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Purpose: To explore the correlation between preoperative cephalic vein pathological types and the maturation of autogenous arteriovenous fistula (AVF) in patients with chronic kidney disease (CKD), providing new ideas and methods for clinical prediction of fistula maturation. Methods: A retrospective analysis was performed in 80 patients who underwent AVF creation surgery from June 2021 to June 2023 at our hospital. Patients were followed up for 6 months. Patients were classified into the mature group (n = 57) and the power loss group (n = 23) based on the AVF maturation status. Preoperative excised venous tissues were examined using Masson's trichrome staining to compare the intimal area (Ia), medial area (Ma), lumen diameter (Ld), average intimal thickness (Avg It), and average medial thickness (Avg Mt), along with the calculations and comparisons of Ia/Ma, Avg It/Avg Mt ratios. Factors influencing AVF power loss were identified using the multifactorial logistic regression analysis. Results: Ia, Ia/Ma, and Ld were lower in the power loss group compared to the mature group (P < 0.01). No significant difference was found in Avg Mt and Avg It/Avg Mt levels between the two groups (P > 0.05). The level of Avg It was higher in the power loss group (P < 0.05). Avg It was a risk factor (P < 0.001), while Ld was a protective factor for AVF power loss (P < 0.05). Conclusion: The levels of Avg It and Ld in preoperative cephalic vein tissue before AVF formation were correlated with AVF power loss. Early monitoring may improve therapeutic outcomes and prognosis of patients with stage 5 CKD. [ABSTRACT FROM AUTHOR]

Background: The axillary vein is preferred over the subclavian vein, and the cephalic vein for cardiac implantable electronic device (CIED) lead insertion. However, studies on ultrasound-guided axillary vein access (US-AVA) in Asia are scarce. This study aims to evaluate the feasibility of US-AVA for CIED lead implantation in Korean patients. Methods: From September 2021 to September 2023, we employed US-AVA for CIED lead implantation procedures. Patients' demographic and procedural data were collected and analyzed retrospectively. Results: US-AVA was successful in 301 patients (97.7%). There were no occurrences of pneumothorax or severe hematoma due to inadvertent arterial puncture, nor were there any other significant vascular access-related acute complications. During the median 1.7 years of follow-up, no CIED infection or lead-related problems have occurred. Compared to a historical cohort of patients who underwent fluoroscopy-guided axillary vein access (FL-AVA), US-AVA significantly reduced procedure and fluoroscopy time and showed a trend toward reduced radiation doses. Conclusion: US-AVA is a safe and effective technique for CIED lead implantation in Korean patients, with advantages over FL-AVA in terms of procedural efficiency and patient safety. [ABSTRACT FROM AUTHOR]

Background: There is a risk of cephalic vein injury during shoulder arthroscopy. However, limited data regarding its anatomic course are available. Purpose: To analyze the positional relationship and factors affecting the distance between the coracoid tip and cephalic veins. Study design: Case series; Level of evidence, 4. Methods: A total of 80 contrast‐enhanced computed tomography images from 80 patients (mean age, 49.6 ± 20.3 years; 61 men) were retrospectively analyzed. The distance between the center of the coracoid tip and the vertical line through the cephalic vein was measured in the axial (D1) and sagittal (D2) planes. The distance between 1 cm lateral to the center of the coracoid tip and the vertical line through the cephalic vein was measured in the sagittal plane (D3). Each distance was compared according to patient sex and laterality. Associations between each distance and the patient's age, height, weight, and body mass index were investigated. Results: The mean D1 was 18.4 ± 7.3 mm in 59 patients. The mean D2 was 23.4 ± 11.6 mm, and it was within 10 mm in 10 patients (12.5%). The mean D3 was 33.7 ± 12.2 mm. There was no significant difference in D1, D2, and D3 according to patient sex or laterality. A positive correlation was observed only between D3 and patient height (r = 0.320; P =.034). Conclusion: The cephalic vein was found to travel a mean of 23.4 mm distal and 33.7 mm distal to 1 cm lateral to the coracoid tip. Therefore, Care should be taken to avoid cephalic vein injury when creating an anterior inferior portal or 5-o'clock portal around these areas. [ABSTRACT FROM AUTHOR]

Background and Aims Intra-pocket ultrasound-guided axillary vein puncture (IPUS-AVP) for venous access in implantation of transvenous cardiac implantable electronic devices (CIED) is uncommon due to the lack of clinical evidence supporting this technique. This study investigated the efficacy and early complications of IPUS-AVP compared to the standard method using cephalic vein cutdown (CVC) for CIED implantation. Methods ACCESS was an investigator-led, interventional, randomized (1:1 ratio), monocentric, controlled superiority trial. A total of 200 patients undergoing CIED implantation were randomized to IPUS-AVP (n = 101) or CVC (n = 99) as a first assigned route. The primary endpoint was the success rate of insertion of all leads using the first assigned venous access technique. The secondary endpoints were time to venous access, total procedure duration, fluoroscopy time, X-ray exposure, and complications. Complications were monitored during a follow-up period of three months after procedure. Results IPUS-AVP was significantly superior to CVC for the primary endpoint with 100 (99.0%) vs. 86 (86.9%) procedural successes (P =.001). Cephalic vein cutdown followed by subclavian vein puncture was successful in a total of 95 (96.0%) patients, P =.21 vs. IPUS-AVP. All secondary endpoints were also significantly improved in the IPUS-AVP group with reduction in time to venous access [3.4 vs. 10.6 min, geometric mean ratio (GMR) 0.32 (95% confidence interval, CI, 0.28–0.36), P <.001], total procedure duration [33.8 vs. 46.9 min, GMR 0.72 (95% CI 0.67–0.78), P <.001], fluoroscopy time [2.4 vs. 3.3 min, GMR 0.74 (95% CI 0.63–0.86), P <.001], and X-ray exposure [1083 vs. 1423 mGy.cm², GMR 0.76 (95% CI 0.62–0.93), P =.009]. There was no significant difference in complication rates between groups (P =.68). Conclusions IPUS-AVP is superior to CVC in terms of success rate, time to venous access, procedure duration, and radiation exposure. Complication rates were similar between the two groups. Intra-pocket ultrasound-guided axillary vein puncture should be a recommended venous access technique for CIED implantation. [ABSTRACT FROM AUTHOR]

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Objective To reduce the empirical dependence of ultrasound measurement of the cephalic vein diameter, improve the repeatability of measurements for inexperienced operators, and provide a new method for inexperienced operators.Methods Operators without ultrasound experience used contact ultrasound and immersion ultrasound to measure the diameter of the cephalic vein. The intraobserver and interobserver repeatability of measurements obtained via the two methods were analyzed.Results The intraobserver and interobserver repeatability of the cephalic vein diameter measured via contact ultrasound by inexperienced operators were average, with intraclass correlation coefficients (ICCs) of 0.572 (95% CI: 0.239–0.759) and 0.405 (95% CI: −0.057–0.666), respectively. The intraobserver and interobserver reproducibility of the cephalic vein diameter measured by immersion ultrasound were very good, with ICCs of 0.955 (95% CI: 0.922–0.975) and 0.943 (95% CI: 0.900–0.967), respectively. In the Bland–Altman diagram of the intraobserver and interobserver agreement of the immersion ultrasound measurements of the cephalic vein diameter, 96% of the points fell within the 95% limits of agreement.Conclusion Immersion ultrasonography can be used to measure the cephalic vein diameter while reducing the dependence of the results on operator experience; inexperienced operators can achieve very good repeatability.

The occurrence of venous aneurysms (VAs) is very rare, and VAs have been seldom reported in the existing literature. The etiology leading to the formation of VAs has not yet been determined. The presentation can range from asymptomatic to painful thrombosis of the sac, with rare events of pulmonary embolism. We have reported the case of a patient who had had a large cephalic vein aneurysm that was treated successfully. A 39-year-old man had presented with swelling in the left forearm that had progressively increased in size for 2 years and was associated with discomfort. On examination, a 5 × 5-cm soft compressible lesion was present over the mid-forearm that disappeared with raising of the arm. Contrast-enhanced magnetic resonance imaging showed a well-defined lesion arising from the cephalic vein. Under local anesthesia, after proximal and distal ligation, the aneurysm was excised. The histopathologic examination showed a thinned out smooth muscle wall and multifocal absence of the smooth muscle layer. The patient was doing well at 1 year of follow-up with no further degeneration in the vein wall. The formation of VAs might result from endophlebohypertrophy and endophlebosclerosis of the veins at the site of recurrent stress. Surgical excision should be considered when the patient is symptomatic, cosmetic disfigurement is present, and/or complications such as venous thrombosis, pulmonary embolism, and/or nerve compression have developed.

Purpose: The aim of this study is to report rare anatomical variations of the cephalic vein (CV) in a 77-year-old Korean male cadaver. Case report: On the right upper arm, the CV located lateral to the deltopectoral groove passed anterior to the clavicle at the lateral one-fourth of the clavicle without anastomosis to the axillary vein. It was connected to the transverse cervical and suprascapular veins by two communicating branches in the middle of its course at the neck, and opened into the external jugular vein at its junction with the internal jugular veins. The suprascapular and anterior jugular veins were flowed into the subclavian vein at the jugulo-subclavian venous confluence, and were connected by a short communicating branch. Conclusion: Detailed knowledge of the variations in the CV is expected to be helpful in decreasing unpredicted injuries and possible postoperative complications when invasive venous access is performed through the CV. [ABSTRACT FROM AUTHOR]

A 60-year-old man presented with focal swelling on the dorsal surface of the left wrist. The sonographic exam revealed the presence of a smoothly rounded hypoechoic mass, with internal blood flow in the lumen of the vein. The histopathological findings led to the diagnosis of intravenous lobular capillary hemangioma (LCH). Here, we reported an intravenous LCH arising from the cephalic vein on the dorsal surface of the left wrist hand and discussed the related ultrasonographic findings.

To reduce the empirical dependence of ultrasound measurement of the cephalic vein diameter, improve the repeatability of measurements for inexperienced operators, and provide a new method for inexperienced operators. Operators without ultrasound experience used contact ultrasound and immersion ultrasound to measure the diameter of the cephalic vein. The intraobserver and interobserver repeatability of measurements obtained via the two methods were analyzed. The intraobserver and interobserver repeatability of the cephalic vein diameter measured via contact ultrasound by inexperienced operators were average, with intraclass correlation coefficients (ICCs) of 0.572 (95% CI: 0.239–0.759) and 0.405 (95% CI: −0.057–0.666), respectively. The intraobserver and interobserver reproducibility of the cephalic vein diameter measured by immersion ultrasound were very good, with ICCs of 0.955 (95% CI: 0.922–0.975) and 0.943 (95% CI: 0.900–0.967), respectively. In the Bland–Altman diagram of the intraobserver and interobserver agreement of the immersion ultrasound measurements of the cephalic vein diameter, 96% of the points fell within the 95% limits of agreement. Immersion ultrasonography can be used to measure the cephalic vein diameter while reducing the dependence of the results on operator experience; inexperienced operators can achieve very good repeatability. [ABSTRACT FROM AUTHOR]

Although transfemoral carotid artery stenting (CAS) is widely performed for carotid stenosis, serious or even fatal complications such as embolic and access site complications can still occur. We devised a novel dual protection system with continuous flow reversal to the cephalic vein of the forearm in transradial CAS, referred to as the “trans-forearm dual protection” technique.A 75-year-old man with a diagnosis of symptomatic left cervical internal carotid artery (ICA) stenosis underwent CAS using the trans-forearm dual protection technique.A 4F sheath was introduced into the cephalic vein of the right forearm. After an 8F balloon-guiding catheter was navigated into the left common carotid artery (CCA) via right sheathless radial access, a distal filter protection device was advanced into the high cervical ICA. The 8F balloon-guiding catheter was inflated and connected to the 4F sheath with a blood filter interposed. Under the dual protection of flow reversal and distal filter, the CAS procedure was performed. The postprocedural course was uneventful. Diffusion-weighted imaging 2 days after the procedure showed no evidence of ischemic stroke. The patient was discharged home without any complications 1 week after the procedure. Carotid duplex ultrasound performed 9 months after the procedure showed no signs of restenosis.This method allows for CAS under the dual protection of flow reversal and filter device protection via the trans-forearm access, reducing the risk of embolism and access site complications. Therefore, the trans-forearm dual protection technique can be a useful option for CAS. [ABSTRACT FROM AUTHOR]

Some studies suggest that regional anesthesia provides better patency for arteriovenous fistula (AVF) for hemodialysis access as compared to local and general anesthesia. This study evaluates the impact of anesthetic modality on long term fistula function at 12 months. A retrospective review of patients undergoing cephalic vein-based hemodialysis access in consecutive cases between 2014 and 2019 was conducted from five safety net hospitals. The primary endpoint was functional patency at 12 months. Subset analysis individually evaluated cephalic-based lower forearm and wrist vs upper arm AVFs. Bivariate and multivariate logistic regression models evaluated the relationship between anesthetic modality and fistula function at 12 months. There were 818 cephalic-based fistulas created during the study period. The overall 12-month functional patency rate was 78.7%, including an 81.3% patency for upper arm AVF and 73.3% for wrist AVF (P =.009). There was no statistically significant difference among patients with functional and nonfunctional AVFs at 12 months with respect to anesthetic modality when comparing regional, local, and general anesthesia (P =.343). Multivariate regression analysis identified that history of AVF/arteriovenous graft (odds ratio [OR], 0.24; P =.007), receiving intraoperative systemic anticoagulation (OR, 2.49; P <.001), and vein diameter (OR, 1.85; P =.039) as independently associated with AVF functional patency at 12 months. There was no association between anesthetic modality and functional patency of cephalic-based AVFs at 12 months. Further studies are needed to better define which patients may benefit from regional anesthesia. [ABSTRACT FROM AUTHOR]

Abstract Background Minimally invasive and safe central venous access is imperative for lead insertion of cardiac implantable electronic devices (CIEDs). The purpose of this trial was to explore and compare the usability of the cephalic vein (CV) between both sexes. Methods and results This single-center prospective study included 102 consecutive patients in a period of six months. Pre-procedural contrast-enhanced venographic images of the upper arm were performed in all included patients. Our attention was focused on comparing several morpho-anatomical CV characteristics such as venous diameter, presence of valves and angle of entrance of the CV into the subclavian vein (SV). Study results concerning the CV morpho-anatomical differences were more favorable regarding the female patient group, with significant differences in CV diameter (p-0.030). There was also a difference in favor of the female group regarding the favorable CV angle of entrance into the SV, found in the 61.7% versus 54.4% in the male patient group. The comparison of usability of the CV and CVC technique was explored by comparing the number of leads inserted through the CV in both sexes. Two leads were implanted in 11.7% in the female group versus 5.8% in the male group, and 0 leads through the CV in 38.2% of the female patients versus 50% of male group. Conclusion Female patients have more favorable cephalic vein morpho-anatomical futures and better usability for lead placement than male patients.

Venous access is needed for implantation of cardiac implantable electronic devices (CIEDs) with endocardial leads. Extrathoracic venous access in the prepectoral region has become the standard of care for CIED implantation because of lower risks for pneumothorax and likely less lead malfunction due to subclavian crush syndrome. The most common extrathoracic venous access sites in the pectoral region are extrathoracic subclavian vein access, axillary vein access, and cephalic vein access. This review provides a detailed description of the anatomy, technical considerations, and relative advantages and disadvantages of each of these extrathoracic venous access sites. [ABSTRACT FROM AUTHOR]

Aim of study; Evaluation of the technical feasibility, durability, complications and patency of rates of stent graft for management of cephalic arch vein stenosis in cases of failing AVF. Patients and Methods: Retrospective analysis for patients referred to vascular clinic with malfunction of AVF due to CAS managed with covered stent therapy from March 2020 till June 2021. Results: 9 patients with endovascular stent-grafting of cephalic vein arch stenosis with age range 27-54 year (mean age: 41.8). All patients received Viabahn® covered stent. Technical success rate was 100%. No major complications.. All patients have shown patent stent graft during outpatient visit with only two patients who developed stent graft edge stenosis at one month and 4 month respectively that was corrected by balloon angioplasty with a high-pressure balloon in one patient and in the other patient a bare metal stent was used. Primary patency rate was 85.7% Conclusion: The use of stent-grafts to address the entire diseased segment in the cephalic vein may reduce recurrence rate and limit the rate of re-interventions. [ABSTRACT FROM AUTHOR]

A 60-year-old man presented with focal swelling on the dorsal surface of the left wrist. The sonographic exam revealed the presence of a smoothly rounded hypoechoic mass, with internal blood flow in the lumen of the vein. The histopathological findings led to the diagnosis of intravenous lobular capillary hemangioma (LCH). Here, we reported an intravenous LCH arising from the cephalic vein on the dorsal surface of the left wrist hand and discussed the related ultrasonographic findings. [ABSTRACT FROM AUTHOR]

Axillary vein puncture guided by ultrasound (US-Ax) versus cephalic vein dissection in pacemaker and defibrillator implant: a multicenter randomized clinical trial is a recently published study in which 88 patients were randomized in a 1:1 fashion to one of the two methods. Even being performed by operators with not previous ultrasound-guided axillary vein puncture experience, this group presented a higher success rate, lower procedural time and comparable complication incidence. Recently a study evaluating two different approaches to cardiac devices implant was published. In the study, 88 patients were assigned to one of two methods for this procedure. The operators had no previous experience in one of the methods, but it demonstrated a higher success rate, took less time and had the same number of complications as the method the doctors had experience in. This paper evaluated the study and discusses what changes might take place in clinics as a result of these findings. [ABSTRACT FROM AUTHOR]

Abstract 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.

Introduction: There is a wide variation in the superficial veins of the cubital area. These veins are used in many medical procedures and are clinically important. This study aimed to evaluate the variation of the superficial cubital veins in students of the Ardabil University of Medical Sciences. Material and methods: The volunteers were 150 females and 160 males from students of different disciplines of the Ardabil University of Medical Sciences aged between 18 and 26 years. To observe the superficial veins of the cubital fossa, the tourniquet was fastened 10 cm above the medial epicondyle of the humerus. One to 3 min after fastening the tourniquet, superficial veins were visualized. The patterns of superficial veins in both arms of the participants were recorded using the vein finder (Vein Revealer Garrote (VRG) −115). Results: Seven patterns of superficial cubital veins were identified. There was no significant difference between the right and left upper limbs among males and females. The most common type or pattern was N-type, which was more reported in males (70.1% in males and 64.7% in females). The I/0 was the second most observed pattern, which was more common in females (56.7% in females and 49.6% in males). M-shape pattern with a frequency of 46% in males and 31.5% in females was the third most patterns in our study. Other patterns make less than 10% of cases. Conclusion: In general, the present study results show that gender and ethnicity may affect the superficial veins pattern. However, despite the significant similarity between patterns obtained in our study and those of other authors, some differences may be observed, probably related to the examined sample (cadaveric material or living sample).

Objective: The external jugular vein drains a considerable part of the head and neck and constitutes a vessel implicated in various procedures in the cervical region. The aim of this study is to present an uncommon anatomical variation of the external jugular vein, and discuss the clinical implications of its presence., Case Report: We present a rare case of an ectopic external jugular vein terminating into the axillary vein, that we came across during routine dissection of a male cadaver of Greek origin., Conclusion: The venous system of the external jugular vein is used during procedures for the treatment of various conditions such as cardiac arrhythmias, hydrocephalus and defects of the head and neck. Hence, encountering the unpredictable course of a variant draining into the axillary vein may complicate these interventions, leading to multiple manipulations and undesirable results. Surgeons should be aware of the alternate anatomy of the venous system of the cervical region, and mindful of the possibility of encountering them.

An 83-year-old male with complete atrioventricular block underwent dual-chamber pacemaker implantation. Venography showed normal anatomy of the left axillary vein. Following sedation with intravenous propofol, local anesthesia, and skin incision, we punctured the left axillary vein on the first limb. However, the guidewire could not be advanced despite blood backflow after the initial puncture. On venography, left axillary vein on the first limb totally disappeared with dilated collaterals. We diagnosed axillary vein spasm and injected 1000 μg of intravenous nitroglycerin. After 15 min, repeated venography showed slight contrast flow in the axillary vein. We alternatively punctured the axillary vein on the second limb. However, the axillary vein was spasmodically occluded again. We considered the possibility that puncture of the right axillary vein could also result in venous spasm. Since the left cephalic vein was identified after waiting time, we partially cut down the left cephalic vein and inserted guidewires into the vein. The ventricular and atrial leads were successfully implanted through sheaths in the right ventricular septum and right atrial appendage, respectively. Pacemaker implantation complicated with puncture-related axillary vein spasm is challenging. Severe venous spasms refractory to waiting time or nitroglycerin sometimes require conversion of access site. However, the bail-out technique from ipsilateral access remains unclear. Cut-down technique of the ipsilateral cephalic vein is one alternative to manage severe axillary vein spasm refractory to nitroglycerin and waiting time. [ABSTRACT FROM AUTHOR]

Objective We aimed to remind surgeons of the presence of the thoracoacromial arterial trunk and cephalic vein (TATCV) for a comfortable and reliable free flap transfer to the head, arm, and trunk, in case the mainstream recipient vessels of these regions pose some inconveniences due to previous surgery, radiotherapy, or trauma. Material and Methods Eight cases of trauma or tumor involving the head and neck or upper extremity, treated with free tissue transfer in which this vascular system was used with different modalities, were reviewed retrospectively. Results This vascular system proved to be reliable in all cases. It enabled chimerization with the pectoral flap. It was used in six patients for head and neck reconstructions and in two upper extremity restrorations. Switching the anastomoses to TAT-CV site and cephalic vein transposition were found to be rapid and reliable methods to rescue a flap with compromised circulation. Discussion Although anatomically well known by many reconstructive surgeons, its ease of dissection, consistency, supply of branches of differing caliber, and strategic location is not adequately appreciated. Moreover, in cases of pectoralis major flap transfer in which additional tissue is required, this vascular system is already there to receive it. [ABSTRACT FROM AUTHOR]

Introduction: Superficial veins in cubital fossa vary frequently in their anatomical pattern. The knowledge of variation of the cubital venous pattern is very essential for medical professionals for venous access during different medical procedures. This study aims to find the prevalence of Type A cubital venous pattern among students of a dental college. Methods: This descriptive cross-sectional study was conducted among 133 dental students of age 18 to 25 years in the department of anatomy of a dental college from November 2020 to February 2021. This study was conducted after obtaining ethical clearance from the Institutional Review Committee. Convenience sampling used and data was analyzed using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 133 dental students, Type A cubital venous pattern was found in 96 (72.18%) (64.56-79.79 at 95% Confidence Interval). Type A cubital venous pattern was seen in the left arm in 116 (43.61%) and in the right arm of 76 (28.57%) students. This pattern was noticed in 30 (22.55%) male and 103 (77.44%) female students respectively. Conclusions: This study showed higher Type A cubital venous pattern among dental students than other international studies.

Background: Venous network of hand is superficially placed and is easy to trace for clinical purposes. Ce-phalic vein on lateral aspect and basilic vein on medial aspect of the hand are clinically important for inva-sive and surgical procedures. Thus the study of cephalic and basilic veins at dorsal venous arch of hand was dissected to observe for length of dorsal venous arch and the diameter and thickness of cephalic and basilic veins. Methods: This is a cross-sectional observational study conducted in 50 hands of cadavers (36 hands of male cadavers, 14 hands of female cadavers) in Department of Anatomy, Kathmandu Medical College Teaching Hospital, Duwakot. Cadavers were performed to measure the length of dorsal venous arch, diame-ter and thickness of cephalic and basilic vein on dorsum of hands. Results: The mean±s.d. length of dorsal venous arch in male cadaver (19.03±2.84 cm.) was significantly greater than in female (16.51±1.36 cm.).There was no significant difference in length of dorsal venous arch on right (18.22 ±2.47 cm.) and left side (18.42±3.05 cm.) in either sex. The mean±s.d thickness of basilic vein (0.10±0.01mm) in either sex was significantly greater than that of cephalic vein (0.09±0.01mm). Conclusions: The length of the dorsal ve-nous arch in male cadavers was found significantly greater than in female cadavers. The diameters based on external and internal circumference of basilic veins was found to be more than diameter of cephalic veins in both male and female cadavers. The thickness of basilic vein was found to be more (0.10±0.01mm) than that of cephalic vein (0.09±0.01mm) in cadaver of both sexes.

Background: The arteriovenous fistula (AVF) is considered the gold standard for haemodialysis access. The fistula needs time to be mature and functional. Maturation process respond to increases in blood flow. Exercise stimulates vascular response as such an increase of blood flow. Aims: The purpose of this study is to determine the effectiveness of hand exercise in increasing grip muscle performance, and its effectiveness in supporting maturation process of fistula. Methods: This experimental study done on 14 patients underwent AVF procedure and on routine haemodialysis. Randomly, 7 subjects allocated on intervention group by doing hand exercise using hand gripper (HG) for 5 weeks, and 7 subjects allocated as control group without introduction to hand gripper. Grip strength and forearm circumference were measured before and after 5 weeks of intervention. Cephalic vein diameter, blood flow volume and velocity were measured using Doppler USG on AVF arm. The comparison of intervention effects between groups treatment were analyzed based on effect size (ES). Results: Grip strength and forearm circumference increased significantly on intervention group before and after exercise intervention (p

Introduction: descriptions of the tributaries of axillary vein including thoracoacromial and cephalic veins are significant clinically however usually are terse and deficient in detail in standard textbooks of anatomy. The knowledge about anatomy of these venous structures is deficient as well as complicated. The chief objective of the present study was to establish the presence of deltoid vein in the deltopectoral groove, its relations in the immediate vicinity and establish any variations which can evaluate its feasibility for catheter implantation for central venous access. Materials and methods: the study was conducted over 12 (24 sides) formalin fixed cadavers perfused with formalin based fixative. After removal of skin flap from the deltopectoral region, deep fascia in the deltopectoral groove was divided to expose the cephalic vein and other structures in deltopectoral triangle. Results: structures including cephalic vein, thoracoacromial artery and vein were identified in the immediate vicinity of deltopectoral triangle. Deltoid branch of thoracoacromial artery was identified close to deltoid vein. The topography and relations of deltoid vein were studied. It was traced till its drainage into recipient vessel. Conclusion: in our study we have studied the relations of cephalic and deltoid veins in the deltopectoral groove which can be useful for successful catheter implantation and prevent damage to these important venous structures with scarce data on their topography. [ABSTRACT FROM AUTHOR]

Background: Small series has shown that cardiac resynchronisation therapy (CRT) can be achieved in a majority of patients using exclusively cephalic venous access. We sought to determine whether this method is suitable for widespread use. Methods: A group of 19 operators including 11 trainees in three pacing centres attempted to use cephalic access alone for all CRT device implants over a period of 8 years. The access route for each lead, the procedure outcome, duration, and complications were collected prospectively. Data were also collected for 105 consecutive CRT device implants performed by experienced operators not using the exclusively cephalic method. Results: A new implantation of a CRT device using exclusively cephalic venous access was attempted in 1091 patients (73.6% male, aged 73 ± 12 years). Implantation was achieved using cephalic venous access alone in 801 cases (73.4%) and using a combination of cephalic and other access in a further 180 (16.5%). Cephalic access was used for 2468 of 3132 leads implanted (78.8%). Compared to a non‐cephalic reference group, complications occurred less frequently (69/1091 vs 12/105; P =.0468), and there were no pneumothoraces with cephalic implants. Procedure and fluoroscopy duration were shorter (procedure duration 118 ± 45 vs 144 ± 39 minutes, P <.0001; fluoroscopy duration 15.7 ± 12.9 vs 22.8 ± 12.2 minutes, P <.0001). Conclusions: CRT devices can be implanted using cephalic access alone in a substantial majority of cases. This approach is safe and efficient. [ABSTRACT FROM AUTHOR]

• Iatrogenic intravenous foreign body retention and migration is a well-known, under reported complications and can be a vexing problem for interventionalist. • Imaging techniques play a very important role for diagnosis and during retrieval of intravenous foreign body. • It can have life threatening complications and legal issues. • Serious complications of intravascular foreign bodies can be avoided by adhering to universal guide lines for intravascular cannulation. • Intravascular foreign bodies should be retrieved immediately to avoid Serious complications. We report a case of iatrogenic fracture of peripheral intravenous cannula in the cephalic vein with proximal migration. It is extremely rare and underreported complication of peripheral intravenous cannulation. It acts as a retained intravascular foreign body with lethal complications. In this case report we conceded that a 23 year-old Hindu female presented to us with pain and discomfort at the site of cannulation in the mid forearm and just over the cubital fossa. The localisation of the fractured cannula was reconfirmed with imaging techniques, venotomy and gentle retrieval of intravascular foreign body was performed. When performed properly peripheral intravenous cannulation is a safe procedure with little serious risks. It can cause many lethal complications. Such complications can be avoided by adhering to universal guide lines of IV cannulation. Early localisation and exploration for retrieval should be the treatment of choice. A fractured peripheral intravenous cannula has potentially devastating consequences. Early detection and the standard operating procedure of peripheral venous access, and meticulous teamwork must be adopted. [ABSTRACT FROM AUTHOR]