Use of Intraoperative Venography to Guide the Distal Portion of a Ventriculoatrial Shunt Past an Obstruction in the Central Veins

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. onsE370-onsE371 ◽  
Author(s):  
Eric N. Momin ◽  
Pablo F. Recinos ◽  
Alexander L. Coon ◽  
Daniele Rigamonti
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Standard Technique ◽  
Pseudotumor Cerebri ◽  
Distal Portion ◽  
Brachiocephalic Vein ◽  
Considerable Difficulty ◽  
Left Brachiocephalic Vein ◽  
Ventriculoperitoneal Shunting ◽  
Atrial Catheter

Abstract OBJECTIVE Ventriculoatrial (VA) shunting is commonly used to treat hydrocephalus when ventriculoperitoneal shunting has failed. Placement of a VA shunt in patients with narrowing or occlusion of the central veins presents considerable difficulty because few imaging modalities exist to safely and reliably insert a guidewire or atrial catheter past the occlusion. We report the use of intraoperative venography to guide the placement of the distal portion of a VA shunt in a patient with a valve blocking the left brachiocephalic vein. CLINICAL PRESENTATION A 42-year-old man with pseudotumor cerebri and a left ventriculoperitoneal shunt presented with severe headaches. He was diagnosed with partial distal shunt obstruction. Because of a history of failed attempts at ventriculoperitoneal shunting, conversion to a VA shunt via the left internal jugular vein was planned. TECHNIQUE Surgery was performed by using the standard technique until resistance was encountered when inserting a guidewire into the internal jugular vein. Intraoperative venography of the central veins was performed, which showed a large valve blocking progression of the guidewire in the left brachiocephalic vein. Using fluoroscopic guidance, a 0.035-inch guidewire was successfully directed through the vein past the obstruction and exchanged for a peel-away introducer. The distal shunt catheter was then inserted, and the correct position in the atrium was confirmed fluoroscopically. CONCLUSION When obstruction of the central veins is found during a VA shunting procedure, intraoperative venography is a useful method to aid in the placement of the atrial catheter through the central veins.

Brachiocephalic Vein Perforation During Cannulation of Internal Jugular Vein

2017 ◽  
Vol 9 (9) ◽  
pp. 258-261
Author(s):  
Atsushi Kainuma ◽  
Keiichi Oshima ◽  
Chiho Ota ◽  
Yu Okubo ◽  
Naoto Fukunaga ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Brachiocephalic Vein

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.

Factors Causing Loss of Normal Doppler Waveform of the Left Internal Jugular Vein: Evaluation on Chest Computed Tomography

2017 ◽  
Vol 18 (5) ◽  
pp. 402-407 ◽  
Author(s):  
Min Cheol Ku ◽  
Myung Gyu Song ◽  
Tae-Seok Seo ◽  
Eun Young Kang ◽  
Hwan Seok Yong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Internal Jugular Vein ◽  
Doppler Ultrasound ◽  
Jugular Vein ◽  
Mediastinal Lymph Node ◽  
Brachiocephalic Vein ◽  
Left Internal Jugular Vein ◽  
Access Port ◽  
Chest Computed Tomography ◽  
Doppler Waveform

Purpose To evaluate the presence and causes of left brachiocephalic vein (LBCV) steno-occlusive lesions in patients with loss of normal waveform in Doppler ultrasound of the left internal jugular vein (LIJV). Materials and Methods We performed Doppler ultrasound of both internal jugular veins in 1912 patients who received an implantable venous access port from August 2013 to January 2016. Among them, 106 patients showed loss of normal Doppler waveforms of the LIJV (56 men and 50 women; mean age, 61.4 ± 11.6 years). We retrospectively analyzed the presence and causes of the LBCV steno-occlusive lesions on contrast-enhanced chest computed tomography (CT) images. Results LBCV steno-occlusive lesions were present in 82 patients (77.4%). The causes of these lesions were anatomic structures (n = 70, 85.4%), tumorous lesions (n = 11, 13.4%), and thrombus (n = 1, 1.2%). The anterior anatomic structures to the LBCV causing stenosis were bony structures (n = 50), right upper lobe (n = 11), and mediastinal fat (n = 9). The posterior anatomic structures to the LBCV resulting in stenosis were right brachiocephalic artery (n = 58), left common carotid artery (n = 7), and aortic arch (n = 5). The tumorous lesions resulting in stenosis were mediastinal lymph node (n = 5), thymic lesions (n = 3), lymphoma (n = 1), lung cancer (n = 1), and bone tumor (n = 1). Conclusions It is necessary to suspect steno-occlusive lesion of the LBCV from various causes and to use caution when performing central venous catheterization in cases with loss of a normal Doppler waveform.

scholarly journals Biometric measurements involving the terminal portion of the thoracic duct on left level IV: an anatomic study

2015 ◽  
Vol 94 (1) ◽  
pp. 1
Author(s):  
Andressa Cristina Sposato Louzada ◽  
Soo Jin Lim ◽  
Alvaro Masahiro Yoshio ◽  
Vergilius José Furtado Araújo-Neto ◽  
Cesar Augusto Simões ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Jugular Vein ◽  
Brachiocephalic Vein ◽  
Left Internal Jugular Vein ◽  
Terminal Portion ◽  
Anatomic Study ◽  
Left Brachiocephalic Vein ◽  
Final Segment ◽  
Biometric Measurements ◽  
Omohyoid Muscle

<p>BACKGROUND: During a neck dissection involving the left IV level, the final segment of the thoracic duct (TD) may be injured, significantly increasing postoperative morbi-mortality. The best treatment is its prevention. However, there is a lack of helpful biometric measurements focusing on the TD termination in the literature. MATERIALS AND METHODS: The TD termination was identified and some helpful biometric measurements were obtained on 25 non-preserved cadavers. Statistical analysis was performed to analyze correlations. RESULTS: TD termination was found on the jugulo-subclavian junction (JSJ - 60%), on the left internal jugular vein (LIJV - 36%), and on the left brachiocephalic vein in 4%. A statistically significant association was found between TD termination on the JSJ and the distance between LIJV and omohyoid muscle (Measurement #1). Individuals with TD termination on the JSJ had median Measurement #1 of 34.5±12.0mm, compared with median Measurement #1 of 22.3±8.7mm among individuals with TD termination on LIJV (p=0.015 – Student´s t-test). The logistic regression showed for every 10mm increment of Measurement #1 there was 1.12x chance to find the TD termination on the JSJ (OR=1.12; CI95%:1,01-1,25; p=0.032). A 19mm cut-off was established for this distance as a diagnostic test to predict the TD termination on the JSJ, with sensitivity of 86.7% (CI95%:59.5-98.3%), specificity of 55.6% (CI95%:21.2-86.3%), PPV of 76.5% (CI95%:50.1-93.2%), NPV of 71.4% (CI95%:25.8-97.2%) and ROC AUC of 79.3% (CI95%: 58.0-92.9%). CONCLUSION: This anatomic study demonstrated the most frequent TD termination was on JSJ and Measurement #1 is able to predict the localization of TD termination.</p>

Pre-procedural ultrasound-guided evaluation of left internal jugular vein and brachiocephalic vein: Experience on infants <1 year

2020 ◽  
pp. 112972982092569
Author(s):  
Filiz Uzumcugil
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Present Report ◽  
Brachiocephalic Vein ◽  
Complication Rates ◽  
Success Rates ◽  
Left Internal Jugular Vein ◽  
Ultrasound Guided ◽  
First Choice ◽  
Plane Technique

Pre-procedural evaluation of central veins prior to cannulation with ultrasound is essential to reduce the complication rates as well as to increase the success rates. The left brachiocephalic vein has been suggested to be considered as first choice in infants including the neonates due to its larger diameter and ease of access with supraclavicular, ultrasound-guided, in-plane technique. There are few studies on neonates and infants comparing the diameter of brachiocephalic vein with internal jugular vein being its most common alternative. The aim of the present report is to share our observations pertaining to the pre-procedural measurements of the diameters of left internal jugular vein and brachiocephalic vein in infants <1 year. The measurements were analysed in accordance with the weights of the infants (<2500 g and ⩾2500 g). In infants <2500 g, the brachiocephalic vein was larger than the internal jugular vein (4.0 ± 0.7 (3.2–5.2) mm vs 3.2 ± 0.7 (1.9– 4.3) mm, p = 0.032), whereas the diameters of two major veins were similar in infants ⩾2500 g (4.8 ± 1.2 (2.3–6.4) mm vs 5.1 ± 0.9 (2.8–6.7) mm, p = 0.363). Our observations support the suggestion of the brachiocephalic vein to be considered as the first choice for large-bore cannulation due to its larger diameter as well as its other advantages, especially in neonates <2500 g.

Sign in / Sign up

Export Citation Format

Share Document