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Complications of hemodialysis access
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Mia Miller, Prakash Jayanthi, William Oppat
Stenting is an attractive option for this disease, but caution must be maintained. The KDOQI recommends it in the setting of failed or recurrent CVS with angioplasty.67 In Figures 29.7 and 29.8, we illustrate a brachiocephalic vein stenosis treated with angioplasty and stenting. It is inadvisable to stent the thoracic outlet, where it will be exposed to the compressive forces of the clavicle and first rib and may result in extrinsic compression and stent fracture.35,67 Stent grafts have shown improved outcomes over bare metal stents, with improved primary and assisted patency rates. This may allow for immediate salvage for accesses in difficult cases.66 A covered stent may unintentionally occlude important collaterals of other central veins, posing complications for the future.67 Post-procedural monitoring should also consider the possibility of edge stent stenosis. In the setting of pacers, it may be easier to place a contralateral access, due to the refractory nature of stenotic lesions from pacer wires.67 However, if relocating the wires is not deemed possible, the pacer wires should be removed and the pacer moved to a different site, to allow for intraluminal stenting without crushing of the wire. Angioplasty alone is possible but has the added risk of injury to the wires.
Venous Anatomy
Published in James Michael Forsyth, Ahmed Shalan, Andrew Thompson, Venous Access Made Easy, 2019
James Michael Forsyth, Ahmed Shalan, Andrew Thompson
The axillary vein continues behind the clavicle as the subclavian vein. It is joined by the jugular veins and curves down behind the sternum to become the brachiocephalic vein. Both brachiocephalic veins join up to form the superior vena cava, which then enters into the right atrium of the heart. Of note, the cavo-atrial junction (which is where PICC line tips are ideally placed) corresponds to the level of the third/fourth intercostal space (Figure 2.2).
Anterior mediastinal lesions
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Antonio D’andrilli, Erino Angelo Rendina, Federico Venuta
The right brachiocephalic vein is occluded distally and the SVC proximally, and both veins are divided on the tumor side. Thus, the thymus, including the tumor, is completely removed. The SVC is reconstructed in the same manner as the left brachiocephalic vein using a ringed Gore-Tex 10.0 mm graft. Some surgeons believe that one brachiocephalic vein is adequate to return blood from the upper half of the body to the heart. Reconstruction of the right brachiocephalic vein can be abandoned without major complications, except for transient swelling in the right upper extremity. In this instance, effort should be made to leave the azygos vein intact. (See Figure 9.4.)
Mediastinal lymphadenopathy: a practical approach
Published in Expert Review of Respiratory Medicine, 2021
Hariharan Iyer, Abhishek Anand, PB Sryma, Kartik Gupta, Priyanka Naranje, Nishikant Damle, Saurabh Mittal, Neha Kawatra Madan, Anant Mohan, Vijay Hadda, Pawan Tiwari, Randeep Guleria, Karan Madan
The International Thymic Malignancy Interest group (ITMIG) classification divides the mediastinum into three compartments viz. prevascular, visceral, and paravertebral. The prevascular space has the same boundaries as the anterior part of inferior mediastinum, but it extends superiorly to the thoracic outlet level. It consists of the thymus, left brachiocephalic vein and lymph nodes. The visceral compartment is behind the anterior fibrous pericardium. It extends posteriorly till an imaginary plane passing from each thoracic vertebra at a point 1 cm behind the anterior border of the central body of the vertebra. It contains heart, ascending aorta, arch of the aorta and descending aorta, superior vena cava, pulmonary arteries, trachea, esophagus, thoracic duct and lymph nodes. Posterior to this imaginary vertical plane lies the paravertebral compartment. This compartment contains the thoracic spine and paravertebral soft tissue [6]. The intra-thoracic lymph nodes are distributed in all of these compartments (Figure 1A).
Behçet’s disease; A rare refractory patient with vena cava superior syndrome treated with infliximab: a case report and review of the literature
Published in Acta Clinica Belgica, 2019
Oguz Abdullah Uyaroglu, Abdulsamet Erden, Levent Kilic, Bora Peynircioğlu, Omer Karadag, Umut Kalyoncu
In our case, the patient had thrombus in inferior vena cava and iliac veins and he was currently using warfarin when he was admitted to us. We detected bilateral internal iliac artery aneurysms and thrombus in vena cava inferior that extends to common iliac veins and external iliac veins, simultaneously. In this time, we decided to implant bilateral stent-graft to the iliac aneurysms. Patient was anticoagulated with warfarin and a shunt was implanted between left brachiocephalic vein and right atrium. We continued therapy with warfarin. After the IFX therapy, we have not detected any thrombus or occlusion again. However, we do not know whether this is due to anticoagulation or infliximab therapy. It is believed that venous disease in BD results from endothelial inflammation [24]. Therefore, to control systemic inflammation is very important. Seyahi et al. reports their approach is to not anticoagulate BD patients with venous thrombosis, instead treating these patients with immunosuppressive agents alone. Therewithal treatment of thrombosis in BD differs between clinics [1].
Double superior vena cava: presentation of two cases and review of the literature
Published in Acta Chirurgica Belgica, 2019
Christos Farazi-Chongouki, Ioannis Dalianoudis, Anestis Ninos, Pantelis Diamantopoulos, Dimitrios Filippou, Stefanos Pierrakakis, Panagiotis Skandalakis
The right anterior and common cardinal veins normally give rise to the SVC. An anastomosis that forms between the right and left anterior cardinal veins become the left innominate (brachiocephalic) vein. The anterior cardinal veins regresses except for a small terminal portion that persist as superior intercostals veins (Figure 8) [6]. When the left anterior cardinal vein regresses, a ligament remains that joins the left superior intercostals vein with the coronary sinus. It is called the ligament of left SVC or Marshall’s ligament (Figure 9). If the left innominate vein fails to develop, the left anterior cardinal vein persists and continues to drain the left brachiocephalic veins. In this situation, it becomes the left SVC. The persistent SVC usually drains into the sinus venosus, which ultimately becomes the coronary sinus [7].