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Surgery of the Shoulder
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Nick Aresti, Omar Haddo, Mark Falworth
The skin incision runs in the deltopectoral groove, from the coracoid to the axillary fold (with the arm adducted and internally rotated). The subcutaneous tissue is reflected with sharp and electrocautery dissection, exposing the deltopectoral interval which is marked by a fatty streak and the cephalic vein. The fascia overlying the interval is divided and the cephalic vein lateralised with the deltoid muscle. The deltoid and pectoralis major are then defined with sharp and electrocautery dissection.
Implantation of Pacemakers and ICDs
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Kushwin Rajamani, Michael P. Brunner, Oussama M. Wazni, Bruce L. Wilkoff
There are variations in the location of the incision line. However, most implanters use the clavicle and deltopectoral groove as landmarks. If the subclavian or axillary vein is used for venous access then an incision line is extended 2–3 cm below the clavicle for a total length of 3–5 cm (dependent on the size of the device), which brings the lateral extension of the incision line just medial to the deltopectoral groove. If the cephalic vein is accessed then the incision extends over the deltopectoral groove.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The cephalic vein is a superficial vein of the upper limb that arises within the anatomical snuffbox. It communicates with the basilic vein by the median cubital vein at the elbow and is located in the superficial fascia along the anterolateral surface of the biceps muscle. At the elbow, it is superficial to the lateral cutaneous nerve of the forearm. Superiorly, the cephalic vein passes between the deltoid and pectoralis major muscles (deltopectoral groove) and through the deltopectoral triangle, where it empties into the axillary vein. As it is a vein, it contains valves.
Contemporary review of management techniques for cephalic arch stenosis in hemodialysis
Published in Renal Failure, 2023
Gift Echefu, Shivangi Shivangi, Ramanath Dukkipati, Jon Schellack, Damodar Kumbala
The Cephalic vein is part of the upper extremity’s superficial venous system. It originates in the anatomical snuffbox from the radial aspect of the superficial venous network of the dorsum of the hand. Coursing along the anterolateral forearm to the elbow, it communicates with the basilic veins via median ante-cubital veins. It then courses along the lateral aspect of the biceps toward the pectoralis major muscle as it enters the deltopectoral groove (a triangular space formed by the adjacent borders of the deltoid and pectoralis major muscles Figure 2). It then passes under the clavicle, turning sharply to pierce the clavipectoral fascia terminating as the axillary vein. The cephalic arch refers to the final arch of the cephalic vein before it drains into the first part of the axillary vein.
Deployment of acute mechanical circulatory support devices via the axillary artery
Published in Expert Review of Cardiovascular Therapy, 2019
Raj Tayal, Colin S. Hirst, Aakash Garg, Navin K. Kapur
We had previously described our technique for percutaneous axillary access with the arm abducted to 90 degrees or greater along the deltopectoral groove in finding the vessel to be more superficial and less angulated in this position. With the arm extended, access was then obtainable either through the true axilla or anterior thoracic wall. Anterior thoracic wall access is most commonly preferred in MCS for patient comfort, mobility and implant stability, and it may be obtained with the arm adducted; however, the access point within the second segment of the vessel remains the same [6]. Abduction of the arm may decrease the tortuosity of the artery and in some instances decrease the depth of the vessel due to the position of soft tissue and the pectoralis minor muscle above it.
Current Evidence for Alternative Access Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2020
J. James Edelman, Chistopher Meduri, Pradeep Yadav, Vinod H. Thourani
More recently, percutaneous access for the TAx approach has been described, but a large series is yet to be published.13 Percutaneous TAx access is achieved using ultrasound and fluoroscopic (with a wire placed into the axillary artery from the groin) guidance. The puncture site is most commonly in the deltopectoral groove. Percutaneous closure devices are used to ‘pre-close’ the artery, as is commonly performed in the femoral approach. Closure is slightly more difficult, as the clavicle prevents direct pressure control of the artery. A percutaneous angioplasty balloon is placed over the subclavian wire (placed originally to guide access) allowing endovascular control if the percutaneous closure devices fail.