Purpose: To define the three-dimensional anatomy of the left central veins and the implication for left-sided dialysis catheter placement.
Materials And Methods: Images from 30 consecutive patients undergoing computed tomography (CT) pulmonary angiography were reconstructed to depict the central venous anatomy. The reconstructed images were analyzed for parameters that could influence dialysis catheter placement. In particular, the cross-sectional diameters of the left brachiocephalic vein were measured, as well as the angulation between the left internal jugular vein and brachiocephalic vein, the angulation between left brachiocephalic vein and superior vena cava, and the angulation of the left brachiocephalic vein in the axial plane as it crosses the mediastinum.
Results: The cross-sectional diameters of the left brachiocephalic vein did not change significantly as it traversed the mediastinum. The mean cross-sectional diameters were 11 (+/-5.2) x 12 (+/-5.1) mm for the peripheral, 13 (+/-5.0) x 13 (+/-4.8) mm for the mid, and 13 (+/-4.6) x 14 (+/-4.5) mm for the central left brachiocephalic vein. The angulation between the left internal jugular and brachiocephalic vein measured 117 degrees (+/-11), the angulation between the left brachiocephalic vein and the superior vena cava measured 116 degrees (+/-7), and the angulation of the left brachiocephalic vein as it traverses the aorta and left brachiocephalic artery measured 106 degrees (+/-9).
Conclusions: A sharp angulation of the left brachiocephalic vein as it drapes over the aorta or arch vessels is a common anatomic finding. This angulation is not apparent on frontal projection radiographs or venograms. A hemodialysis catheter torqued over this angulation could contact the vessel wall and lead to endothelial irritation. Further study may help define whether this contributes to the higher complication rates associated with left-sided catheters.
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http://dx.doi.org/10.1016/j.jvir.2006.12.721 | DOI Listing |
Cureus
December 2024
Orthopedic Department, King Fahad Medical City, Riyadh, SAU.
Posterior sternoclavicular joint (SCJ) dislocation is a rare but potentially life-threatening injury due to its proximity to critical mediastinal structures. Early diagnosis and prompt management are essential to prevent severe complications such as vascular or respiratory compromise. We report a case of a 23-year-old male who presented to our emergency department five days after a high-energy motor vehicle accident with isolated, closed posterior dislocation of the SCJ.
View Article and Find Full Text PDFFront Cardiovasc Med
December 2024
Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Background: The number of people undergoing maintenance hemodialysis is increasing rapidly worldwide. Central vein stenosis (CVS) is a common vascular complication in undergoing hemodialysis, especially those with a history of catheterization. This study aimed to investigate the characteristics of CVS and the clinical effectiveness of percutaneous transluminal angioplasty (PTA) alone and sequential percutaneous transluminal stenting (PTS) in hemodialysis patients with CVS.
View Article and Find Full Text PDFJ Vasc Access
December 2024
St. Joseph's Regional Medical Center, Paterson, NJ, USA.
Background: The decision to place a subcutaneously tunneled catheter is an infection prevention strategy for long term venous access allowing the proceduralist to access a vein and relocate the catheter exit site to a region on the body where care and maintenance can be safely performed. Subcutaneously tunneled centrally inserted dialysis catheter (ST-CIDC) placement is commonly performed in patients with renal disease and is traditionally performed with fluoroscopy in the interventional radiology suite or the operating theater. However, today's interventional radiologists and surgeons perform advanced invasive procedures that can be time-consuming resulting in delays in the scheduling of elective tunneled catheter placements.
View Article and Find Full Text PDFAnn Pediatr Cardiol
November 2024
Department of Paediatric Cardiac Surgery, N. H. Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India.
The left brachiocephalic vein (LBCV) usually passes superior and anterior to the aortic arch. In rare cases, this vein follows an anomalous course. We present a case of duplicated circumaortic LBCV in a 10-year-old child with Tetralogy of Fallot.
View Article and Find Full Text PDFIndian J Radiol Imaging
January 2025
Department of Radiodiagnosis, Continental Hospitals, Hyderabad, Telangana, India.
Oftentimes, incidental findings are made on routine diagnostic imaging. An intra- and extravascular lipoma is one example of an important incidental finding. Intravascular lipomas are rare benign vascular tumors that are typically asymptomatic.
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