scholarly journals Anatomical variations of the phrenic nerve: an actualized review

2015 ◽  
Vol 32 (01) ◽  
pp. 053-056 ◽  
Author(s):  
A. Prates Júnior ◽  
L. Vasques ◽  
L. Bordoni
Keyword(s):  
Subclavian Artery ◽  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Internal Thoracic Artery ◽  
Anatomical Variations ◽  
Surgical Anatomy ◽  
Diaphragm Muscle ◽  
Normal Anatomy ◽  
The Subject ◽  
Superior Portion

Abstract Introduction: The phrenic nerve normally arises from ventral rami of C3, C4 and C5. It emerges laterally to the superior portion oflateral border of scalenus anterior muscle and presents a descendent course between subclavian artery and vein. It crosses anterior to internal thoracic artery and descends through the mediastinum, until the diaphragm muscle, to supply it with motor and sensitive fibers. Matherials and Methods: A bibliographic review was conducted, based on anatomy, neuroanatomy and surgical anatomy textbooks, published in Brazil and abroad, as well as a review of scientific articles, published over the last 20 years, available on research databases PubMed, Scielo, LILACS and MEDLINE, from keywords phrenic nerve, variation and anomaly. Results: Variations of the phrenic nerve are frequent, but they are not often discussed. Thus, we aimed to conduct an actualized review over the subject. Regarding the variations in the origin of the phrenic nerve, textbooks vaguely inform that it is mainly formed by C4, but the recent cadaveric studies pointed the segments C4 and C5 as the most common origin. About the variations in its course, the most described is its passage anterior to the subclavian vein, before reaching the thorax. However, the presence of accessory phrenic nerve represents the greatestvariation, mostly arising from nerve to subclavian. There are few reports in literature about the complications associated to these variations, but some are suggested, as the possibility of causing its damage during the puncture of the subclavian vein, when the nerve descends anterior to it, which may lead to a hemidiaphragmatic paresis. When variations are present, even simple procedures may cause injuries. Conclusion: Therefore it is fundamental to know the normal anatomy and the possible variations of the phrenic nerve, in order to perform safe procedures in its topography, as well as to enable a timely recognition of complications.

scholarly journals Incidence of Accessory Phrenic Nerve and its Clinical Significance: A Cadaveric Study

2008 ◽  
Vol 51 (3) ◽  
pp. 181-184 ◽  
Author(s):  
Soubhagya R. Nayak ◽  
Ashwin Krishnamurthy ◽  
Latha V. Prabhu ◽  
Lakshmi Ramanathan ◽  
Mangala M. Pai ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Indian Population ◽  
Internal Thoracic Artery ◽  
Gross Anatomy ◽  
Neck Surgery ◽  
Cervical Region ◽  
Thoracic Region ◽  
Formalin Fixed

The description of accessory phrenic nerve (APN) in the standard textbooks and available literature is vague and sometimes limited to few lines. The incidence of APN varies a great deal from 17.6 % to 80.9 % in the available literature. The aim of the present study was to calculate the incidence and variation of APN in Indian population. Material and methods: Forty five adult formalin-fixed cadavers (35 male, 10 female; 90 sides) used for gross anatomy dissection for undergraduates; during the 2 year period 2006–2007 were considered. Findings were recorded at different stages of the dissection. Results: Out of 90 body sides studied, the APN was present in 48 sides (53.3 %). In 17 of the above sides the APN was confined to the cervical region (Cervical type) and in 31 sides the APN entered the thorax (Thoracic type), all anterior to the subclavian vein (SV). In eleven specimens the APN was found bilaterally. Conclusion: The incidence of APN, with its course and relation to the various structures in cervical and thoracic region will help the surgeons while performing internal thoracic artery (ITA) grafting and other radical neck surgery.

In-situ left-sided bilateral internal thoracic artery: elevated hemidiaphragm

2018 ◽  
Vol 26 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Oren Lev-Ran ◽  
Dan Abrahamov ◽  
Nina Baram ◽  
Menachem Matsa ◽  
Yaron Ishai ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Phrenic Nerve ◽  
Internal Thoracic Artery ◽  
Statistical Significance ◽  
Anatomical Variations ◽  
Transverse Sinus ◽  
Phrenic Nerve Injury ◽  
Right Internal Thoracic Artery ◽  
Bilateral Internal Thoracic Artery

Background Procurement of the internal thoracic artery risks ipsilateral phrenic nerve injury and elevated hemidiaphragm. Anatomical variations increase the risk on the right side. Patients receiving left-sided in-situ right internal thoracic artery configurations appear to be at greatest risk. Methods From 2014 to 2016, 432 patients undergoing left-sided in-situ bilateral internal thoracic artery grafting were grouped according to right internal thoracic artery configuration: retroaortic via transverse sinus (77%) or ante-aortic (23%); targets were the circumflex and left anterior descending artery territories, respectively. Elevated hemidiaphragm was assessed by serial chest radiographs and categorized by side, complete (≥2 intercostal spaces) versus partial, and permanent versus transient. Results Right elevated hemidiaphragm occurred in 4.2% of patients. The incidence of radiological complete right elevated hemidiaphragm was 2.8% (12/432); 8 cases were transient with recovery in 3.5 ± 0.3 weeks. Permanent right elevated hemidiaphragm occurred in 0.9% (retroaortic group only). Permanent left elevated hemidiaphragm occurred in 0.9% and was significantly higher in the ante-aortic group (3/99 vs. 1/333, p = 0.039). No bilateral hemidiaphragm elevation was documented. Partial right elevated hemidiaphragm occurred in 1.4% and was not associated with adverse early or late respiratory outcomes. Conclusions Despite susceptible right phrenic nerve-internal thoracic artery anatomy, the incidence of permanent right elevated hemidiaphragm is low and no higher than left-sided in prone bilateral internal thoracic artery subsets. This reflects skeletonized internal thoracic artery procurement. Although statistical significance was not achieved, a retroaortic right internal thoracic artery configuration may constitute a higher risk of right phrenic nerve injury.

Anatomical Variations of the Left Subclavian Artery and Their Significance in Clinical Practice

2020 ◽  
Vol 30 (1) ◽  
pp. 3-12
Author(s):  
Anna Botou ◽  
Eleni Panagouli ◽  
Maria Piagkou ◽  
Paschalis Strantzias ◽  
Stavros Angelis ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Anatomical Variations

Carotid-Axillary Bypass as an Alternative to Carotid-Subclavian Bypass Following Coverage of Left Subclavian Artery During TEVAR

2020 ◽  
pp. 153857442098365
Author(s):  
Michael H. Parker ◽  
Dayle K. Colpitts ◽  
Genevieve F. Gilson ◽  
Liam Ryan ◽  
Dipankar Mukherjee
Keyword(s):  
Subclavian Artery ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Left Subclavian Artery ◽  
Vascular Complications ◽  
Complication Rates ◽  
Nerve Injuries ◽  
Phrenic Nerve Palsy ◽  
Safe Alternative ◽  
Landing Zone

Introduction: Thoracic Endovascular Aortic Repair (TEVAR) has become the procedure of choice for pathology involving the descending thoracic aorta since its approval by the FDA in 2005. Left subclavian artery (LSA) coverage is commonly required to facilitate an adequate proximal landing zone for the endograft. The traditional revascularization procedure of choice is carotid-subclavian bypass, however recent studies report complication rates as high as 29%—specifically phrenic nerve palsy in 25% of patients undergoing this procedure. Our aim is to present our experience using carotid-axillary bypass as a safe alternative to carotid-subclavian bypass. Methods: All patients undergoing carotid-axillary bypass for TEVAR with LSA coverage between June 2016 and September 2019 at a tertiary medical center were retrospectively identified. Short-term and long-term complications were identified and analyzed including: phrenic nerve, recurrent laryngeal nerve, and axillary nerve injuries, as well as local vascular complications requiring re-intervention. All perioperative chest radiographs were reviewed for new hemidiaphragm elevation to assess for phrenic nerve injuries. Results: 35 patients underwent carotid-axillary bypass in conjunction with TEVAR during this time period. The majority of bypasses were performed concurrently with TEVAR (80.0%, 28/35) utilizing GORE PROPATEN 8 mm externally supported vascular graft (91.4%, 32/35). The complication rate specific to carotid-axillary bypass was 14.3% (5/35). We observed a significantly lower (0%, 0/35, P < 0.01) rate of phrenic nerve palsy for carotid-axillary bypass compared to the previously reported 25% (27/107) for carotid-subclavian bypass. For patients with available follow-up imaging (85.7%, 30/35), there was a 100% patency rate at time intervals ranging from 0-1066 days (IQR = 3-37.8). Conclusion: Carotid-axillary bypass can be performed as a safe alternative to carotid-subclavian bypass for LSA coverage during TEVAR involving a more superficial anatomic course of dissection. Phrenic nerve palsy, a well-described complication of the traditional carotid-subclavian bypass, was not observed in this retrospective series.

Phrenic nerve palsy: a rare complication of indwelling subclavian vein catheter

2000 ◽  
Vol 14 (3) ◽  
pp. 203-204 ◽  
Author(s):  
S. Aggarwal ◽  
P. Hari ◽  
A. Bagga ◽  
S.N. Mehta
Keyword(s):  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Nerve Palsy ◽  
Rare Complication ◽  
Phrenic Nerve Palsy ◽  
Vein Catheter

Differential actions of brevetoxin on phrenic nerve and diaphragm muscle in the rat

Toxicon ◽  
1993 ◽  
Vol 31 (4) ◽  
pp. 459-470 ◽  
Author(s):  
Sharad S. Deshpande ◽  
Michael Adler ◽  
Robert E. Sheridan
Keyword(s):  
Phrenic Nerve ◽  
Diaphragm Muscle

scholarly journals CADAVERIC ANATOMY AND RELATIONSHIP OF PHRENIC NERVE AND SUBCLAVIAN VEIN

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Dr. Sandeep Madaan ◽  
Dr. Lavlesh Mittal
Keyword(s):  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Theoretical Data ◽  
Anterior Wall ◽  
Medical Sciences ◽  
Phrenic Nerve Palsy ◽  
Vein Wall ◽  
Clinical Interest ◽  
Relationship Of ◽  
Vein Catheterization

INTRODUCTION: Deep knowledge of anatomy is an essential part of surgical practice. Students of medical sciences gain knowledge and theoretical data through actual visualization of anatomic structures of the cadavers also anatomic relations can be studied more efficiently by practicing on cadavers. As phrenic nerve may be damaged during subclavian vein catheterization the relationship between the phrenic nerve and the subclavian vein is of clinical interest. During the subclavian vein catheterization analogous variable relationships are helpful to explain and prevent damage to the phrenic nerve. MATERIAL AND METHODS: Dissection was started from the root of the neck. No surgical scars, gross anatomical and morphological abnormalities was noted on the cadaver. Measurements were taken during the anatomical dissections.  RESULTS: Of the 36 cadavers dissected in 34 (94.44%) cases phrenic nerve was found posterior to the subclavian vein and in 2(5.56%) cases found anterior to the subclavian vein of which one case was male and the other was female. In the male case in which phrenic nerve was passing anterior to the subclavian vein, it was adherent to the anterior wall of the subclavian vein and was nor piercing the vein wall. CONCLUSION: The cannulating needle may damage the phrenic nerve which is adherent to the subclavian vein. So, the puncture site should be more laterally at the outermost portion of the subclavian vein. Anatomical variants during invasive practical procedures should be always kept in mind. KEYWORDS: phrenic nerve, subclavian vein, phrenic nerve palsy, catheterization.

Visualization of the diaphragm muscle with ultrasound improves diagnostic accuracy of phrenic nerve conduction studies

2014 ◽  
Vol 49 (5) ◽  
pp. 669-675 ◽  
Author(s):  
Nicholas E. Johnson ◽  
Michael Utz ◽  
Erica Patrick ◽  
Nicole Rheinwald ◽  
Marlene Downs ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Phrenic Nerve ◽  
Nerve Conduction ◽  
Nerve Conduction Studies ◽  
Diaphragm Muscle

scholarly journals Diaphragm neuromuscular transmission failure in aged rats

2019 ◽  
Vol 122 (1) ◽  
pp. 93-104 ◽  
Author(s):  
Matthew J. Fogarty ◽  
Maria A. Gonzalez Porras ◽  
Carlos B. Mantilla ◽  
Gary C. Sieck
Keyword(s):  
Nerve Stimulation ◽  
Phrenic Nerve ◽  
Neuromuscular Transmission ◽  
Motor Units ◽  
Diaphragm Muscle ◽  
Muscle Stimulation ◽  
Transmission Failure ◽  
Old Rats ◽  
Motor Neuron Loss ◽  
Fast Twitch

In aging Fischer 344 rats, phrenic motor neuron loss, neuromuscular junction abnormalities, and diaphragm muscle (DIAm) sarcopenia are present by 24 mo of age, with larger fast-twitch fatigue-intermediate (type FInt) and fast-twitch fatigable (type FF) motor units particularly vulnerable. We hypothesize that in old rats, DIAm neuromuscular transmission deficits are specific to type FInt and/or FF units. In phrenic nerve/DIAm preparations from rats at 6 and 24 mo of age, the phrenic nerve was supramaximally stimulated at 10, 40, or 75 Hz. Every 15 s, the DIAm was directly stimulated, and the difference in forces evoked by nerve and muscle stimulation was used to estimate neuromuscular transmission failure. Neuromuscular transmission failure in the DIAm was observed at each stimulation frequency. In the initial stimulus trains, the forces evoked by phrenic nerve stimulation at 40 and 75 Hz were significantly less than those evoked by direct muscle stimulation, and this difference was markedly greater in 24-mo-old rats. During repetitive nerve stimulation, neuromuscular transmission failure at 40 and 75 Hz worsened to a greater extent in 24-mo-old rats compared with younger animals. Because type IIx and/or IIb DIAm fibers (type FInt and/or FF motor units) display greater susceptibility to neuromuscular transmission failure at higher frequencies of stimulation, these data suggest that the age-related loss of larger phrenic motor neurons impacts nerve conduction to muscle at higher frequencies and may contribute to DIAm sarcopenia in old rats. NEW & NOTEWORTHY Diaphragm muscle (DIAm) sarcopenia, phrenic motor neuron loss, and perturbations of neuromuscular junctions (NMJs) are well described in aged rodents and selectively affect FInt and FF motor units. Less attention has been paid to the motor unit-specific aspects of nerve-muscle conduction. In old rats, increased neuromuscular transmission failure occurred at stimulation frequencies where FInt and FF motor units exhibit conduction failures, along with decreased apposition of pre- and postsynaptic domains of DIAm NMJs of these units.

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