A Prospective, Comparative Evaluation on Totally Implantable Venous Access Devices by External Jugular Vein versus Cephalic Vein Cutdown

2018 ◽  
Vol 84 (6) ◽  
pp. 841-843
Author(s):  
Olga Iorio ◽  
Sergio Gazzanelli ◽  
Giuseppe D'ermo ◽  
Angela Pezzolla ◽  
Angela Gurrado ◽  
...  
Keyword(s):  
Success Rate ◽  
Jugular Vein ◽  
Venous Access ◽  
External Jugular Vein ◽  
Cephalic Vein ◽  
Complication Rates ◽  
First Choice ◽  
Group A ◽  
Group B ◽  
Venous Access Devices

The request for totally implantable venous access devices (TIVADs) has rapidly grown up through the last decades. TIVADs are implanted by direct vein puncture or by surgical approach with vein cutdown. The authors present a comparative prospective study evaluating external jugular vein (EJV) and cephalic vein cutdown techniques. Two hundred and fifteen patients were consecutively submitted to TIVAD implantation to perform chemotherapy. Patients were divided in two groups, depending on the implantation technique. Group A patients (106) underwent implantation via EJV cutdown and group B (109) patients underwent implantation by cephalic vein cut-down. The following variables were investigated: operating time, need for conversion to other approaches, complications, and intraoperative and postoperative pain. In Group A patients, the success rate of the procedure was 100 per cent, whereas in 11 patients (10.1%) of Group B, a modification of the initial approach was needed. Mean operative time was 23.9 ± 9.2 minutes in Group A and 35.4 ± 11.9 in Group B, and this was statistically significant (P < 0.05). Complication rates at 30 days were similar. Considering intraoperative pain, a difference was found between the two groups because the mean value of pain in Group Awas lower than that in Group B (4.13 ± 0.3 vs 5.22 ± 1.24), even if not significant. External jugular vein cutdown approach is quick and safe and allows a very high success rate with very low risk of complications. For these reasons, this approach could be considered as a first choice in TIVAD placement.

scholarly journals Comparison of early versus standard timing for silicone stent removal following External Dacrocystorhinostomy under local anaesthesia

2019 ◽  
Vol 11 (1) ◽  
pp. 24-28
Author(s):  
Ben Limbu ◽  
Hannah S Lyons ◽  
Mohan Krishna Shrestha ◽  
Geoffrey C Tabin ◽  
Rohit Saiju
Keyword(s):  
Success Rate ◽  
Financial Burden ◽  
Controlled Trial ◽  
Nasolacrimal Duct ◽  
Complication Rates ◽  
Tube Removal ◽  
Significant Difference ◽  
Silicone Stent ◽  
Group A ◽  
Group B

Introduction: The first line treatment for nasolacrimal duct obstruction (NLDO) is external dacrocystorhinostomy (DCR). Following DCR, patients are required to return to Tilganga Institute of Ophthalmology (TIO) six weeks postoperatively for the removal of a silicone stent. As the majority of patients travel large distances at significant cost to reach TIO, most often patients remain within Kathmandu during this six weeks interval. This places a large financial burden on patients. Methods: A randomized controlled trial was designed to compare patient outcomes after early (two weeks postoperatively) versus standard (six weeks postoperatively) removal of silicone stents. 50 selected patients were randomized into two equal groups. Results: At the time of publication, 31 patients (14 in group A and 17 in group B) had completed three months follow up. A success rate of 92.9% was noted in Group A and a success rate of 94.1% observed in group B. No significant difference was found between the two groups for success rate and rate of complications. Conclusion: Early tube removal post DCR appears to cause no significant difference in outcome or complication rates compared to standard tube removal.

Cutdowns for Totally Implantable Access Ports to Central Veins

Vascular ◽  
2009 ◽  
Vol 17 (5) ◽  
pp. 273-276 ◽  
Author(s):  
Mahmoud Kulaylat ◽  
Constantine P. Karakousis
Keyword(s):  
Success Rate ◽  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
External Jugular Vein ◽  
Cephalic Vein ◽  
Seldinger Technique ◽  
Basilic Vein

For insertion of totally implantable access ports, with the catheter end in the superior vena cava, the percutaneous (Seldinger) technique is commonly used. Of cutdowns, the cephalic vein cutdown is the most popular one (success rate about 80%), followed by the external jugular vein cutdown. Our preliminary experience suggests that internal jugular vein and basilic vein cutdowns have the anatomic features to prove both of them superior to the cephalic vein cutdown.

scholarly journals Comparison of Complication Rates of Implantable Venous Access Devices: Percutaneous Versus Cephalic Vein Cut-down Techniques

2013 ◽  
Vol 57 (5) ◽  
pp. 62S
Author(s):  
Farah Karipineni ◽  
Nadia Awad ◽  
Lisa Jablon ◽  
Nyali Taylor ◽  
Rashad G. Choudry
Keyword(s):  
Venous Access ◽  
Cephalic Vein ◽  
Complication Rates ◽  
Venous Access Devices

Emergency versus elective ureteroscopy for the management of ureteral stones

2021 ◽  
pp. 039156032098716
Author(s):  
Nariman K Gadzhiev ◽  
Gagik N Akopyan ◽  
Farzona I Tursunova ◽  
Andrew S Afyouni ◽  
Dmitry O Korolev ◽  
...  
Keyword(s):  
Success Rate ◽  
Medical Records ◽  
Ureteral Stones ◽  
Complication Rates ◽  
Distal Ureter ◽  
Renal Obstruction ◽  
Stone Fragmentation ◽  
Group A ◽  
Ureteral Stenting ◽  
Group B

Objective: To assess the safety and efficacy of emergency ureteroscopy (URS) compared with elective URS. Methods: We conducted a retrospective analysis of patients who underwent URS for isolated ureteral stones in a single center from October 2001 to February 2014. Our patient cohort was divided into two groups: an emergency URS group (Group A), which consisted of patients who underwent URS within the first 24 h of admission, and an elective or planned URS group (Group B). The URS success rate was defined as being the incidence of successful stone fragmentation and whether there was resolution of renal obstruction. Results: A total of 2957 patients’ medical records were available for analysis. Of these, 704 (21%) comprised of emergency cases and the remaining 2253 (79%) were elective cases. Patients in Group A were younger, had a smaller BMIs, and had smaller stone sizes ( p < 0.001). The URS success rate was found to be 97% in Group A and 96% in Group B ( p = 0.35). Intraoperative or postoperative complication rates were not found to vary significantly between the groups (8% vs 7%, respectively, p = 0.50). The incidence of ureteral stenting was nearly twice as high if URS was performed during night hours (85% vs 45%, p < 0.001). However, ureteral stenting was more prevalent in Group B compared to Group A patients (57% vs 25%, p < 0.001), possibly as a result of the number of pre-stented patients (73%). Conclusions: Emergency URS is an effective and safe option for patients with renal colic. Younger patients without pre-existing obesity and with stone sizes up to 8 mm located in the distal ureter might be a better match for emergency URS.

A novel “shrug technique” for totally implantable venous access devices via the external jugular vein: A consecutive series of 254 patients

2016 ◽  
Vol 115 (3) ◽  
pp. 291-295
Author(s):  
Tetsuya Kagawa ◽  
Satoshi Ueyama ◽  
Tatsunori Kobayashi ◽  
Hiroki Okabayashi ◽  
Shinji Kuroda ◽  
...  
Keyword(s):  
Jugular Vein ◽  
Venous Access ◽  
External Jugular Vein ◽  
Consecutive Series ◽  
Venous Access Devices

scholarly journals Implantation of Biventricular Cardiac Devices Using a Double Venous Approach — An Alternative Implantation Technique

2014 ◽  
Vol 60 (2) ◽  
pp. 57-60 ◽  
Author(s):  
Raluca Șoșdean ◽  
S Pescariu ◽  
B Enache ◽  
Ri Macarie ◽  
Raluca Marca
Keyword(s):  
Standard Technique ◽  
Cephalic Vein ◽  
Cardiac Resynchronization ◽  
Implantation Technique ◽  
Complication Rates ◽  
Cardiac Devices ◽  
Implantation Techniques ◽  
Group A ◽  
Group B ◽  
Slight Downward Trend

Abstract Background: A standard technique regarding venous approach for implantation of biventricular cardiac electrical devices used for cardiac resynchronization therapy implementation has not yet been established. We analyzed the safety and efficiency of implanting these devices using a double venous approach (cephalic and subclavian) by comparing it with the simple approaches, in order to overcome some of their inconvenients. Materials and methods: We retrospectively analyzed all 228 resynchronization patients implanted at the Timișoara Institute of Cardiovascular Medicine between January 1st, 2000 and January 1st, 2013. The 204 patients successfully implanted with biventricular pacemakers or defibrillators were divided according to the implantation techniques, and compared by complication rates and values of acute stimulationdetection thresholds. Group A featured a subclavian approach (48 patients), group B a cephalic approach (81 patients) and group C a double venous approach (76 patients). Results: Adjusting for age, sex and device type there is no evidence in the data that complication rates are significantly different when using the different techniques: 6 complications (12.5%) in group A, 8 (9.87%) in group B and 5 (6.75%) in group C (p = 0.51). A slight downward trend was observed by using double venous approach. Values of acute stimulation-detection thresholds had no statistically significant differences neither (p = 0.36). Cephalic vein was of high quality in 59.8% of cases. Conclusions: Subclavian and cephalic double venous approach implantation technique for biventricular devices proved to be feasible and at least as safe as single venous approach using subclavian or cephalic vein alone, and it can be used as a first resort technique.

scholarly journals Variation in the Course and Termination of the Cephalic Vein in the Deltopectoral Triangle

2017 ◽  
Vol 34 (2) ◽  
pp. 99-106 ◽  
Author(s):  
Atoni Atoni Dogood ◽  
Oyinbo Charles Aidemise
Keyword(s):  
Subclavian Vein ◽  
Jugular Vein ◽  
Deltoid Muscle ◽  
Venous Access ◽  
External Jugular Vein ◽  
Cephalic Vein ◽  
The Other ◽  
Axillary Vein ◽  
Bilateral Presentation ◽  
Surgical Emergencies

Summary The knowledge of cephalic vein variation would aid proper identification and prevent error in surgical emergencies. The path, distribution, and termination of the cephalic vein in relation to the deltopectoral triangle were studied in twenty formalin-embalmed cadavers. Results show the bilateral presentation of the cephalic vein in all the shoulders examined. Thirty-seven (37) cases presented with a superficial and lateral course of the cephalic vein in the deltopectoral groove, while the rest three cases presented a deep course. Of these 37 cases with the superficial course, two cases ascended anteriorly and above the clavicle and drained into the external jugular vein in the neck. Another case presented a cephalic vein that ascended anteriorly and then above the clavicle and drained into an unnamed vein in the neck. In one case, the cephalic vein ascended superficially in the deltopectoral groove and laterally in the deltopectoral triangle. In one bilateral pattern, the cephalic vein in the deltopectoral triangle drained into the axillary vein. In all the three cases where the cephalic vein ascended deep within the deltopectoral groove, they terminated deep in the deltopectoral triangle. In one of these, the cephalic vein received a tributary that originated from a venous network beneath the deltoid muscle and then drained into athe xillary vein, deep in the deltopectoral triangle. In the other two cases, the cephalic vein gave a tributary to the axillary vein and continued deep and medially in the deltopectoral triangle, passed below the clavicle and drained into the subclavian vein. The knowledge of these variations of the cephalic vein is essential to clinicians and surgeons for venous access during emergencies and surgery.

scholarly journals Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia

2020 ◽  
Vol 9 (12) ◽  
pp. 4132
Author(s):  
Andrea Laufer ◽  
Adrien Frommer ◽  
Georg Gosheger ◽  
Robert Roedl ◽  
Frank Schiedel ◽  
...  
Keyword(s):  
External Fixation ◽  
Bone Transport ◽  
Bone Union ◽  
Complication Rates ◽  
Union Rate ◽  
Bone Fusion ◽  
Group A ◽  
Primary Bone ◽  
Group B

Treatment of congenital pseudarthrosis of the tibia remains a major challenge in pediatric orthopedics. Ideal timing and preference of surgical procedures are discussed controversially. A variety of reconstructive treatment strategies have been described in literature, but so far none has proven its superiority. The aim of treatment is to obtain long-term bone union, to prevent refracture, and to correct angular deformities and leg length discrepancies. This study retrospectively evaluates the outcome of different reconstructive strategies. Sixty-nine patients were identified who presented to our outpatient department between 1997 and 2019. Twenty-six of these patients underwent reconstructive surgical treatment and were included in this study. The study cohort was divided into three groups. Excision of the pseudarthrosis was performed in all patients in Group A and B, and in two patients of Group C. Group A (six/26 patients) received subsequent bone transport through external fixation maintaining original length. In Group B (15/26 patients), patients underwent either previous, simultaneous, or subsequent extrafocal lengthening through external fixation to reconstitute length. In Group C (five/26 patients), internal fixation with intramedullary nails was applied. Radiological and clinical evaluation was performed to assess bone union and complication rates. Results varied considerably between the study groups. Overall, the primary bone fusion rate was 69.2%. There were four refractures, all occurring in Group B. The long-term bone union rate without refracture was 53.8%. The overall complication rate was 53.8% and 23.1% showed persistent pseudarthrosis. Two secondary amputations were performed due to failed bone fusion. In conclusion, excision of the pseudarthrosis and extrafocal lengthening achieves a satisfying bone union rate and limb reconstruction, while bone transport does not offer significant advantages but shows higher complication rates. Intramedullary stabilization should be applied to maintain bone union, but shows lower bone union rates when used as a stand-alone treatment regimen. Regardless of the primary bone fusion rates, the probability of long-term bone union remains unpredictable.

scholarly journals 439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Durity ◽  
G Elliott ◽  
T Gana
Keyword(s):  
Complicated Diverticulitis ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Female Ratio ◽  
Stoma Reversal ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract Introduction Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management. Method We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017. Results Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s. Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%). Conclusions In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.

scholarly journals Effect of supplemental dexmedetomidine in interventional embolism on cerebral oxygen metabolism in patients with intracranial aneurysms

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110029
Author(s):  
Zhang Guo ◽  
Weiwei Wang ◽  
Dahua Xie ◽  
Ruisheng Lin
Keyword(s):  
Intracranial Aneurysms ◽  
Jugular Vein ◽  
Oxygen Metabolism ◽  
Cerebral Oxygen ◽  
Cerebral Oxygen Metabolism ◽  
Time Points ◽  
Venous Oxygen Saturation ◽  
Group A ◽  
Group B ◽  
Oxygen Difference

Objective To investigate the effect of supplemental dexmedetomidine in interventional embolism on cerebral oxygen metabolism in patients with intracranial aneurysms. Methods Ninety patients who underwent interventional embolism of intracranial aneurysms were equally divided into Group A and Group B. In Group A, dexmedetomidine was injected intravenously 10 minutes before inducing anesthesia, with a loading dose of 0.6 µg/kg followed by 0.4 µg/kg/hour. Group B received the same amount of normal saline by the same injection method. Heart rate (HR), mean arterial pressure (MAP), arterial–jugular venous oxygen difference [D(a-jv) (O2)], cerebral oxygen extraction [CE (O2)], and intraoperative propofol use were recorded before inducing anesthesia (T0) and at five time points thereafter. Results The amount of propofol in Group A was lower vs Group B. At all five time points after T0, HR, MAP, D(a-jv) (O2), and CE (O2) in Group A were significantly lower vs Group B, with significant differences for jugular venous oxygen saturation (SjvO2) and the oxygen content of the internal jugular vein (CjvO2) between the groups. Conclusion Dexmedetomidine resulted in less intraoperative propofol, lower D(a-jv) (O2) and CE (O2), and improved cerebral oxygen metabolism.

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