measurement preoperatively, at 2 weeks and 12 weeks postoperatively. Arm circumference was significantly increased at 2 weeks in all cohorts (lateral, p <0.001; medial, p = 0.007; ligated, p = 0.011) and at 12 weeks in the laterally-mobilized (p = 0.022) and ligated cohorts (p = 0.003) as compared to preoperatively. Reverse shoulder arthroplasty demonstrated significantly greater arm circumference at 12 weeks as compared to total shoulder arthroplasty (p = 0.014). Intraoperative determination of patency was moderately correlated with 2- and 12-week (r = 0.70, 0.59) ultrasound assessment. Medial cephalic vein mobilization in a deltopectoral approach resulted in significantly less arm edema at 3-months when compared to lateral mobilization/ligation. Reverse shoulder arthroplasty demonstrated greater arm edema at 3-months when compared to total shoulder arthroplasty. Intraoperative determination of cephalic vein patency was moderately correlated with postoperative vein patency as assessed by ultrasound. III. [ABSTRACT FROM AUTHOR]

Background: Port-a-Cath are routinely warranted as a universal venous access for chemotherapy, due to their operational ease, comparatively less complications and relative ease of maintenance. Catheter implantation can be done either by surgical approach by vein cut-down technique or ultrasound-guided percutaneous technique or by landmark technique using fluoroscopy. Here we present our data on our novel technique. Methods: A descriptive cross-sectional study of 92 consecutive patients who underwent Port-a- Cath implantation for adjuvant therapy, from August 2017 through to July 2019 was done. The procedure was carried out in the minor operation theatre under local anaesthesia with anaesthetist doing a transthoracic echocardiography and surgeon doing a cephalic vein cut down under echocardiography guidance, as a day care procedure. This allowed the catheter to reach the superior vena cava smoothly thus avoiding inadvertent cannulation of the internal jugular vein. Results: Four (4.34%) of 92 patients required additional sedation. No patients required to be reexplored in lieu of erroneous placement of the catheter. In all patients the catheter was placed properly in the superior vena cava- right atrial junction. Late complications amounted to 8.69% of the study group, this included flip over, puncture site infection and catheter blockage. All patients were followed-up for a period of 1 to 6 months. Conclusions: We advocate a combined approach of echocardiography guided Port-a-Cath insertion through cephalic vein cut down as a simple, safe, with satisfactory success rate. It offers a suitable alternative to the other invasive procedures performed under image guidance and avoids radiation exposure and malposition. [ABSTRACT FROM AUTHOR]

Background: Whether ligation of the dorsal branch of the cephalic vein during the surgical establishment of the radiocephalic arteriovenous fistula (RCAVF) favorably or adversely affects the patency rate of the RCAVF remains controversial. We performed a randomized controlled trial to evaluate the effect of dorsal branch ligation on the patency rate of RCAVF.Methods: A total of 115 patients who underwent surgical establishment were randomized to two groups treated with or without ligation of the dorsal branch of the cephalic vein during the surgical process. The primary patency rates of the RCAVF at 90, 270, and 360 days after the surgery and the secondary patency rates during a follow-up up to 1 year were compared.Results: The patency rate did not differ significantly between the two groups at 3, 9, or 12 months after the procedure (P > 0.05). The combined primary patency rates of the RCAVF in patients from both groups at 3, 9 and 12 months after the procedure were 87.6, 82, and 74.5% respectively, while the combined secondary patency rate was 92.2% at the 1-year follow-up. The Log-rank test indicated that the initial patency rate and secondary patency rate did not differ significantly between the two groups (P = 0.674 and 0.759, respectively).Conclusion: This clinical study indicated that ligation of the dorsal branch of the cephalic vein does not significantly affect the patency of the arteriovenous fistula with a 1-year follow-up.Trial Registration: ISRCTN ISRCTN12288675, Registered 25 September 2019 in the ISRCTN registry. retrospectively registered. [ABSTRACT FROM AUTHOR]

The jugulocephalic anastomosis is a rare anatomical variant which normally undergoes atrophy during embryonic development. We found 2 cases of the jugulocephalic vein variant with supraclavicular course in Korean male cadavers. In a 50-year-old cadaver, the right cephalic vein ascended anterior to the clavicle, and terminated into the external jugular vein as well as to the axillary vein through a classic branch. In a 76-year-old cadaver, the left cephalic vein ascended supraclavicular course without any branch to the axillary vein, and terminated to the external jugular vein. We discussed the embryological explanation as well as its frequency since this jugulocephalic vein variant could cause unpredicted danger during clinical procedures. [ABSTRACT FROM AUTHOR]

Background: Active fixation leads have provided stable atrial and ventricular pacing; however, long-term follow-up data have not been satisfactory. The purpose of this study was to investigate the long-term reliability of active fixation leads and their electrical characteristic stability. Methods: A total of 1196 pacing leads were implanted in 830 patients consecutively between 2002 and 2013. In this retrospective study, we were able to trace 1092 leads in 750 patients to investigate the prognosis of implanted leads. The measurement values (including pacing thresholds, sensing amplitudes, and lead impedances of both the atrial and ventricular leads) were obtained from medical records at the time of implantation and during follow up at the outpatient device clinic. All pacing leads were FINELINE II Sterox EZ Leads (Boston Scientific, MN, USA), which are sweet-tip type screw-in active fixation leads, except for the shock leads in patients with implantable cardioverter defibrillator. Results: The mean follow-up period was 51.3±29.2 months (median, 48 months). A total of 1092 leads were implanted in either the atrium (682 leads) or the ventricle (410 leads). Venous access was achieved through cephalic vein cut down (CVC) method (914 leads) or the subclavian vein puncture (SVP) method (178 leads). The overall lead survival rate was 99.6% at both 5 and 10 years. Lead fracture was observed in 4 of 1092 leads (0.37%), all of which were implanted by the SVP method. No lead fracture occurred among patients wherein CVC method was applied (p

In Romania the prevalence of chronic kidney disease is estimated to be 7% and end-stage renal disease is an increasingly common diagnosis. A long-term, reliable, dependable, and safe method of repeatedly accessing patient’s blood is one of the most difficult challenges for haemodialysis therapy. The best method to date to accomplish vascular access the arterio-venous fistula (AVF). This segment can be accessed with dialysis needles, providing blood for dialysis. We present a case of a 57-year-old man was diagnosed with an end-stage renal disease and occluded distal radial artery. The cephalic vein was transposed and looped in a tunnel created in the volar aspect of the forearm’s subcutaneous tissue with the end to side anastomosis with the proximal radial artery in the antecubital fossa. The fistula matured in 40 days and the flow volume was 1100 mL/min. He continues his dialysis sessions and is included on the national kidney transplant list. [ABSTRACT FROM AUTHOR]

Introduction: The most widespread venous sites of access for implantation intravenous implantable cardiac electronic device (CIED) are the cephalic and subclavian vein. Fluoroscopy‐guided axillary venous access is an alternative, but efficacy and safety have not been studied under equal conditions. The aim of the present study is to compare the efficacy and safety of fluoroscopy‐guided axillary vs cephalic vein access in CIED implant. Methods and Results: Two hundred and forty patients were randomized to receive CIED implantation by the fluoroscopy‐guided axillary vein access vs cephalic vein access. The implantation success, the procedure times and the complications were recorded. A comparison of the results of operators was made. The success rate of the randomized venous access was superior in the axillary group than in cephalic (98.3% vs 76.7%, P < .001). Time to access (6.8 ± 3.1 minute vs 13.1 ± 5.8 minutes, P < .001) and implantation duration was significantly shorter in the axillary group than in the cephalic group (42.3 ± 11.6 minutes vs 50.5 ± 13.3 minutes, P < .001). There was no difference in the incidence of complication and inter‐operator success rate, complications rate and time to access. Conclusion: The fluoroscopy‐guided axillary venous access is safe and has a better success rate and faster execution time compared with the cephalic vein access. When the results were compared among the study operators, neither in the axillary nor in the cephalic group there were differences in the success rate, the complication rate, and the time to access. Trial Registration: www.clinicaltrials.gov, NCT03860090 [ABSTRACT FROM AUTHOR]

The anatomical variations in the tributaries pattern of the axillary vein are not uncommon. In this case report, we describe three distinct findings observed in the right upper limb of a 65-year-old male cadaver: (1) a venous chiasma formed between the common brachial and basilic veins in the middle of the arm, (2) the variant course of ulnar nerve passing deep into the gap created by the chiasma, and (3) the cephalic vein terminating in the basilic vein. The knowledge of such variations could be resourceful for surgeons in avoiding neurovascular damage during basilic vein catheterization and anticipating difficulty in creating the brachio-basilic arteriovenous fistula. [ABSTRACT FROM AUTHOR]

Knowledge of varying patterns of formation and termination of external jugular vein is not only important for anatomists but also for surgeons operating at this level and interventional radiologists who perform transjugular procedures. Two different variations related to formation and communications of external jugular vein were observed during routine dissection for the first MBBS students in the Department of Anatomy at Sree Narayana Institute of Medical Sciences, Chalakka, Ernakulum in two different cadavers. The external jugular vein had a communicating channel with cephalic vein which traversed superficial to the clavicle on right side and in second cadaver the right external jugular vein was formed by union of undivided retromandibular vein with posterior auricular vein. Knowing the venous patterns in neck region is of paramount importance in order to avoid unnecessary bleeding during surgical procedures.

Abstract Background The aims of this study were to elucidate why the cephalic vein provides a reliable cannulation site from a morphological viewpoint and identify an effective landmark for avoiding injury to the superficial branch of the radial nerve (SBRN), allowing for safe venipuncture of the cephalic vein. Findings We examined 32 forearms and wrists from 18 cadavers. The cephalic vein was a constant structure containing a branch communicating with a collateral vein of the deep palmar arch via the first dorsal interossei muscle. The metacarpal vein from the medial two digits flowed into the cephalic vein. The venous confluence formed 5.8 ± 1.2 cm proximal to the radial styloid process. The SBRN passed 0.4 ± 0.3 cm volar to the venous confluence. The distance between the venous confluence and subcutaneous emergence of the SBRN was 2.6 ± 1.0 cm. Conclusions These observations suggest that the cephalic vein is a constant structure that serves as a drainage vein of the hand and provides a reliable cannulation site in the forearm. The venous confluence may serve as a novel landmark to predict the running course of the SBRN.

In this case report, we present a patient scheduled for operation due to critical leg ischemia in whom a bilateral great saphenous vein (GSV) had already been used during previous cardiac and peripheral vascular surgeries. The patient underwent femorofemoral crossover bypass from left to right with a small saphenous vein and right femoropopliteal bypass with cephalic vein (CV) during the same session. Distal pulses became palpable, and symptoms regressed dramatically following the operation. A control computed tomographic angiography scan revealed no signs of graft stenosis 32 months after the surgery. Despite the recent advances in synthetic graft materials, small saphenous and CVs should be remembered as alternative long-standing conduits in the absence of the GSV. [ABSTRACT FROM AUTHOR]