Objective With the implementation of the K-DOQI guidelines, more patients are in need of long-term dialysis catheters until maturation of the arteriovenous fistula. However, on occasion, when placing a tunneled cuffed catheter for hemodialysis, we have encountered difficulty with passing the guidewire in spite of demonstration of a patent cervical portion of the internal jugular vein on duplex. Herein, we review our experience with intraoperative venoplasty for placement of Tesio™ catheters (Medcomp Harleysville, PA). Methods Of the 1147 Tesio™ catheters placed since 1997 by our service, 35 venograms were performed due to difficulty encountered with placement of the guidewire. Patent veins were all crossed with the use of angle-guiding catheters, angled glidewires, and a torque vise. If chronically occluded intrathoracic veins were identified, an alternate site was selected for the placement of the Tesio™ catheter. Results Of the 35 cases with difficulty in catheter placement, venogram demonstrated a patent but tortuous vein in 9, chronically occluded intrathoracic veins in 6, and severe stenosis of the intrathoracic veins in 20. In 19 cases with severe stenosis of the intrathoracic veins, balloon angioplasty with an 8-mm balloon was successfully performed, which allowed successful placement of a functional Tesio™ catheter. In the additional one case, the catheter was not able to be placed despite angioplasty. Seven lesions that underwent balloon angioplasty were in the innominate vein, 11 were in the proximal internal jugular vein, and two were in the superior vena cava. Conclusion Venous balloon angioplasty can be used to maintain options for the site of access for tunneled cuffed catheters and may be necessary to assist with placement of long term cuffed dialysis catheters.
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http://dx.doi.org/10.1177/1708538117728866 | DOI Listing |
Eur J Radiol
January 2025
Department of Radiology, Liverpool Heart and Chest NHS Foundation Trust, Thomas Drive, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool, UK. Electronic address:
There is a wide and ever-increasing range of imaging indications for thoracic computed tomography (CT). Identifying and appropriately triaging cardiovascular findings is often challenging, especially in non-gated or unenhanced studies. The authors provide a pictorial review of clinically relevant abnormalities of the main intrathoracic vessels (aorta, superior vena cava, pulmonary arteries and coronary arteries), for radiologists reporting non-gated enhanced or unenhanced CT of the thorax.
View Article and Find Full Text PDFMedicine (Baltimore)
October 2024
Department of General Medicine, People's Hospital of Deyang City, Deyang, Sichuan, China.
Rationale: Intravenous catheter placement in the healthy upper extremity is preferred for chemotherapy in patients with breast cancer. Common venous accesses are peripherally inserted central catheters (PICCs) and totally implantable intravenous port catheters (TIVPs). In this case, a patient with breast cancer had a history of infusion port placement through the left internal jugular vein, with ipsilateral innominate vein stenosis after placement.
View Article and Find Full Text PDFJ Stroke Cerebrovasc Dis
December 2024
Department of Neurosurgery, Kyoto Tanabe Central Hospital, Kyoto, Japan.
Vet Med Sci
July 2024
Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA.
Background: Radiographic assessment of the intrathoracic caudal vena cava (CVC) is commonly used to evaluate hemodynamic status in veterinary patients without and with pulmonary, pericardial, or right-sided cardiac diseases. Many of these patients are now commonly evaluated with computed tomography (CT) in both emergency and referral settings. Traditional radiographic ratios in dogs, particularly the CVC height/aorta height (CVC/Ao) ratio, are often extrapolated to CT in order to determine if the CVC is normal in size.
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