Anatomical variants of upper arm veins on preoperative mapping venography for hemodialysis access in Korean adults

2018 ◽  
Vol 20 (3) ◽  
pp. 270-275 ◽  
Author(s):  
Hyung Seok Lee ◽  
Young Rim Song ◽  
Jwa Kyung Kim ◽  
Sun Ryoung Choi ◽  
Narae Joo ◽  
...  
Keyword(s):  
Surgical Planning ◽  
Venous Drainage ◽  
Anatomical Variations ◽  
Hemodialysis Access ◽  
Basilic Vein ◽  
Upper Arm ◽  
Anatomical Variants ◽  
Preoperative Mapping ◽  
Anatomical Relationship ◽  
Brachial Vein

Introduction: The number of elderly patients requiring hemodialysis has increased, along with the need for multiple vascular access placements. Thus, the frequency of access creation using the upper arm veins, including transposed basilic arteriovenous fistula, has also increased. The purpose of this study was to identify the prevalence of anatomical variations in the upper arm veins on preoperative mapping venography and to investigate the implications of such variants on access creation. Methods: A total of 494 venograms were performed on 251 patients for primary access creation from June 2014 to June 2017 in this single-center, retrospective study. The venograms were classified into eight subtypes, based on the anatomical relationship between the basilic and brachial veins. The presence of bifid cephalic arches and brachial–basilic ladders was also examined. Results: The presence of bifid cephalic arches and brachial–basilic ladders was identified in 8.7% and 14.0% of cases, respectively. Paired brachial veins joined separately with the basilic vein in 67.4% of venograms, whereas these veins merged into a common brachial vein before connecting to the basilic vein in 13.1% of cases. A single brachial vein was present in 19.3% of cases. 15.7% of cases were considered unsuitable for basilic vein transposition due to the early confluence of the brachial–basilic vein, posing a risk of obliterating the deep venous drainage if transposed. Conclusion: There are significant anatomical variations of upper arm veins, and the recognition of certain variants can affect surgical planning and outcomes of access placement. It is important to identify anatomical variants of the upper arm veins during preoperative vein mapping.

Anatomical variations in upper arm vasculature pertinent to haemodialysis access creation: are surgeons aware sufficiently?

2020 ◽  
pp. 1-14
Author(s):  
Zia Ur Rehman ◽  
Zainab Majid ◽  
Laila Tul Qadar ◽  
Aamina Majid
Keyword(s):  
Arteriovenous Fistula ◽  
Brachial Artery ◽  
End Stage Renal Disease ◽  
Anatomical Variations ◽  
Chronic Hemodialysis ◽  
Basilic Vein ◽  
Increased Risk ◽  
Brachial Vein ◽  
Stage Renal Disease ◽  
End Stage

Abstract There exist wide anatomical variations of upper limb. Their implication is perhaps greatest when it comes to failure of arteriovenous fistula (AVF) for chronic hemodialysis. Among arteries of forearm, brachial artery is of note, whose high bifurcation is associated with increased risk of failure. The superficial and accessory variants also cause difficulty for the surgeon. The single unpaired brachial vein and stenosis of cephalic vein compound the difficulties associated with AVF among many others. A thorough understanding of surgeons regarding normal anatomy and diverse variants holds high importance in context of deciding an appropriate site for arteriovenous (AV) anastomosis. Negligence in creation of fistula not only pose a threat to patients of end stage renal disease (ERSD) but also contributes to numerous other complications involving nerves and drug administration. Keywords: Brachial artery; basilic vein; arteriovenous fistula; vascular variations. Continuous....

scholarly journals Duplication in the formation of median nerve - a case report

2015 ◽  
Vol 04 (01) ◽  
pp. 043-045
Author(s):  
Gyata Mehta ◽  
Varsha Mokhasi
Keyword(s):  
Case Report ◽  
Median Nerve ◽  
Lateral Root ◽  
Axillary Artery ◽  
Anatomical Variations ◽  
Upper Arm ◽  
Present Case Report ◽  
Lateral Cord ◽  
Two Stages ◽  
Different Levels

AbstractThe median nerve is formed in the axilla by fusion of the two roots from the lateral and medial cords. The present case report describes an anomalous presentation of double formation of median nerve and its relation with axillary and brachial arteries. The median nerve was formed in two stages at different levels, first in the axilla and then in the upper arm by receiving double contribution from the lateral root of the lateral cord, which fuse with the medial root of the medial cord to form the median nerve. The formation took place medial to the axillary artery in the axilla and antero-medial to the brachial artery in the arm. Such anatomical variations and their relation with the arteries are important for the surgeons and anesthesiologists and of great academic interest to the anatomists.

Effectiveness and safety of repeated percutaneous intervention in an office-based endovascular center in maintaining hemodialysis access

Vascular ◽  
2021 ◽  
pp. 170853812110043
Author(s):  
Jay Patel ◽  
Stephanie Chang ◽  
Shaan Manawar ◽  
John Munn ◽  
Mark C Rummel ◽  
...  
Keyword(s):  
Percutaneous Intervention ◽  
Dialysis Access ◽  
Arteriovenous Graft ◽  
Hemodialysis Access ◽  
Upper Arm ◽  
Access Site ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
The Mean

Objectives Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. Methods Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007–2016) were included in this study. The patients’ demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. Results A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula ( n = 74, 39%) and radio cephalic fistula ( n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm ( n = 66, 61%) followed by the forearm ( n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). Conclusions This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men

scholarly journals Basilic vein transposition fistula: a good option for maintaining hemodialysis access site options?

2004 ◽  
Vol 39 (5) ◽  
pp. 1043-1047 ◽  
Author(s):  
Rajeev K. Rao ◽  
G.Darius Azin ◽  
Douglas B. Hood ◽  
Vincent L. Rowe ◽  
Roy D. Kohl ◽  
...  
Keyword(s):  
Good Option ◽  
Hemodialysis Access ◽  
Basilic Vein ◽  
Access Site

scholarly journals Anatomic variants of pulmonary venous drainage and their relation to recurrences of atrial fibrillation after pulmonary vein isolation

2021 ◽  
Vol 27 (3) ◽  
pp. 55-68
Author(s):  
Svetla Dineva ◽  
Milko Stoyanov ◽  
Aneliya Partenova ◽  
Boyan Kunev ◽  
Victoria Stoyanova ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Local Population ◽  
Venous Drainage ◽  
Anatomical Variant ◽  
Cox Regression Analysis ◽  
Anatomical Variants ◽  
The Impact ◽  
Variant Anatomy ◽  
Af Recurrence

Anatomical variants of pulmonary venous drainage in the left atrium are often found. Divergent results have been reported on the impact of variant anatomy on atrial fi brillation (AF) recurrence after catheter ablation. We aimed to study the frequency of different anatomical variants of pulmonary venous drainage and their relationship with documented recurrences of AF after ablation. Material and methods: A retrospective study of patients with AF in whom radiofrequency pulmonary vein isolation was done after previously performed cardiac contrast-enhanced multidetector computed tomography. Clinical and procedural characteristics, type and frequency of anatomical variants of the veno-atrial junction and their association with AF recurrences were studied. Results: One hundred seventy-seven patients (112 men, 63.3%) with AF were studied, of which 148 (83.6%) with paroxysmal AF. Variant anatomy was found in 91 patients (51.4%). In 20.9% there was a common left trunk, in 23.2% – more or less than two right-sided veins, and in 7.3% – variations for both right and left veins. No differences in clinical and procedural characteristics were found between the groups with normal and variant anatomy. Recurrences of AF and their association with pulmonary venous anatomy were studied in 104 patients with follow-up ≥ 3 months. No signifi cant relation was found between the presence of variant anatomy and AF recurrences within the blinding period after ablation, OR = 0.864, 95% CI = 0.397 – 1.88, p = 0.843, nor afterwards, OR = 1.12, 95% CI = 0.5 – 2.5, p = 0.839. Cox regression analysis showed no differences in AF recurrence-free survival regardless of the anatomical variant of pulmonary venous drainage, HR = 1.09, 95% CI = 0.58 – 2.05, p = 0.779. Conclusion: In this local population of patients with AF, the incidence of variant pulmonary venous drainage is just over 50%. No association was found between variant anatomy and the rate of AF recurrences after fi rst pulmonary vein isolation.

scholarly journals Brachial Vein Transposition Arteriovenous Fistula for Hemodialysis Access

2012 ◽  
Vol 23 (2) ◽  
pp. 59-64
Author(s):  
Harunobu Matsumoto ◽  
Eisuke Yamamoto ◽  
Chiaki Kamiya ◽  
Emi Miura ◽  
Tadashi Kitaoka ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Hemodialysis Access ◽  
Brachial Vein

Abstract 1122‐000181: Collateral Circulation in Ischemic Stroke is Not Determined by Anatomical Variants of the Cerebral Arteries

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Karolina Brzegowy ◽  
Bernard Solewski ◽  
Paweł Brzegowy ◽  
Agata Musiał ◽  
Tadeusz Popiela ◽  
...  
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Collateral Circulation ◽  
Cerebral Arteries ◽  
Anatomical Variations ◽  
Detailed Knowledge ◽  
Collateral Blood Flow ◽  
Posterior Portion ◽  
Cortical Vein ◽  
Anatomical Variants

Introduction : In acute ischemic stroke, collateral circulation determines tissue fate and treatment results. The aim of this study was to evaluate the role of anatomical variations of the Circle of Willis (CoW) in formation of cerebral collateral blood flow in patients with acute M1 occlusion. Methods : This study was a retrospective assessment of radiological examinations of patients with stroke due to middle cerebral artery M1 segment occlusion. All patients underwent mechanical thrombectomy from January 2015 until March 2021. The anatomy of the CoW was assessed on initial CT‐angiography and DSA. CTA was utilized to grade cranial collateral vasculature status and cortical vein opacification score (COVES). Non‐contrast CT scans and ASPECTS scores (using RAPID software) were used to determine the ischemic area. Results : A total of 100 patients were included in the analysis (58 females and 42 males, mean age: 71.6 +/‐ 13.9). We classified the anatomy of the CoW according to its continuity as a full circle. Patients with fully continuous CoW (n = 19) had worse COVES scores than those with CoW incomplete at both anterior and posterior portion (n = 9) (89% vs 68% with COVES 0–2, p = 0.179). No statistically significant results were found when comparing the enhancement of collaterals between these two groups (p = 0.390). The COVES scores were similar for patients with complete and incomplete anterior portions of CoW (77% vs 80% with COVES 0–2, p = 0.812). Patients with incomplete posterior portions of CoW had lower COVES scores than those with complete (80% vs 67% with COVES 0–2, p = 0.206). No statistically significant differences were discovered when comparing different types of the posterior communicating artery (adult, transitional and fetal). Analysis of ischemic areas determined as ASPECTS scores pre‐ and post‐thrombectomy yielded no significant differences between any of the groups. Conclusions : Although certain variants of the CoW have been reported to increase the risk of ischemic stroke, our results show that the anatomy of CoW has no large effect on collateral blood flow during acute M1 occlusion. We presume that the greater role is played by pial arterioles than anatomical variants of major cerebral arteries in cerebral collateral circulation formation. Detailed knowledge about the factors that influence collateral blood flow is crucial as it may aid in identification of patients prone to worse outcomes of ischemic stroke. Anatomical variants of CoW do not play a major role in formation of cerebral collaterals.

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