Internal jugular to internal jugular vein bypass of symptomatic central vein obstruction

2022 ◽  
pp. 112972982110707
Author(s):  
Jared Carleton ◽  
Jason Chang ◽  
Qinghua (Richard) Pu ◽  
Robert Rhee
Keyword(s):  
Upper Extremity ◽  
Jugular Vein ◽  
Hemodialysis Patients ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Central Venous ◽  
Av Fistula ◽  
Facial Swelling ◽  
Vein Bypass ◽  
The Creation

Introduction: Central venous obstruction (CVO) often arises among hemodialysis patients with upper extremity access due to a varying number of risk factors. While the true incidence of CVO in hemodialysis patients is unknown, it been reported in the range of 20%–40% in dialysis patients undergoing venograms. In the non-hemodialysis population, chronic central vein obstruction has a compensatory mechanism comprised of numerous collaterals along the chest wall, neck, and mediastinum. However, the presence of an AVF or AVG ipsilateral to a central venous stenosis or occlusion can overwhelm the collateral network due to the significantly elevated blood flow. This may result in severe and debilitating upper extremity and fascial swelling. While ligation results in almost instantaneous symptomatic relief, it does not address the patient’s underlying pathologic process and necessitates an additional access. As these patients continue to live longer, our strategies to manage these failing accesses are becoming increasingly complex. The goal of preserving existing access while correcting any symptoms is paramount. Previous case reports have documented various surgical options for preserving an existing access. Case presentation: Our patient is a 49-year-old female with hypertension and end-stage renal disease, on hemodialysis through a right arm arteriovenous (AV) fistula. She had a history of multiple AV fistulae creations in the past, all of which previously thrombosed. Several years after the creation of her most recent fistula, she developed severe throbbing headaches, right arm and facial swelling, right eye lacrimation, and blurry vision. AV fistula angiogram demonstrated right brachiocephalic vein chronic occlusion and endovascular revascularization through both trans-AVF and transfemoral approaches were attempted, but unsuccessful. Discussion: This case illustrates the success of the creation of an internal jugular-jugular vein bypass to maintain a right arm arteriovenous fistula, while at the same time, correcting the symptoms of a right brachiocephalic vein occlusion.

Upper-Extremity Venous Duplex Evaluation

2005 ◽  
Vol 29 (2) ◽  
pp. 79-83
Author(s):  
Kari A. Olmsted
Keyword(s):  
Central Venous Catheter ◽  
Upper Extremity ◽  
Venous Catheter ◽  
Waveform Analysis ◽  
Central Vein ◽  
Venous Obstruction ◽  
Central Venous ◽  
Extrinsic Compression ◽  
Facial Swelling ◽  
Spectral Doppler

As many as 80% of upper-extremity venous thrombosis cases develop in response to an easily identified problem, such as central venous catheter. The remaining 20% of obstructions are caused by other central venous obstruction, trauma, or Paget-Schroetter syndrome. Appropriate clinical indications for upper-extremity venous duplex evaluation include (but are not limited to) unilateral upper-extremity swelling in the presence of indwelling central venous catheter, upper-extremity erythema and tenderness, superficial palpable cord, or facial swelling. Physical examination and thorough patient history compliment the duplex findings to arrive at an accurate diagnosis. The most effective way to determine the presence or absence of thrombosis is with vein wall compressions. However, most of the upper-extremity central vein segments are located beneath bony structures, which prevent extrinsic compression with transducer pressure. Therefore, the spectral Doppler waveform analysis component of the duplex exam becomes crucial in determining venous obstruction. Common technical components and pitfalls include appropriate color and spectral Doppler settings to reliably demonstrate presence/absence of flow or accurate accounting for innominate vein and supraclavicular/infraclavicular subclavian vein versus occluded native anatomy and large patent branches. When properly executed, the aforementioned components comprise a thorough duplex evaluation of the upper extremity venous system.

MO783CENTRAL VEIN STENOSIS IN HEMODIALYSIS PATIENTS WITH PAST CENTRAL VEIN MANIPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Pedro Reis Pereira ◽  
Círia Sousa ◽  
Natalia Silva ◽  
Jose Francisco ◽  
Mónica Fructuoso ◽  
...  
Keyword(s):  
Vascular Access ◽  
Significant Proportion ◽  
Previous History ◽  
Hemodialysis Patients ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Central Venous ◽  
Short Term ◽  
History Of

Abstract Background and Aims Central vein stenosis (CVS) is frequently observed in hemodialysis patients. Risk factors for CVS include prior ipsilateral central venous catheterization (CVC) and cardiac rhythm device (CRD) insertions. Though it may have clinical manifestations, CVS is often asymptomatic and, therefore, not diagnosed. The aim of this work was to evaluate the prevalence of CVS in a population of hemodialysis patients, as well as underlying risk factors, clinical manifestations and impact in patients’ vascular access. Method We retrospectively evaluated all venous angiographies of prevalent patients in our hemodialysis units from 2013 to 2018. In patients with proved CVS, we evaluated history of prior short term and long term upper ipsilateral CVC and CRD insertions. We also analyzed symptoms associated CVS as well as the rate of loss of vascular access for hemodialysis related to the presence of CVS. Results The prevalence of CVS in prevalent patients in hemodialysis during the period of our study (n=209) was 14%. We identified 31 upper CVS in 29 patients undergoing venous angiography. Left brachiocephalic vein was the most commonly affected site (45.1% of cases), followed by the right brachiocephalic vein (19.3%), left subclavian vein (16.1%), right subclavian vein (12.9%) and superior vena cava (6.4%). The majority of patients with CVS (95%) had previous history of ipsilateral CVC (previous short-term CVC in 40%, pervious short term and long-term CVC in 27% and previous long-term CVC in 33%). Loss of vascular access for hemodialysis due do CVS was observed in 26% of patients with CVS. Conclusion A significant proportion of patients in hemodialysis presents CVS. The majority of patients with CVS had a previous history of ipsilateral central venous catherization. A significant proportion of patients with CVS had a previous history central venous catherization uniquely with short term CVC, highlighting the importance of the risk of vascular lesion, even during short periods of catherization. The presence of CVS is associated with a significant rate of loss hemodialysis vascular access.

Central Venous Occlusion in End-Stage Renal Failure—A Rare Mimic of Dural Arteriovenous Fistula (DAVF)

2021 ◽  
Vol 4 (1) ◽  
pp. 81-83
Author(s):  
Sharath Kumar Goddu Govindappa ◽  
Lakshminarayanapuram Gopal Viswanathan ◽  
Shashidhar Kallappa Parameshwarappa ◽  
Naveen Nayak ◽  
Sujit Kumar ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Rare Complication ◽  
Venous Occlusion ◽  
Venous Hypertension ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Av Fistula ◽  
Central Venous Occlusion ◽  
End Stage

Intracerebral hemorrhage is a devastating form of stroke and is more common in patients with hypertension and renal disease. We present the case of a lady suffering from chronic kidney disease who presented with severe headache and aphasia. On evaluation, she was found to have an intraparenchymal hemorrhage in the left temporal lobe with prominent pial and dural veins suggestive of a dural arteriovenous fistula (DAVF). Subsequently, she was detected to have occlusion of the left brachiocephalic vein (LBCV), which resulted in venous hypertension and resulted in this rare complication. Angioplasty followed by stenting of the LBCV resulted in subsidence of her symptoms. We wish to highlight this unusual but treatable complication of limb AV fistula which can mimic intracranial DAVF.

The diagnostic value of multi-detector CT angiography for catheter-related central venous stenosis in hemodialysis patients

2020 ◽  
pp. 026835552095509
Author(s):  
Yuliang Zhao ◽  
Letian Yang ◽  
Yating Wang ◽  
Huawei Zhang ◽  
Tianlei Cui ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Hemodialysis Catheter ◽  
Central Venous Stenosis

The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen’s kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.

scholarly journals Diagnostic accuracy of internal jugular vein ultrasound in quantification of the central venous pressure for hemodialysis patients

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ahmed Abd Alrahman Baz ◽  
Amro Abdulrahim Ibrahim ◽  
Hussein Saeed El-Fishawy ◽  
Abo El-Magd Mohamed Al-Bohy
Keyword(s):  
Central Venous Pressure ◽  
Internal Jugular Vein ◽  
Significant Positive Correlation ◽  
Jugular Vein ◽  
Venous Pressure ◽  
Hemodialysis Patients ◽  
Central Venous ◽  
Positive Correlation ◽  
Non Invasive ◽  
Accuracy Measures

Abstract Background Assessment of the central venous pressure (CVP) is an essential hemodynamic parameter for monitoring the dialyzing patients. Our objective of the present study is to investigate the accuracy of CVP measurement by internal jugular vein US in comparison to the direct measurement by the central venous catheters for hemodialysis patients. We included 106 patients; where their CVP was assessed in two different non invasive US methods (CVPni) separately and in combination and the obtained measurements were correlated to the invasive measurements (CVPi) by catheters. Results By method 1, there is a highly significant positive correlation between CVPni and CVPi (ρ < 0.001) and a Pearson correlation coefficient (r = 0.913 n = 93), and by method 2, there is also a highly significant positive correlation between the CVPni and CVPi in both groups (r = 0.832, 95%, n = 106, p < 0.001), 1.935 was the cut-off point for prediction of CVP ≥ 10cmH20. For differentiation between patients with CVP < 10cmH20 and ≥ 10cmH20, the accuracy measures (sensitivity, specificity, PPV, NPV, and overall accuracy) were 100%, 79.31%, 74.47%, 100%, and 87.10% by method 1, and were 91.11%, 85.48%, 82.00%, 92.98%, and 87.85% by method 2, while the combination of both methods had gained 88.57%, 89.66%, 83.78%, 92.86%, and 89.25%, respectively. Conclusion The US offered a reliable and non-invasive tool for monitoring CVP. The present study has a novelty of combining more than one US method and this had reported higher accuracy measures and outperformed the use of a single method.

scholarly journals Brachiocephalic Vein Stenosis in Association with Ipsilateral Hyperdynamic Brachio-Basilic Fistula Causing Ipsilateral Facial Swelling and Contralateral Papillodema and Visual Loss

2010 ◽  
Vol 16 (3) ◽  
pp. 322-325 ◽  
Author(s):  
P. Eames ◽  
L. Senthil ◽  
A. Thomas ◽  
P. Riley ◽  
M.A. Burdon
Keyword(s):  
Visual Loss ◽  
Jugular Vein ◽  
Brachiocephalic Vein ◽  
Facial Swelling ◽  
The Face ◽  
Dialysis Fistula ◽  
History Of ◽  
Hypertensive Woman ◽  
The Right ◽  
Vein Stenosis

A 69-year-old hypertensive woman with a hyperdynamic, left brachio-basilic dialysis fistula presented with a long history of throbbing in her head, swelling of the left side of the face and two months of right visual loss with gross swelling of the right optic disc. Tight stenosis of left brachiocephalic vein was found to be causing retrograde flow into the left jugular vein which normalised after dilatation and stenting with resolution of the papillodema.

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