RESUMO
BACKGROUND: We evaluated the impact of completion intraoperative venography on clinical outcomes for axillosubclavian vein (AxSCV) thrombosis owing to venous thoracic outlet syndrome (vTOS). METHODS: We performed a retrospective, single-center review of all patients with vTOS treated with first rib resection (FRR) and intraoperative venography from 2011 to 2023. We reviewed intraoperative venographic films to classify findings and collected demographics, clinical and perioperative variables, and clinical outcomes. Primary end points were symptomatic relief and primary patency at 3 months and 1 year. Secondary end points were time free from symptoms, reintervention rate, perioperative complications, and mortality. RESULTS: Fifty-one AxSCVs (49 patients; mean age, 31.3 ± 12.6 years; 52.9% female) were treated for vTOS with FRR and external venolysis followed by completion intraoperative venography with a mean follow up of 15.5 ± 13.5 months. Before FRR, 32 underwent catheter-directed thrombolysis (62.7%). Completion intraoperative venography identified 16 patients with no stenosis (group 1, 31.3%), 17 with no stenosis after angioplasty (group 2, 33.3%), 10 with residual stenosis after angioplasty (group 3, 19.7%), and 8 with complete occlusion (group 4, 15.7%). The overall symptomatic relief was 44 of 51 (86.3%) and did not differ between venographic classifications (group 1, 14 of 16; group 2, 13 of 17; group 3, 10 of 10; and group 4, 7 of 8; log-rank test, P = .5). The overall 3-month and 1-year primary patency was 42 of 43 (97.7%) and 32 of 33 (97.0%), respectively (group 1, 16 of 16 and 9 of 9; group 2, 16 of 17 and 12 of 13; group 3, 10 of 10, 5 of 5; group 4, primary patency not obtained). There was one asymptomatic rethrombosis that resolved with anticoagulation, and three patients underwent reintervention with venous angioplasty for significant symptom recurrence an average 2.89 ± 1.7 months after FRR. CONCLUSIONS: Our single-center retrospective study demonstrates that FRR with completion intraoperative venography has excellent symptomatic relief and short- and mid-term patency despite residual venous stenosis and complete occlusion. Although completion intraoperative venographic classification did not correlate with adverse outcomes, this protocol yielded excellent results and provides important clinical data for postoperative management. Our results also support a conservative approach to AxSCV occlusion identified after FRR.
Assuntos
Flebografia , Costelas , Síndrome do Desfiladeiro Torácico , Grau de Desobstrução Vascular , Humanos , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/cirurgia , Síndrome do Desfiladeiro Torácico/fisiopatologia , Feminino , Masculino , Estudos Retrospectivos , Adulto , Costelas/cirurgia , Costelas/diagnóstico por imagem , Adulto Jovem , Resultado do Tratamento , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Fatores de Tempo , Veia Subclávia/diagnóstico por imagem , Veia Subclávia/cirurgia , Veia Axilar/diagnóstico por imagem , Veia Axilar/cirurgia , Cuidados Intraoperatórios , Valor Preditivo dos Testes , Terapia Trombolítica/efeitos adversosRESUMO
INTRODUCTION: Laser lead extraction is a well-established method for removing unwanted leads with low morbidity and mortality. In this small series of cases, we documented our experience with venous thrombosis after laser lead extraction. METHODS: Retrospective data of patients who underwent laser lead extraction with postoperative axillo-subclavian vein thrombosis between May 2010 and January 2020 were analyzed. Demographic, operative, clinical, and follow-up characteristics of those patients were collected from our medical database. RESULTS: Six patients underwent percutaneous laser lead extraction. Mean age of the patients was 64±7 years. And four of them were male. A total of 11 leads with a mean age of 92±43.8 months were extracted. Patients presented with painful arm swelling postoperatively. CONCLUSION: Laser lead extraction may lead to symptomatic upper extremity deep venous occlusion.
Assuntos
Veia Subclávia , Trombose Venosa , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Pré-Escolar , Criança , Feminino , Veia Subclávia/cirurgia , Estudos Retrospectivos , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Braço/irrigação sanguínea , Extremidade SuperiorRESUMO
Intravascular lipomas (IVL) located in the superior vena cava (SVS) are rare benign primary venous tumors with less than 15 cases reported in the literature. We report a case of a 64-year-old woman with IVL of the SVC extending to the right brachiocephalic vein. She was treated successfully using a hybrid procedure which involved endovascular control of the right subclavian vein and surgical approach via median sternotomy followed by mass resection and use of pericardial patch for vein defect closure.
Assuntos
Lipoma , Veia Cava Superior , Feminino , Humanos , Pessoa de Meia-Idade , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/cirurgia , Resultado do Tratamento , Veias Braquiocefálicas/diagnóstico por imagem , Veias Braquiocefálicas/cirurgia , Veias Braquiocefálicas/patologia , Veia Subclávia , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Lipoma/patologiaRESUMO
OBJECTIVES: The primary objective was to determine the prevalence and characteristics associated with malpositioned temporary, nontunneled central venous catheters (CVCs) placed via the internal jugular (IJ) and subclavian (SC) veins in pediatric patients. DESIGN: Single-center retrospective cohort study. SETTING: Quaternary academic PICU. PATIENTS: Children greater than 1 month to less than 18 years who had a CVC placed between January 2014 and December 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the CVC tip position located on the first postprocedural radiograph. CVC tip was defined as follows: "recommended" (tip location between the carina and two vertebral bodies inferior to the carina), "high" (tip location between one and four vertebral bodies superior to the carina), "low" (tip position three or more vertebral bodies inferior to the carina), and "other" (tip grossly malpositioned). Seven hundred eighty-one CVCs were included: 481 (61.6%) were in "recommended" position, 157 (20.1%) were "high," 131 (16.8%) were "low," and 12 (1.5%) were "other." Multiple multinomial regression (referenced to "recommended" position) showed that left-sided catheters (adjusted odds ratio [aOR], 2.00, 95% CI 1.17-3.40) were associated with "high" CVC tip positions, whereas weight greater than or equal to 40 kg had decreased odds of having a "high" CVC tip compared with the reference (aOR, 0.45; 95% CI, 0.24-0.83). Further, weight category 20-40 kg (aOR, 2.42; 95% CI, 1.38-4.23) and females (aOR, 1.51; 95% CI, 1.01-2.26) were associated with "low" CVC tip positions. There was no difference in rates of central line-associated blood stream infection, venous thromboembolism, or tissue plasminogen activator usage or dose between the CVCs with tips outside and those within the recommended location. CONCLUSIONS: The prevalence of IJ and SC CVC tips outside of the recommended location was high. Left-sided catheters, patient weight, and sex were associated with malposition. Malpositioned catheters were not associated with increased harm.
Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Criança , Feminino , Humanos , Estudos Retrospectivos , Veia Subclávia , Ativador de Plasminogênio TecidualRESUMO
BACKGROUND AND OBJECTIVES: The aim of this study was to analyze risk factors for failure of subclavian vein catheterization. METHODS: A retrospective analysis of 1562 patients who underwent subclavian vein puncture performed by the same experienced operator at Peking University Cancer Hospital from January 1, 2016 to January 1, 2019 was conducted. The success or failure of subclavian vein catheterization was registered in all cases. Various patient characteristics, including age, gender, body mass index (BMI), preoperative hemoglobin, preoperative hematocrit, preoperative mean corpuscular hemoglobin concentration (MCHC), preoperative albumin, preoperative serum creatinine, puncture needles from different manufacturers and previous history of subclavian vein catheterization were assessed via univariate and multivariate analyses. RESULTS: For the included patients, landmark-guided subclavian vein puncture was successful in 1476 cases and unsuccessful in 86 cases (success rate of 94.5%). Successful subclavian vein catheterization was achieved via right and left subclavian vein puncture in 1392 and 84 cases, respectively. In univariate analyses, age and preoperative hemoglobin were associated with failure of subclavian vein catheterization. In a multivariate analysis, aged more than 60 years was a risk factor while the central venous access with Certofix® was associated with an increased rate of success (p-values of 0.001 and 0.015, respectively). CONCLUSIONS: This study has demonstrated that patient aged more than 60 years was a risk factor for failure of subclavian vein catheterization while the central venous access with Certofix® was associated with an increased rate of success.
Assuntos
Cateterismo Venoso Central , Veia Subclávia , Cateterismo Venoso Central/efeitos adversos , Humanos , Punções/efeitos adversos , Estudos Retrospectivos , Fatores de RiscoRESUMO
RESUMEN: El músculo subclavio (MS) guarda estrecha relación con las estructuras neurovasculares (ENV) en el tercio medio de la región clavicular, situación de suma importancia para la realización de procedimientos invasivos de esta región. Pocos estudios han determinado la distancia desde el MS hacia la vena subclavia (VS), arteria subclavia (AS) y plexo braquial (PB). El propósito de este estudio fue valuar la expresión morfológica del MS y su relación con las ENV en una muestra de especímenes cadavéricos frescos. Estudio descriptivo en el que se realizó disección anatómica sobre la región clavicular de 30 especímenes de cadáveres humanos frescos no reclamados del Instituto Nacional de Medicina Legal y Ciencias Forenses, Colombia. Se realizó la caracterización cualitativa y cuantitativa del MS y se determinó la relación del MS con las ENV en la región clavicular. El MS presentó una longitud de 102,4±10,3 mm, con un espesor anteroposterior de 8,8±1,9 mm y superoinferior de 7,0±1,9 mm. El MS se caracterizó así: tipo I en 12 (40 %) especímenes, tipo II en 18 especímenes, tipo IIa: 10 especímenes. No encontramos tipos III y IV. La VS, AS y PB se relacionaron con el MS en el tercio medial y medio de su longitud a una distancia desde el margen superior del MSde 9,4±2,2 mm, 11,3±2,1 mm y 12,0±1,5 mm respectivamente. Los MS se relacionaron con las ENV de la región clavicular en una zona comprendida entre el 36,2±3,6 % y 89,4±4,8 % de su longitud total. Los hallazgos cualitativos y morfométricos de este estudio enriquecen los conceptos anatómicos subclaviculares y son de utilidad para el manejo quirúrgico de fracturas de clavícula.
SUMMARY: The subclavian muscle (MS) is closely related to the neurovascular structures (VNS) in the middle third of the clavicular region, and is critical when performing invasive procedures in this region. Few studies have determined the distance from the MS to the subclavian vein (VS), subclavian artery (AS) and brachial plexus (PB). The purpose of this study was to evaluate the morphological expression of MS and its relationship with VNS in a sample of fresh cadaveric specimens. The study involved the anatomical dissection in the clavicular region of 30 specimens of fresh unclaimed human cadavers from the National Institute of Forensic Medicine and Sciences, Colombia. The qualitative and quantitative characterization of the MS was carried out and the relationship of the MS with the VNS in the clavicular region was determined. The MS presented a length of 102.4 ± 10.3 mm, with an anteroposterior thickness of 8.8 ± 1.9 mm and a superoinferior thickness of 7.0 ± 1.9 mm. The DM was characterized as follows: type I in 12 (40 %) specimens, type II in 18 specimens, type IIa: 10 specimens. We did not find types III and IV. The SV, AS and PB were related to the MS in the medial and middle third of its length at a distance from the upper edge of the MS of 9.4 ± 2.2 mm, 11.3 ± 2.1 mm and 12.0 ± 1,5 mm respectively. The MS were related to the VNS of the clavicular region in an area between 36.2 ± 3.6 % and 89.4 ± 4.8 % of its total length. The qualitative and morphometric findings of this study enrich the subclavicular anatomical concepts and are useful for the surgical management of clavicle fractures.
Assuntos
Humanos , Artéria Subclávia/anatomia & histologia , Veia Subclávia/anatomia & histologia , Clavícula , Músculo Esquelético/irrigação sanguínea , Autopsia , Cadáver , Estudos TransversaisRESUMO
Resumo A síndrome da costela cervical ocorre quando o triângulo intercostoescalênico é ocupado por uma costela cervical, deslocando o plexo braquial e a artéria subclávia anteriormente, o que pode gerar dor e espasmo muscular. O objetivo deste estudo é discutir sobre o diagnóstico da síndrome da costela cervical e as possibilidades de tratamento. Este desafio terapêutico descreve a condução clínica e cirúrgica de uma paciente de 37 anos com obstrução arterial em membro superior causada por costela cervical.
Abstract The cervical rib syndrome occurs when the interscalene triangle is occupied by a cervical rib, displacing the brachial plexus and the subclavian artery forward, which can cause pain and muscle spasms. The objective of this study is to discuss diagnosis of the cervical rib syndrome and treatment possibilities. This therapeutic challenge describes clinical and surgical management of a 37-year-old female patient with upper limb arterial occlusion caused by a cervical rib.
Assuntos
Humanos , Feminino , Adulto , Síndrome da Costela Cervical/cirurgia , Síndrome da Costela Cervical/diagnóstico , Artéria Subclávia , Veia Subclávia , Plexo Braquial , Síndrome da Costela Cervical/tratamento farmacológico , Anticoagulantes/uso terapêuticoRESUMO
PURPOSE: To report the device performance and safety for the Surfacer Inside-Out access catheter system in patients with thoracic central venous obstruction (TCVO) requiring central venous access (CVA). MATERIALS AND METHODS: Five sites prospectively enrolled 30 patients requiring a tunneled dialysis catheter between February 2017 and September 2018 in the SAVE (Surfacer System to Facilitate Access in Venous Obstructions) registry. Patient demographics, medical history, and type of TCVO were documented at enrollment. Device performance and adverse events were collected during the procedure and upon hospital discharge. Twenty-nine of the 30 patients enrolled required CVA for hemodialysis. Retrospective classification of TCVOs according to SIR reporting standards showed 9 patients (30%) had Type 4 obstructions, 8 (26.7%) had Type 3, 5 (16.7%) had Type 2, and 8 (26.7%) had Type 1 obstruction. RESULTS: Central venous catheters (CVCs) were successfully placed in 29 of 30 patients (96.7%). The procedure was discontinued in 1 patient due to vascular anatomical tortuosity. All 29 patients with successful CVC placement achieved adequate catheter patency and tip positioning. There were no device-related adverse events, catheter malposition, or intra- or postprocedural complications. Mean time from device insertion to removal for the 29 patients who successfully completed the procedure was 24 ± 14.9 (range, 6-70) minutes. Mean fluoroscopy time was 6.8 ± 4.5 (range, 2.2-25.5) minutes. CONCLUSIONS: The Surfacer Inside-Out procedure provided an alternative option to restore right-sided CVA in patients with TCVO.
Assuntos
Veias Braquiocefálicas , Cateterismo Venoso Central/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Veias Jugulares , Diálise Renal , Veia Subclávia , Doenças Vasculares , Veia Cava Superior , Adulto , Idoso , Idoso de 80 Anos ou mais , Veias Braquiocefálicas/diagnóstico por imagem , Cateterismo Venoso Central/efeitos adversos , Constrição Patológica , Desenho de Equipamento , Europa (Continente) , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , América do Sul , Veia Subclávia/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/etiologia , Veia Cava Superior/diagnóstico por imagemRESUMO
Resumo Os traumas penetrantes de vasos subclávios atingem mortalidade de até 60% em um cenário pré-hospitalar. A mortalidade no intraoperatório varia de 5-30%. Apresenta-se um caso de estratégia de controle de danos para um paciente com lesão na origem da artéria subclávia esquerda, através de ligadura, sem necessidade de outra intervenção, mantendo a viabilidade do membro superior esquerdo por meio de circulação colateral. Os autores fazem uma revisão sobre vias de acesso e estratégias de tratamento com ênfase em controle de danos para lesões de vasos subclávios.
Abstract Mortality from penetrating traumas involving the subclavian vessels can be as high as 60% in pre-hospital settings. Operating room mortality is in the range of 5-30%. This paper presents a case in which a strategy for damage control was employed for a patient with an injury to the origin of the left subclavian artery, using subclavian ligation, with no need for any other intervention, and maintaining viability of the left upper limb via collateral circulation. The authors also review surgical approaches and treatment strategies with a focus on damage control in subclavian vessel injuries.
Assuntos
Humanos , Masculino , Adulto , Adulto Jovem , Artéria Subclávia/lesões , Veia Subclávia/lesões , Traumatismos Torácicos/cirurgia , Lesões do Sistema Vascular , Síndrome do Roubo Subclávio , Toracotomia/métodos , Circulação Colateral , Extremidade Superior , Hemostasia Cirúrgica/métodos , Ligadura/métodosRESUMO
INTRODUCCIÓN: la lesión de los vasos subclavios durante la cirugía de clavícula es una situación rara, de suceder podría resultar incluso mortal; conocer su ubicación es indispensable para minimizar ese riesgo.OBJETIVO: determinar la ubicación y la distancia de la AS y VS respecto a la clavícula. Secundariamente, identificar las características particulares que influencien la ubicación y la distancia. MATERIALES Y MÉTODO: estudio retrospectivo, AngioTAC de tórax y cuello entre 2012 y 2017; se midió la longitud de la clavícula, distancia y dirección de los vasos subclavios en cada tercio de la clavícula, como también la angulación entre una horizontal y el centro de los vasos subclavios. Resultados: 39 AngioTC, 78 hombros. Distancia AS/clavícula tercio proximal, medio y distal 32,8mm (20,3-46,3), 15,4mm (6,8-28,0) y 62,7mm (37,0-115,4) respectivamente. La distancia VS/clavícula tercio proximal, medio y distal fue: 7,4mm (1,0-19,2), 16,2mm (6,7-34,7) y 67,1mm (29,7-117,0) respectivamente. La ubicación de AS y VS con respecto a la clavícula es posterosuperior en el tercio proximal, posteroinferior en el tercio medio e inferior en el tercio distal. CONCLUSIÓN: En el tercio proximal la vena puede estar solo a 1mm de la clavícula y la arteria a 6mm en dirección antero-posterior, resultando esa zona la más peligrosa. En el tercio medio la distancia es mayor, pudiendo estar arteria y vena a solo 6mm, la dirección de brocado más peligrosa es antero-inferior con una inclinación promedio de 45° caudal. El tercio distal es el más seguro, los vasos están al menos a 30mm de distancia hacia caudal. Nivel de evidencia III.
BACKGROUND: injury to the subclavian vessels during clavicle surgery is a rare situation, if it happens it could even be fatal; knowing their location is essential to minimize that risk. OBJECTIVE: determine location and distance of the AS and VS with respect to the clavicle. Secondarily identify particular characteristics that influence location and distance. MATERIAL AND METHODS: retrospective study, AngioTAC of thorax and neck between 2012 and 2017; it was measured the length of the clavicle, distance and direction of the subclavian vessels in each third of the clavicle and angulation between a horizontal and the center of the subclavian vessels were measured. Results: 39 AngioTC, 78 shoulders. AS / clavicle third proximal, middle and distal distance 32.8mm (20.3-46.3), 15.4mm (6.8-28.0) and 62.7mm (37.0-115.4) respectively. Distance VS / clavicle third proximal, middle and distal was: 7.4mm (1.0-19.2), 16.2mm (6.7-34.7) and 67.1mm (29.7-117.0) respectively. The location of AS and VS with respect to the clavicle is posterosuperior in the proximal third, posteroinferior in the middle third and inferior in the distal third. CONCLUSION: In the proximal third the vein can be only 1mm from the clavicle and the artery to 6mm in the anterior-posterior direction, this zone is the most dangerous. In the middle third the distance is greater, artery and vein can be only to 6mm, the most dangerous drilling direction is antero-inferior with an average inclination of 45° caudal. The distal third is the safest, the vessels are at least 30mm away from the vessels. Level of evidence III.