Refractory axillary venous spasm during permanent pacemaker implantation

Abstract Background Vascular spasm is well known to occur in the arterial system. Central venous spasm during pacemaker implantation is uncommon with only a few cases reported from time to time. Sometimes, the venous spasms may not respond to nitroglycerine injections which requires a change of access site and undue discomfort for the patient. Case presentation A 72-year-old female patient with no prior comorbidities presented to us with recurrent dizziness on exertion and at rest. The electrocardiogram showed complete heart block, likely to be of sclerodegenerative etiology as the patient did not have any ischemic symptoms, also the electrocardiogram and echocardiogram did not show any evidence of ischemia. As part of the hospital protocol, a venogram was performed by giving intravenous diluted contrast (iohexol) through the left brachial vein, which showed good-sized axillary and subclavian veins. We attempted to cannulate the left axillary vein with a 16G needle using Seldinger technique, but the axillary vein could not be cannulated despite multiple attempts. We gave incremental boluses of intravenous nitroglycerine, despite that the left axillary vein could not be cannulated. Repeat intravenous contrast injection showed severe spasm of axillary and subclavian veins. Finally, the axillary vein was cannulated from the right side using anatomical landmarks and a pacemaker was implanted. Conclusions Venous spasm during device implantation although uncommon, it should be anticipated in patients with difficult cannulation to prevent inadvertent complications like pneumothorax and arterial injuries. Mild venous spasm may relieve with time but severe venous spasm may require a change of access site

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Surgical Repair of Subacute Right Ventricular Perforation after Pacemaker Implantation

Case Reports in Cardiology ◽

10.1155/2017/3242891 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Takeshi Oda ◽

Takanori Kono ◽

Keiichi Akaiwa ◽

Yasushi Takahara ◽

Chie Yasuoka ◽

...

Keyword(s):

Right Ventricle ◽

Right Ventricular ◽

Rare Complication ◽

Pacemaker Implantation ◽

Median Sternotomy ◽

Axillary Vein ◽

Pericardial Cavity ◽

Temporary Pacing ◽

Pacing Lead ◽

The Right

We report an 84-year-old woman who presented with right ventricular perforation 4 days after pacemaker implantation for syncope due to sick sinus syndrome. Median sternotomy revealed no pericardial effusion, but the pacing lead had penetrated the right ventricle and pericardium. When the pleura was opened, the tip of the lead was seen in the visceral pleura. The lead was cut in the pericardial cavity and extracted from the left subclavian wound together with the generator. The right ventricular perforation was sutured and a temporary pacing lead was placed on the right ventricular wall intraoperatively. Ten days after the surgery, a new pacemaker lead was placed in the ventricular septum via the right axillary vein. Right ventricular perforation is a rare complication after pacemaker implantation. Typically, it occurs at the time of implantation or within 24 hours after implantation. In the present case, the perforation of the right ventricle which needed urgent surgery occurred 4 days after implanting the pacing lead at the right ventricular apex. Great care should have been taken not to overlook this life-threatening complication even more than 24 hours after pacemaker implantation.

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The value of real-time ultrasound-guidance for definite placement of a right supraclavicular subclavian central venous catheter

The Journal of Vascular Access ◽

10.1177/1129729821998531 ◽

2021 ◽

pp. 112972982199853

Author(s):

Jens M Poth ◽

Stefan F Ehrentraut ◽

Se-Chan Kim

Keyword(s):

Ultrasound Guidance ◽

Venous Catheter ◽

Needle Insertion ◽

Major Surgery ◽

Axillary Vein ◽

Central Venous ◽

Supraclavicular Fossa ◽

The Right ◽

High Index Of Suspicion ◽

Insertion Process

Central venous catheters (CVC) are widely used in critically ill patients and in those undergoing major surgery. Significant adverse events, such as pneumothorax and hemothorax, can be caused by needle insertion during CVC insertion. CVC misplacement is less often described, yet equally important, as it can lead to deleterious complications. Here, we describe a case in which misplacement of a guidewire following infraclavicular puncture of the right axillary vein was detected by continuous ultrasound employing the right supraclavicular fossa view. Utilizing this ultrasound view, the insertion approach to the vessel was changed and correct CVC placement could be achieved. While ultrasound guidance is widely accepted for vessel puncture, this case demonstrates the value of continuous ultrasound guidance for the entire process of CVC insertion: vessel puncture, correct guidewire advancement, catheter placement, and exclusion of complications such as pneumothorax. It also shows that there should be a high index of suspicion for guidewire misplacement, even after successful venipuncture. In conclusion, ultrasound protocols covering the complete CVC insertion process should be implemented into current clinical practice.

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Mediastinal anatomical landmarks, their variants and tips for video-assisted thoracoscopic navigation during oesophageal extirpation

Surgical and Radiologic Anatomy ◽

10.1007/s00276-021-02820-8 ◽

2021 ◽

Author(s):

Sergey Dydykin ◽

Friedrich Paulsen ◽

Tatyana Khorobykh ◽

Natalya Mishchenko ◽

Marina Kapitonova ◽

...

Keyword(s):

Prone Position ◽

Anatomical Study ◽

Structural Features ◽

Posterior Mediastinum ◽

Visual Navigation ◽

Anatomical Landmarks ◽

Video Assisted ◽

Before And After ◽

Human Cadavers ◽

The Right

Abstract Purpose There is no systematic description of primary anatomical landmarks that allow a surgeon to reliably and safely navigate the superior and posterior mediastinum’s fat tissue spaces near large vessels and nerves during video-assisted endothoracoscopic interventions in the prone position of a patient. Our aim was to develop an algorithm of sequential visual navigation during thoracoscopic extirpation of the esophagus and determine the most permanent topographic and anatomical landmarks allowing safe thoracoscopic dissection of the esophagus in the prone position. Methods The anatomical study of the mediastinal structural features was carried out on 30 human cadavers before and after opening the right pleural cavity. Results For thoracoscopic extirpation of the esophagus in the prone position, anatomical landmarks are defined, their variants are assessed, and an algorithm for their selection is developed, allowing their direct visualization before and after opening the mediastinal pleura. Conclusion The proposed algorithm for topographic and anatomical navigation based on the key anatomical landmarks in the posterior mediastinum provides safe performance of the video-assisted thoracoscopic extirpation of the esophagus in the prone position.

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Single center experience with ultrasound guided axillary vein port placement

The Journal of Vascular Access ◽

10.1177/11297298211008094 ◽

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.

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Minimally invasive permanent pacemaker implantation immediately after birth: from delivery room to heart surgery

Cardiology in the Young ◽

10.1017/s1047951121002808 ◽

2021 ◽

pp. 1-3

Author(s):

Mehmet Taşar ◽

Nur Dikmen Yaman ◽

Burcu Arıcı ◽

Ömer Nuri Aksoy ◽

Huseyin Dursin ◽

...

Keyword(s):

Minimally Invasive ◽

Atrioventricular Block ◽

Heart Surgery ◽

Pacemaker Implantation ◽

Skin Incision ◽

Permanent Pacemaker ◽

Invasive Technique ◽

Permanent Pacemaker Implantation ◽

Congenital Atrioventricular Block ◽

The Right

Abstract Introduction: Congenital atrioventricular block is diagnosed in uterine life, at birth, or early in life. Atrioventricular blocks can be life threatening immediately at birth so urgent pacemaker implantation techniques are requested. Reasons can be cardiac or non-cardiac, but regardless of the reason, operations are challenging. We aimed to present technical procedure and operative results of pacemaker implantation in neonates. Materials and methods: Between June 2014 and February 2021, 10 neonates who had congenital atrioventricular block underwent surgical operation to implant permanent epicardial pacemaker by using minimally invasive technique. Six of the patients were female and four of them were male. Mean age was 4.3 days (0–11), while three of them were operated on the day of birth. Mean weight was 2533 g (1200–3300). Results: Operations were achieved through subxiphoidal minimally skin incision. Epicardial 25 mm length dual leads were implanted on right ventricular surface and generators were fixed on the right (seven patients) or left (three patients) diaphragmatic surface by incising pleura. There were no complication, morbidity, and mortality related to surgery. Conclusion: Few studies have characterised the surgical outcomes following epicardial permanent pacemaker implantation in neonates. The surgical approach is attractive and compelling among professionals so we aimed to present the techniques and results in patients who required permanent pacemaker implantation in the first month of life.

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Subarachnoid hemorrhage in a case of segmental arterial mediolysis with coexisting intracranial and intraabdominal aneurysms

Journal of Neurosurgery ◽

10.3171/2012.1.jns111967 ◽

2012 ◽

Vol 116 (5) ◽

pp. 948-951 ◽

Cited By ~ 13

Author(s):

Ryosuke Matsuda ◽

Yasuo Hironaka ◽

Yasuhiro Takeshima ◽

Young-Su Park ◽

Hiroyuki Nakase

Keyword(s):

Subarachnoid Hemorrhage ◽

Distal Portion ◽

Dissecting Aneurysm ◽

Arterial System ◽

Left Vertebral Artery ◽

Retroperitoneal Hemorrhage ◽

Segmental Arterial Mediolysis ◽

History Of ◽

The Right ◽

Distal Anterior Cerebral Artery

The authors report the rare case of a 58-year-old man with segmental arterial mediolysis (SAM) with associated intracranial and intraabdominal aneurysms, who suffered subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm. This disease primarily involves the intraabdominal arterial system, resulting in intraabdominal and retroperitoneal hemorrhage in most cases. The patient presented with severe headache and vomiting. The CT scans of the head revealed SAH. Cerebral angiography revealed 3 aneurysms: 1 in the right distal anterior cerebral artery (ACA), 1 in the distal portion of the A1 segment of the right ACA, and 1 in the left vertebral artery. The patient had a history of multiple intraabdominal aneurysms involving the splenic, gastroepiploic, gastroduodenal, and bilateral renal arteries. He underwent a right frontotemporal craniotomy and fibrin coating of the dissecting aneurysm in the distal portion of the A1 segment of the right ACA, which was the cause of the hemorrhage. Follow-up revealed no significant changes in the residual intracranial and intraabdominal aneurysms. An SAH due to SAM with associated multiple intraabdominal aneurysms is extremely rare. The authors describe their particular case and review the literature pertaining to SAM with associated intracranial and intraabdominal aneurysms.

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Pacemaker-Generated Stress Fracture of The Second Rib: A Case Report

10.21203/rs.3.rs-42299/v1 ◽

2020 ◽

Author(s):

Jus Ksela ◽

Mark Racman ◽

Rok Zbacnik ◽

Anze Djordjevic ◽

Matevz Jan

Keyword(s):

Physical Activity ◽

Computed Tomography ◽

Female Patient ◽

Stress Fracture ◽

Pulse Generator ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Direct Trauma ◽

The Right ◽

Intense Physical Activity

Abstract Background: Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or decubitus, device migration, and Twiddler's syndrome, with other pathologies such as nerve impairment or bone lesions being extremely rarely encountered. We report a case of a 20-year old asthenic, non-athlete female patient presenting with a device-generated fracture of the second rib several months after sub-muscular permanent pacemaker implantation due to repeated bilateral pre-pectoral pocket infections.Case presentation: A 20-year old female patient was readmitted to our institution 9 months following sub-pectoral implantation of a permanent pacemaker, complaining of severe pocket-related pain, which arose spontaneously in the absence of direct trauma, intense physical activity or vigorous coughing, and was associated with normal day-to-day activity. To rule out a pacemaker re-infection, a native computed tomography and a positron emission tomography - computed tomography of the thorax were performed. Both modalities excluded an infection but showed a healing fracture and a focus of enhanced metabolic activity in the anterolateral part of the right second rib, indicating a non-traumatic or stress fracture of the bone. Consequently, a complete extraction of the pulse generator and both leads was performed and the smallest available single-chamber pulse generator with a single atrial electrode was implanted in the sub-fascial, pre-muscular pocket in the now recovered and uninfected left subclavicular region, alleviating patient’s severe pain symptoms and significantly enhancing her quality of life.Conclusions: In the absence of direct trauma, intense physical activity or vigorous coughing, we assume that in this asthenic girl a normal day-to-day motion of the right shoulder has persistently forced the sub-muscularly placed pulse generator toward thoracic wall, putting increased repetitive pressure force on the underlying bones, finally causing a fatigue stress fracture of the second rib. In asthenic phenotype patients with small thorax and short subclavicular distance, a sub-muscular pacemaker implantation can potentially cause unique and unexpected pocket-related adverse events necessitating advanced diagnostics and timely treatment.

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Non-recurrent inferior laryngeal nerve: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20204159 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3469

Author(s):

Shah Urvin Manish ◽

Boopathi Subbarayan ◽

Saravanakumar Subbaraj ◽

Tirou Aroul Tirougnanassambandamourty ◽

S. Robinson Smile

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nodular Goiter ◽

Anatomical Variations ◽

Laryngeal Nerve ◽

Anatomical Landmarks ◽

Inferior Laryngeal Nerve ◽

Nonrecurrent Inferior Laryngeal Nerve ◽

Aged Woman ◽

Middle Aged Woman ◽

The Right

The incidence of Non-recurrent laryngeal nerve (NRLN) is reported to be 0.6%-0.8% on the right side and in 0.004% on the left side. Damage to this nerve during thyroidectomy may lead to vocal cord complications and should therefore be prevented. A middle-aged woman with a nodular goiter who underwent subtotal thyroidectomy for multinodular colloid goiter. We encountered a non-recurrent laryngeal nerve on the right side in a patient during surgery. We were not able to find the inferior laryngeal nerve in its usual position using the customary anatomical landmarks. Instead, it was emerging directly from the right vagus nerve at a right angle and entering the larynx as a unique non-bifurcating nerve. Nonrecurrent inferior laryngeal nerve incidence is very rare, but when present, increases the risk of damage during thyroidectomy. Hence, it is very important to be aware of the anatomical variations of the inguinal lymph node (ILN) and the use of safe meticulous dissection while looking for the nerve during thyroidectomy. The use of Intra-operative neuro-monitoring (IONM) if available in thyroid surgery allows the surgeon to recognize and differentiate branches of the inferior laryngeal nerve (ILN) from sympathetic anastomoses, as well as NRLN during surgery.

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Corpus callosum in schizophrenia with deficit and non-deficit syndrome: a statistical shape analysis

General Psychiatry ◽

10.1136/gpsych-2021-100635 ◽

2021 ◽

Vol 34 (6) ◽

pp. e100635

Author(s):

Yaşar Türk ◽

Ilker Ercan ◽

Ibrahim Sahin ◽

Basak Erdemli Gursel ◽

Arda Uzunoglu ◽

...

Keyword(s):

Corpus Callosum ◽

Three Dimensional ◽

Anatomical Landmarks ◽

Deficit Syndrome ◽

Statistical Shape ◽

Schizophrenic Patients ◽

Healthy Control ◽

Gradient Echo Imaging ◽

The Right ◽

Cognitive Data

BackgroundThe corpus callosum (CC) is the most targeted region in the cerebrum that integrates cognitive data between homologous areas in the right and left hemispheres.AimsOur study used statistical analysis to determine whether there was a correlation between shape changes in the CC in patients with schizophrenia (SZ) (deficit syndrome (DS) and non-deficit syndrome (NDS)) and healthy control (HC) subjects.MethodsThis study consisted of 27 HC subjects and 50 schizophrenic patients (20 with DS and 30 with NDS). 3 patients with DS and 4 patients with NDS were excluded. Three-dimensional, sagittal, T1-spoiled, gradient-echo imaging was used. Standard anatomical landmarks were selected and marked on each image using specific software.ResultsAs to comparing the Procrustes mean shapes of the CC, statistically significant differences were observed between HC and SZ (DS+NDS) (p=0.017, James’s Fj=73.732), HC and DS (p<0.001, James’s Fj=140.843), HC and NDS (p=0.006, James’s Fj=89.178) and also DS and NDS (p<0.001, James’s Fj=152.967). Shape variability in the form of CC was 0.131, 0.085, 0.082 and 0.086 in the HC, SZ (DS+NDS), DS and NDS groups, respectively.ConclusionsThis study reveals callosal shape variations in patients with SZ and their DS and NDS subgroups that take into account the CC’s topographic distribution.

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