scholarly journals Use of Bony Landmarks during Adrenal Venous Sampling to Guide Catheterization of the Left Adrenal Vein

2021 ◽  
Author(s):  
Lucas R. Cusumano ◽  
Sipan Mathevosian ◽  
Joshua K. Sweigert ◽  
Ravi N. Srinivasa ◽  
Aarti P. Luhar ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Cortisol Level ◽  
Selectivity Index ◽  
Adrenal Vein ◽  
Catheter Position ◽  
Bony Landmarks ◽  
Catheter Tip ◽  
Body Level ◽  
Sampling Catheter ◽  
Repeat Procedures

Abstract Purpose The aim of this study was to examine the utility of fluoroscopic bony landmarks in predicting the location of the left adrenal vein during adrenal vein sampling (AVS). Methods Eighty-six AVS procedures were performed in 81 patients between August 2013 and March 2020. A selectivity index was calculated for each case by dividing the measured left adrenal vein cortisol level by the peripheral vein cortisol level. Successful “target” left adrenal vein catheterization was confirmed in cases with a selectivity index of three or greater. Intraprocedural AVS fluoroscopic images were selected that demonstrated catheter position in the left adrenal vein. Lateral distance from the catheter tip in the left adrenal vein to the lateral margin of the left pedicle at the associated vertebral body level was measured. Results Mean patient age was 56.4 years (range: 19–80 years) and 48 (59.3%) patients were male. Target sampling in the left adrenal vein was confirmed in 82 (95.3%) cases. In 78 (95.1%) targeted cases, the catheter terminated less than 25 mm from the left lateral pedicle at a mean distance of 11.2 mm. The catheter was most frequently placed at the T12 and L1 vertebral body levels. Four (4.7%) cases demonstrated nontarget catheter positioning, two (50.0%) of these cases were within 25 mm. Conclusion The position of the left adrenal vein is generally located in a predictable position relative to bony landmarks. By utilizing these landmarks, positioning of the sampling catheter during AVS can be more reliable with the potential to avoid repeat procedures and delays in patient care.

A guide to placement of parietooccipital ventricular catheters

1995 ◽  
Vol 82 (2) ◽  
pp. 300-304 ◽  
Author(s):  
Matthew A. Howard ◽  
Jayashree Srinivasan ◽  
Carl G. Bevering ◽  
H. Richard Winn ◽  
M. Sean Grady
Keyword(s):  
Ct Scanning ◽  
Catheter Placement ◽  
Target Point ◽  
Catheter Position ◽  
Content Type ◽  
Ventriculoperitoneal Shunting ◽  
Frontal Horn ◽  
Catheter Tip ◽  
Ventricular Catheters ◽  
Entire Procedure

✓ Accurate placement of parietooccipital ventricular catheters can be difficult and frustrating. To minimize the morbidity of the procedure and lengthen the duration of shunt function, the catheter tip should lie in the ipsilateral frontal horn. The authors describe a posterior ventricular guide (PVG) for placement of parietooccipital catheters that operates by mechanically coupling the posterior burr hole to the anterior target point. In a series of 38 patients who underwent ventriculoperitoneal shunting with the assistance of the guide, postoperative computerized tomography (CT) scanning revealed that 35 (92.0%) had accurate catheter placement. In comparison, a retrospective review of free-hand posterior catheter placement revealed good catheter position in only 22 of 43 patients (51.1%). The use of the guide added less than 5 minutes to the entire procedure, and there were no complications related to its use. The PVG is a simple and useful tool that aids in the placement of parietooccipital ventricular catheters.

Distal effects of tracheal gas insufflation: changes with catheter position and oleic acid lung injury

1996 ◽  
Vol 81 (3) ◽  
pp. 1121-1127 ◽  
Author(s):  
A. Nahum ◽  
S. A. Ravenscraft ◽  
A. B. Adams ◽  
J. J. Marini
Keyword(s):  
Oleic Acid ◽  
Lung Injury ◽  
Dead Space ◽  
Minute Ventilation ◽  
Catheter Position ◽  
Tracheal Gas Insufflation ◽  
Before And After ◽  
Dead Space Volume ◽  
Catheter Tip ◽  
Conducting Airways

We separated distal (turbulence-related) and proximal (dead space washout-related) effects of tracheal gas insufflation (TGI) by comparing the effects of straight and inverted catheters. We reasoned that the inverted catheter was unlikely to remove CO2 from conducting airways distal to its orifice. In six normal dogs during TGI at 10 l/min, advancing the catheters from 10 to 1 cm above the main carina decreased dead space volume by 29 +/- 12 and 12 +/- 6 ml (P < 0.04) with the straight and inverted catheters, respectively. By comparison, the tracheal volume between 10 and 1 cm above the carina was 15 +/- 2 ml. In another set of dogs (n = 5), we examined the distal effects of TGI before and after oleic acid-induced lung injury. During TGI at 10 l/min before and after oleic acid injury, the differences in arterial PCO2 between the straight and inverted catheters were 5 +/- and 9 +/- 6 Torr (P < 0.18), respectively. Our data suggest that distal effects of TGI become more pronounced as the catheter tip is positioned closer to the main carina. The distal effects of TGI were not diminished after oleic acid injury when minute ventilation was maintained constant.

scholarly journals Comparison of Cortisol, Androstenedione and Metanephrines to Assess Selectivity and Lateralization of Adrenal Vein Sampling in Primary Aldosteronism

2021 ◽  
Vol 10 (20) ◽  
pp. 4755
Author(s):  
Giulio Ceolotto ◽  
Giorgia Antonelli ◽  
Brasilina Caroccia ◽  
Michele Battistel ◽  
Giulio Barbiero ◽  
...  
Keyword(s):  
Decision Making ◽  
Primary Aldosteronism ◽  
Inferior Vena ◽  
Clinical Decision Making ◽  
Vena Cava ◽  
Clinical Decision ◽  
Selectivity Index ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling ◽  
The Right

Success of adrenal vein sampling (AVS) is verified by the selectivity index (SI), i.e., by a step-up of cortisol levels between the adrenal vein and the infrarenal inferior vena cava samples, beyond a given cut-off. We tested the hypothesis that androstenedione, metanephrine, and normetanephrine, which have higher gradients than cortisol, could increase the rate of AVS studies judged to be bilaterally successful and usable for the clinical decision making. We prospectively compared within-patient, head-to-head, the selectivity index of androstenedione (SIA), metanephrine (SIM), and normetanephrine (SINM), and cortisol (SIC) in consecutive hypertensive patients with primary aldosteronism submitted to AVS. Main outcome measures were rate of bilateral success, SI values, and identification of unilateral PA. We recruited 136 patients (55 + 10 years, 35% women). Compared to the SIC, the SIA values were 3.5-fold higher bilaterally, and the SIM values were 7-fold and 4.4-fold higher on the right and the left side, respectively. With the SIA and the SIM the rate of bilaterally successful AVS increased by 14% and 15%, respectively without impairing the identification of unilateral PA. We concluded that androstenedione and metanephrine outperformed cortisol for ascertaining AVS success, thus increasing the AVS studies useable for the clinical decision making.

Anatomy Revisited: Hemodialysis Catheter Malposition into the Chest

2018 ◽  
Vol 47 (1-3) ◽  
pp. 58-61
Author(s):  
Pan Xie ◽  
Kanfu Peng ◽  
Keqin Zhang ◽  
Hongwen Zhao ◽  
Yuxiu Sheng ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Chronic Hemodialysis ◽  
Catheter Position ◽  
Cross Sectional ◽  
Hemodialysis Catheter ◽  
Catheter Tip ◽  
And Migration ◽  
Wall Perforation ◽  
The Right

In most situations, central catheters are implanted in the right jugular vein as initial access for hemodialysis. However, after repeated punctures, the proximal vessels become stenosed and thrombosed and misplacement is likely to occur. Correct catheter position in the vein can be easily ascertained with X-ray or cross-sectional CT imaging. In this report, we describe the case of a 77-year-old patient on chronic hemodialysis via catheter due to arteriovenous fistula dysfunction. We placed a cuffed-tunneled hemodialysis catheter in the left internal jugular vein. Malpositioning of the catheter led to perforation of the great veins and migration of the catheter tip into the chest. It is important to be aware of the risk of potential incorrect positioning of dialysis catheters. Due to the stenosis and fragility of the vessel wall, perforation may occur. In cases of doubt, correct placement of large-bore catheters via the internal jugular vein should be verified by means of appropriate imaging before hemodialysis is performed.

The Modified Lateral Approach: Experience of a Single Center using an Alternative Technique to Conventional Transpedicular Percutaneous Vertebroplasty

2019 ◽  
Vol 3 ◽  
pp. 6
Author(s):  
Isabelle Dupuis ◽  
Reza Forghani ◽  
Huy Le
Keyword(s):  
Vertebral Body ◽  
Cement Leakage ◽  
Conventional Technique ◽  
Lateral Approach ◽  
Bivariate Analysis ◽  
Chi Square ◽  
Transpedicular Approach ◽  
Significant Difference ◽  
Classic Approach ◽  
Body Level

Objective: The objective of this study was to assess whether the placement of a needle more lateral to the pedicle while using a transpedicular approach compared to the conventional technique yields comparable or better vertebral body filling. Methods: Retrospective review of 134 thoracic and lumbar unipedicular vertebroplasties performed by a single radiologist (110 lateral and 24 classic). Vertebral bodies were divided into eight voxels on computed tomography and the percent of coverage was documented. 50% and 75% cement filling thresholds were defined as “efficient.” Complications were retrospectively collected. Chi-square (χ2) was used to compare the filling efficacy and rates of extravertebral cement leakage between the approaches. Bivariate analysis was performed to assess variables potentially influencing the efficacy. Results: There was no significant difference between the two approaches for 50% coverage (classic; n = 21 [87.5%] vs. lateral; n = 98 [89.1%], P = 0.8228). There was more efficient coverage >75% using the lateral approach (classic; n = 4 [16.7%] vs. lateral; n = 46 (41.8%), P = 0.0210). Vertebral body level (50.8% thoracic vs. 26.0% lumbar, P = 0.0031) and fracture type (45.6% pathological vs. 29.2% osteoporotic, P = 0.0444) were associated with 75% coverage. Three classic cases (12.5%) had extravertebral cement leakage versus 34 lateral cases (30.9%), which was not statistically significant (P = 0.0676). Other complications included one asymptomatic lung embolization using both approaches, one pedicular fracture using the classic approach, and one overnight admission for analgesia using the lateral approach. Conclusion: A modified lateral approach proved to be as safe and more effective in achieving 75% or more vertebral filling in treating compression fractures compared to the conventional approach.

Intra- and Inter-Rater Agreement between X-Ray Views for Umbilical Catheter Position

2019 ◽  
Author(s):  
Srinivasa Murthy Doreswamy ◽  
Sumesh Thomas ◽  
Sourabh Dutta
Keyword(s):  
Random Sequence ◽  
Venous Catheter ◽  
Rater Agreement ◽  
Catheter Position ◽  
X Ray ◽  
Umbilical Catheter ◽  
Catheter Tip ◽  
Tip Position ◽  
Umbilical Arterial Catheter

Abstract Objective We determined intra- and inter-rater agreement for umbilical arterial/venous catheter (umbilical arterial catheter [UAC] and umbilical venous catheter [UVC], respectively) positions on supine anteroposterior (AP) and horizontal dorsal decubitus (HDD) X-ray views to determine whether two views are routinely required. Study Design This retrospective study was conducted in McMaster University, Canada. Pairs of AP and HDD radiographs were coded and rated in random sequence by two experienced raters. Primary outcome was intra-rater agreement (κ) between AP and HDD views for UVC catheter tip position. Secondary outcomes included inter-rater κ for UVC position; inter- and intra-rater κ for UAC position, inter- and intra-rater κ for follow-up action. To detect κ of 0.8 (width of 95% confidence interval = 0.1), 138 radiograph pairs were required. Results Intra-rater agreement tended to be higher for UVC versus UAC position (Rater#1: κ = 0.44 vs. 0.16, respectively, p = 0.08; and #2: κ = 0.56 vs. 0.47, respectively, p = 0.5). Inter-rater agreement was higher on AP versus HDD view for UVC position (κ = 0.6 vs. 0.29, respectively, p = 0.03) and action recommended for UVC (κ = 0.61 and 0.19, respectively, p < 0.001). Conclusion AP is superior to HDD view for UVC.

Two-Dimensional Echographic Localization of Intracardiac Cerebrospinal Fluid Shunt Catheters

Neurosurgery ◽  
1984 ◽  
Vol 14 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Daniel Soyeur ◽  
Jacques Born ◽  
Jacques Lenelle ◽  
Achille Stevenaert
Keyword(s):  
Cardiac Cycle ◽  
Accurate Determination ◽  
Head Movements ◽  
Anatomical Landmarks ◽  
Two Dimensional ◽  
Ventriculoatrial Shunt ◽  
Catheter Position ◽  
X Ray ◽  
Catheter Tip ◽  
Chest X Ray

Abstract This study evaluated the ability of two-dimensional echocardiography (2D echo) to detect and localize the distal end of ventriculoatrial shunt catheters in the cardiac chambers of hydrocephalic patients. Twenty-eight patients were studied, and the performances of 2D echo and standard chest x-ray filming were compared. Although standard chest x-ray filming allowed accurate determination of the catheter position in only half of the patients, 2D echo afforded clear visualization and accurate localization of the catheter in all instances. By its precise definition of intracardiac anatomical landmarks and its excellent time determination, 2D echo can provide valuable information on the movements of the catheter's distal end during the cardiac cycle, during head flexion or rotation, and during deep breathing movements. Some interesting observations were made with 2D echo. A to-and-fro motion of the catheter tip through the tricuspid orifice during the cardiac cycle was visualized in two instances. The combination of head movements and deep respiratory movements induced a variation in the position of the catheter tip. The magnitude of this displacement was 6 cm at the most. Two patients underwent reoperation for lengthening or shortening of the catheter. The operative findings confirmed the ultrasonic localization in both cases where the chest x-ray film had failed to identify or adequately locate the catheter tip. It is concluded that 2D echo is a safe, innocuous, and accurate method with which to locate the distal end of a ventriculoatrial shunt. It is the only available technique that provides visualization of intracardiac structures and cardiac cycle reference. In our neurosurgical unit, 2D echo is now considered the standard reference procedure to localize postoperatively the distal end of ventriculoatrial shunts and to follow patients in an attempt to appreciate the ideal timing for prophylactic lengthening of the shunt.

scholarly journals Determination of the correct Selectivity Index (SI) for pre-ACTH and post-ACTH stimulation adrenal vein sampling (AVS)

2017 ◽  
Vol 28 (2) ◽  
pp. S138-S139
Author(s):  
E Violari ◽  
C Georgiades ◽  
C Singh ◽  
M Arici ◽  
B Tendler ◽  
...  
Keyword(s):  
Selectivity Index ◽  
Adrenal Vein ◽  
Acth Stimulation ◽  
Adrenal Vein Sampling

scholarly journals The Catheter Tip Position and Effects of Percutaneous Epidural Neuroplasty in Patients with Lumbar Disc Disease During 6-Months of Follow-up

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. E599-E608 ◽  
Author(s):  
Prof. Dong Ah Shin
Keyword(s):  
Back Pain ◽  
Clinical Outcomes ◽  
Lumbar Disc ◽  
Controlled Study ◽  
Disc Disease ◽  
Catheter Position ◽  
Lumbar Disc Disease ◽  
Single Level ◽  
Catheter Tip

Background: Percutaneous epidural neuroplasty (PEN) is a minimally invasive intervention designed to treat neck, back, and low back pain. The efficacy of lumbar PEN has been relatively well investigated, but clinical effectiveness according to catheter position has not yet been established. Objective: The purpose of this study was to compare clinical outcomes between the ventral and dorsal positions of the catheter tip during lumbar PEN procedures using a retrospective review series. Methods: A total of 303 patients with back pain from single-level lumbar disc disease with and without radiculopathy were included in this study. In all patients, an attempt was made to place the catheter tip in the ventral position to maximize theoretical clinical improvement; however, several catheters failed to reach the desired position. Patients were assigned to 2 groups after lumbar PEN procedures were completed: those with catheters in the ventral position (Ventral group) and those with catheters in the dorsal position (Dorsal group). Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain at 0, 1, 3, and 6 months after treatment. Results: The only demographic difference observed between the 2 groups (Ventral and Dorsal groups) was an elongated symptom duration in the Dorsal group compared to the Ventral group (16.1 vs. 9.4 months, P = 0.013). The VAS (back) scores during the follow-up period (1, 3, and 6 months) were similar between the 2 groups. In one area of the VAS scoring (leg), the Ventral group showed a similar effect at postoperative one month compared to the Dorsal group, but significantly improved at postoperative 3 and 6 months (1.3 and 0.9 in ventral group, and 1.9 and 1.4 in dorsal group, respectively; P = 0.002 and 0.010). Odom’s criteria were also significantly improved over 6 months in the Ventral group compared to the Dorsal group. Limitations: This study was a retrospective analysis with a relatively short follow-up duration was not a randomized, controlled study. Therefore, the clinical effects of the catheter position could be confounded by other variables. Conclusion: In this short-term follow-up study, the effects of lumbar PEN on VAS scores were different according to the position of the catheter tip in patients with single-level lumbar disc herniation. Better outcomes in the Ventral group may have been achieved by more localized treatment with a selective block in the epidural space closer to the dorsal root ganglion and ventral aspect of the nerve root. Key words: Lumbar disc disease, pain management, percutaneous epidural neuroplasty, catheter position, dorsal, ventral

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