Single center experience with ultrasound guided axillary vein port placement

2021 ◽  
pp. 112972982110080
Author(s):  
Patrick Tivnan ◽  
Micaela Nannery ◽  
Yan Epelboym ◽  
Rajendran Vilvendhan
Keyword(s):  
Demographic Data ◽  
Axillary Vein ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Port Placement ◽  
Chi Square ◽  
Vein Thrombosis ◽  
Single Center Experience ◽  
Procedural Complications ◽  
The Right

Purpose: To retrospectively review a single institution experience of ultrasound guided axillary vein port placement. Methods: In this retrospective study, a patient list was generated after searching our internal database from 1/1/2012 to 10/1/2018. Patients who had undergone axillary vein port placement were included. Chart review was performed to confirm approach, laterality and to gather demographic data, clinical indications, technical outcomes, and complications. Descriptive statistics were used to analyze this cohort. Chi-square statistics were used to compare outcomes by laterality. Results: Three hundred seven patients (51% female) with an average age of 58 years were included. The port was placed via the right axillary vein in 85% (261/307), predominantly for the indication of chemotherapy access (296/307). Technical success was achieved in all 307 cases. Peri procedural complications occurred in 1% (4/307) of cases and included port malpositioning requiring replacement and a case of port pocket hematoma. Post procedural complications including deep vein thrombosis and port malfunction occurred in 17% (52/307) of cases and port removal as a result of complication occurred in 9% (29/307) of cases. Conclusions: Ultrasound guided placement of an axillary port is a safe procedure to perform and demonstrates good clinical outcomes.

scholarly journals Recurrent pulmonary embolism related with Paget–Schroetter syndrome: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Yuki Sahashi ◽  
Junko Naito ◽  
Masanori Kawasaki
Keyword(s):  
Pulmonary Embolism ◽  
Lifestyle Modification ◽  
Axillary Vein ◽  
Vein Thrombosis ◽  
Cardiology Department ◽  
Recurrent Pulmonary Embolism ◽  
The Right ◽  
Contrast Ct ◽  
First Rib Resection ◽  
Deep Vein

Abstract Background Paget–Schroetter syndrome (PSS) is an unusual cause of venous thromboembolism, which is frequently misdiagnosed and undiagnosed in clinical settings. Although axillary-subclavian vein thrombosis is related with PSS typically presents in healthy young athletes, it is possible for this phenomenon to occur in various age settings. Case summary We present a case of recurrent pulmonary embolism caused by a thrombus in dilated axillary vein related with PSS. A 74-year-old man was referred to our cardiology department for chest discomfort and hypoxaemia. The contrast computed tomography (CT) revealed that he suffered from bilateral pulmonary embolism. However, we could not find the source of embolism despite other examinations such as ultrasonography of the inferior limb deep vein. Three months later, the patient complained of dyspnoea for a second time, and a contrast CT scan was subsequently performed revealing a new pulmonary embolism. Surgical resection of the giant thrombus was performed, resulting in a good clinical course without recurrence. Discussion We experienced a case of recurring pulmonary embolism in a patient with undiagnosed PSS, which was related to the active and vigorous movement of the right arm during his working. Although there are various treatments for PSS including anticoagulation, first rib resection, and lifestyle modification, we need to consider what is the best treatment individually.

A modified approach for ultrasound-guided axillary venipuncture in the infraclavicular area: A retrospective observational study

2019 ◽  
Vol 20 (6) ◽  
pp. 630-635
Author(s):  
Minmin Yao ◽  
Wanxia Xiong ◽  
Liying Xu ◽  
Feng Ge
Keyword(s):  
Observational Study ◽  
Success Rate ◽  
Central Venous Access ◽  
Demographic Data ◽  
Venous Access ◽  
Axillary Vein ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Venous Catheterization ◽  
Out Of Plane

Background: Catheterization of the axillary vein in the infraclavicular area has important advantages in patients with long-term, indwelling central venous catheters. The two most commonly used ultrasound-guided approaches for catheterization of the axillary vein include the long-axis/in-plane approach and the short-axis/out-of-plane approach, but there are certain drawbacks to both approaches. We have modified a new approach for axillary vein catheterization: the oblique-axis/in-plane approach. Methods: This observational study retrospectively collected data from patients who underwent ultrasound-guided placement of an axillary vein infusion port in the infraclavicular area at the Central Venous Access Clinics of Zhongshan Hospital at Fudan University between March 2014 and May 2017. The patients’ demographic data, success rate of catheterization, venous catheterization site, and immediate complications associated with catheterization were recorded. Results: Between March 2014 and May 2017, a total of 858 patients underwent placement of an axillary vein infusion port in the infraclavicular area at our center. The ultrasound-guided oblique-axis/in-plane approach was used for all patients, and the venipuncture success rate was 100%. Two cases of accidental arterial puncture and one case of local hematoma formation were reported, and no other complications, such as pneumothorax or nerve damage, were reported. Conclusion: The ultrasound-guided oblique-axis/in-plane approach is a safe and reliable alternative to the routine ultrasound-guided approach for axillary venous catheterization.

Incidence and clinical significance of iliac vein compression

Vascular ◽  
2014 ◽  
Vol 23 (4) ◽  
pp. 337-343 ◽  
Author(s):  
M Nazzal ◽  
M El-Fedaly ◽  
V Kazan ◽  
W Qu ◽  
AW Renno ◽  
...  
Keyword(s):  
Ct Scan ◽  
Clinical Symptoms ◽  
Iliac Vein ◽  
Adjacent Segment ◽  
Common Iliac Vein ◽  
Chi Square ◽  
Vein Thrombosis ◽  
History Of ◽  
The Right ◽  
Deep Vein

Objectives To determine the frequency of left common iliac vein (CIV) compression by the right common iliac artery (CIA) based on CT scan images. Methods CT scan images were reviewed and the diameter of CIV was measured at the area of minimal diameter and compared to the distal adjacent segment and the contralateral CIV at the same level. Medical records were reviewed for symptoms, deep vein thrombosis (DVT) and risk factors that might be associated with DVT. Data were analyzed with SPSS program using both Chi square and t test. A p < 0.05 was considered statistically significant. Linear regression (R2) was used to evaluate correlation. Results A total of 300 complete records were reviewed. The mean age was 51.89 years, with 126 (42%) males. Comparison between the two groups (>70% vs <70%) showed similar clinical factors such as history of DVT, surgery, immobilization, malignancy, limb trauma, pregnancy, obesity, CHF, and smoking. There were more females with CIV compression of 70% or more than males (19.5% vs 11.1% P < .049). Conclusion Diameter stenosis more than 70% was present in 30.6% of cases with higher incidence in females. The presence of stenosis was not associated with the presence of clinical symptoms.

Endoscopic ultrasound: A safe procedure for elderly oncology patients?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21531-e21531
Author(s):  
Elizabeth S. John ◽  
Hadi Razjouyan ◽  
Nakul Singhal ◽  
Sita Chokhavatia ◽  
Amy Tilara
Keyword(s):  
Endoscopic Ultrasound ◽  
Performance Status ◽  
Poor Performance ◽  
The Elderly ◽  
Poor Performance Status ◽  
Safe Procedure ◽  
Chi Square ◽  
Gastrointestinal Malignancies ◽  
Procedural Complications ◽  
Therapeutic Decision Making

e21531 Background: Endoscopic ultrasound (EUS) has many indications in the management of gastrointestinal tumors, and has become pivotal in guiding therapy. While studies show that surgery in the elderly with malignancy causes increased morbidity and costs, no studies exist to assess the safety of EUS in this group. Methods: A single center retrospective analysis of patients who underwent EUS by two advanced endoscopists from April 2015 to December 2015 was performed. Patient demographics, procedure indications, final diagnoses, procedure length, sedation type, ASA classification, and intra-procedural complications, peri-procedural (immediate) complications, and post-procedural (24 hours after) complications were collected. Statistical analysis was done with Chi-square and comparison of mean tests. Results: 111 patients were identified with either a confirmed or suspected gastrointestinal malignancy out of 200 total patients included in the study. These patients included 38 with suspected pancreatic adenocarcinoma, one of which revealed pancreatic gastrinoma; 27 with suspected gastric adenocarcinoma or for staging; 17 with suspicious esophageal masses or for staging of squamous cell carcinoma or adenocarcinoma; 9 duodenal masses, 3 colorectal masses, 2 mediastinal masses, 1 biliary mass, 3 potential metastatic lesions to the GI system, and 8 patients with abdominal lymphadenopathy suspicious for malignancy. Patients over 65 years tended to have a lower risk of intra-procedure complications compared to those under 65, irrespective of all other factors including gender, performing endoscopist, and length of procedure (8.3% vs. 18.3%, p = 0.09). No significant differences were found in peri- and post-procedural complications between the over age 65 and under age 65 groups (4.0% vs. 1.6%, p = 0.44; 5.9% vs. 15.2%, p = 0.19). Conclusions: Due to the poor performance status often seen in the elderly oncology population, complications often arise from invasive procedures leading to increased morbidity, mortality, and costs. EUS aids in diagnosis, staging, and therapeutic decision-making of patients with gastrointestinal malignancies, and as this study shows, can be performed in older patients without incurring increased risks.

scholarly journals Spontaneous central venous thrombosis and shunt occlusion following peritoneovenous shunt placement for intractable ascites

2017 ◽  
Vol 99 (5) ◽  
pp. e145-e147
Author(s):  
D Hariharan ◽  
EA Wilkes ◽  
GP Aithal ◽  
SJ Travis ◽  
DN Lobo
Keyword(s):  
Rare Complication ◽  
Chylous Ascites ◽  
Axillary Vein ◽  
Jugular Veins ◽  
Vein Thrombosis ◽  
Shunt Thrombosis ◽  
Peritoneovenous Shunt ◽  
Shunt Occlusion ◽  
Shunt Dysfunction ◽  
The Right

A 43-year-old man had a peritoneovenous shunt inserted for the treatment of chylous ascites secondary to myelofibrosis. Despite being on anticoagulation for superior mesenteric vein thrombosis, he developed shunt dysfunction within two weeks of insertion. Superior venacavography showed multiple filling defects in the right axillary vein, no filling of the right brachiocephalic and right subclavian vein, and thrombotic occlusion of the internal jugular veins bilaterally. The shunt was removed 11 days after insertion, and there was extensive thrombosis of the venous end of the shunt and the compressible pump chamber. Shunt thrombosis is known to occur but remains a rare complication, with 87% of such obstructions being due to a thrombus at the tip of the venous end of the shunt. Extensive thrombosis of the shunt (as in the present case) is very rare.

scholarly journals Laparoscopic cholecystectomy for gall stone disease. A single center experience.

2020 ◽  
Vol 27 (09) ◽  
pp. 1983-1988
Author(s):  
Shehzad Ahmad Qamar ◽  
Munawar Jamil ◽  
Kokab Salim
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Demographic Data ◽  
Gall Stone ◽  
Major Complication ◽  
Stone Disease ◽  
Safe Procedure ◽  
Trocar Site ◽  
Single Center Experience ◽  
Gall Stone Disease

Objectives: Laparoscopic cholecystectomy has turned into the gold standard for patients with symptomatic cholelithiasis. But still this procedure is not complication free. Many a time’s laparoscopic cholecystectomy needs to be converted to open cholecystectomy. Study Design: Observational study. Setting: Civil Hospital Bahawalpur. Period: 3 years from July 2015 to June 2018. Material & Methods: Carried out to review the frequency of complications encountered in laparoscopic cholecystectomy by assessing 400 cases of laparoscopic cholecystectomies. Performa was intended to incorporate important demographic data, history of illness, examination and investigations. Results: The major complication of our procedure was bleeding. Bleeding from the trocar site happened in 11 cases (2.75%), vascular damage in the callots triangle in 2 (0.5%) and from liver bed in 19 (4.75%) cases, followed by biliary leak that happened in 20 (5%) cases. Spilled gallstones were seen in 8(2%), Port site infection in 24 (6%) cases. Common bile channel stricture was accounted for in 5 patients, 14 (3.5%) out of 400 patients were converted to open surgery. Mortality was low for our situation I.e. 1 patient. Conclusion: Laparoscopic cholecystectomy is becoming a safe procedure in terms of complications.

scholarly journals Coagulopathy in COVID-19 infection: a case of acute upper limb ischemia

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Nikiforos Galanis ◽  
Chara Stavraka ◽  
Filon Agathangelidis ◽  
Evangelos Petsatodis ◽  
Christos Giankoulof ◽  
...  
Keyword(s):  
Upper Limb ◽  
Severe Infection ◽  
Limb Ischemia ◽  
Axillary Vein ◽  
The Novel ◽  
Vein Thrombosis ◽  
Treatment Dose ◽  
The Right ◽  
Deep Vein ◽  
Severe Coagulopathy

Abstract Coagulation abnormalities and thrombosis have been recently identified as sequelae of severe infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report a case of severe coagulopathy manifesting with right upper limb arterial and deep vein thrombosis in an 80-year-old male patient with severe COVID-19 associated pneumonia. He clinically deteriorated and received care in the intensive care unit where he was intubated. At that point, his coagulation laboratory tests were deranged, and he eventually developed dry gangrene in his right thumb and index finger, as well as a deep venous thromboembolism in his right axillary vein. Despite receiving treatment dose anticoagulation and undergoing arterial embolectomy, revascularization was unsuccessful. Amputation of the right arm at the level of the elbow was considered, but the patient died from respiratory failure.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

Percutaneous Trans-Hepatic Embolization of an Iatrogenic Extra-Hepatic Pseudoaneurysm of the Right Hepatic Artery in a Patient With Previous Occlusion of the Proper Hepatic Artery: An Endovascular Procedure to Avoid a Difficult Surgical Repair

2021 ◽  
pp. 153857442110225
Author(s):  
Giuseppe S. Gallo ◽  
Roberto Miraglia ◽  
Luigi Maruzzelli ◽  
Francesca Crinò ◽  
Christine Cannataci ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hepatic Artery ◽  
Surgical Repair ◽  
Endovascular Embolization ◽  
Proper Hepatic Artery ◽  
Ultrasound Guided ◽  
Complete Occlusion ◽  
Right Hepatic Artery ◽  
Ultrasonographic Guidance ◽  
The Right

We report a case of successful percutaneous transhepatic, embolization of an iatrogenic extra-hepatic pseudoaneurysm (PsA) of the right hepatic artery (RHA) under combined fluoroscopic and ultrasonographic guidance. A 73-year-old man underwent percutaneous transhepatic biliary drainage placement in another hospital, complicated by haemobilia and development of a RHA PsA. Endovascular embolization was attempted, resulting in coil embolization of the proper hepatic artery, and persistence of the PsA. At this point, the patient was referred to our hospital. Computed tomography and direct angiography confirmed the iatrogenic extra-hepatic PsA of the RHA, refilled by small collaterals from the accessory left hepatic artery (LHA) and coil occlusion of the proper hepatic artery. Attempted selective catheterization of these vessels was unsuccessful due to the tortuosity and very small caliber of the intra-hepatic collaterals, the latter precluding endovascular treatment of the PsA. Percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA was performed with Lipiodol® and cyanoacrylate-based glue (Glubran®2). Real time fluoroscopic images and computed tomography confirmed complete occlusion of the pseudoaneurysm. Surgical repair, although feasible, was considered at high risk. In our patient, we decided to perform a percutaneous trans-hepatic combined fluoroscopic and ultrasound-guided embolization of the PsA using a mix of Lipiodol® and Glubran®2 because of the fast polymerization time of the glue allowing the complete occlusion of the PsA in few seconds, thus eliminating the risk of coil migration, reducing the risk of PsA rupture and avoid a difficult surgical repair.

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