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Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Venous TOS entails compression of the subclavian vein, thereby restricting blood flow returning from the arm. This causes arm swelling, cyanosis, and enlarged arm veins. The enlarged veins, which can be visualized thermographically, may not drain normally when the arm is raised.
Invasive hemodynamic monitoring in obstetrics
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Luis D. Pacheco, Shannon Clark, Gary D. V. Hankins
The subclavian vein lies just beneath the clavicle. Exposure of the vein may be improved by placing a small rolled towel between the shoulder blades. The right side is also preferred since the right lung apex is lower than the left, diminishing the chances of a pneumothorax when this side is chosen. Also injuries to the thoracic duct may happen (albeit infrequently) when attempting to access the left subclavian vein.
Vascular Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Yiu-Che Chan, John Wang, Julian Wong, Edward Choke, Tjun Tang
How would you confirm the diagnosis?A Duplex ultrasound scan has high accuracy in diagnosing thrombosis of axillo-subclavian vein.This is performed with the arm in a neutral position. These are the features:Lack of compressibility and absence of flow in thrombosed veins.In the early stages, a fresh thrombus will be echolucent whereas in older lesions, a chronic clot will be more fibrotic and echogenic.Prominent collateral venous pathways may be presentPotential disadvantages include inadequate visualisation of the central portions of the subclavian and innominate veins and difficulty in differentiating a central vein from a large collateral.
A simple method of axillary venipuncture using single landmark for pacemaker leads implantation
Published in Acta Cardiologica, 2023
Peng Zhao, Ying Wang, Shan Zeng
We are proposing a simple and operational method of axillary venipuncture with a high success rate. Considering that subclavian vein is located beneath the medial third of clavicle and anatomical adjacent relationship between axillary vein and the connecting point of medial and middle third of clavicle is relatively fixed, our approach of axillary venipuncture uses this point as the sole landmark. Deflecting lateral 45° and inserting the needle 30–45° angle relative to skin can ensure that extra-thoracic portion of the vessel is punctured and minimise the risk of pneumothorax associated with a deep puncture that passes through intercostal space. Clavicle anatomy is unaffected by body type, which makes locating process simple and time-saving. Furthermore, the most common techniques describing axillary venipuncture require a skin incision or pacemaker pocket made prior to vein puncture [7,12]. Once the puncture fails, additional surgical wounds have been caused. Conversely, our approach can avoid unnecessary surgical cutting by making skin incision after successful puncture.
Experience with implantation of Select Secure® leads in paediatric patients
Published in Acta Cardiologica, 2023
Mehmet Küçük, Sevket Balli, Huseyin Karadag
In their prospective randomised study, Liu et al. compared the subclavian vein technique versus axillary vein technique and showed that the rate of periprocedural and midterm complications was higher in the subclavian vein group. They reported subclavian crush syndrome in two patients and a pneumothorax in three patients in the subclavian vein group, compared to none in the axillary vein group [19]. Also, De Filippo et al. preferred the axillary vein approach in their study to avoid the lead to pass under the clavicle. In their study, the axillary approach with the Select Secure lead was shown to be feasible and safe in a paediatric population with no complications during implantation and no lead damage during follow-up [8]. The mean follow-up duration in these studies was 24.1 ± 7.4 and 72 ± 34.8 months, respectively. We used the previously described subclavian technique in all of our patients [20]. In a follow-up duration of median 47 months, we did not encounter any lead crush in our patients, as well. We thought that larger series and longer follow-up periods are necessary to make a conclusion regarding the optimal puncture site in this subgroup of patients.
Paget-Schroetter Syndrome: a case report of diagnosis, treatment, and outcome in a healthy 18-year-old athletic swimmer
Published in The Physician and Sportsmedicine, 2020
Almaan El-Attrache, Eric Kephart
Because of the patient’s persistent symptoms, mainly mild right upper extremity nonpitting edema, 9 days later, it was recommended she undergo thoracic outlet decompression via elective first rib resection and further surgical exploration to evaluate for compression and venous stenosis. Intraoperatively, after first rib resection, the subclavian vein was exposed after further dissection and discovered to be surrounded by dense scar tissue, attaching it to the first rib, clavicle and subclavius muscle. This discovery prompted successful venolysis that further relieved the extrinsic venous compression. Furthermore, after successful venolysis, intraoperative venography revealed greater than 90% residual intrinsic venous stenosis, prompting successful venoplasty that restored vein patency and flow. Importantly, no visible anomalies were identified intraoperatively. Postoperatively, anticoagulation with rivaroxaban was continued for approximately 4 months. Approximately 4 months from initial diagnosis, repeat ultrasound was negative for recurrent thrombosis, and the patient was found to be continually asymptomatic after thrombolysis and subsequent thoracic outlet decompression.