A new percutaneous technique for establishing venous bypass access in orthotopic liver transplantation

Oken, Andrew; Frank, Steven M.; Merritt, William T.; Fair, Jeff; Klein, Andrew S.; Burdick, James F.; Thompson, Sharon; Beattie, Charles

doi:10.1016/1053-0770(94)90013-2

Cited by 26 publications

(13 citation statements)

References 4 publications

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“…Traditionally, a venous return cannula was inserted into the axillary vein with surgical cut‐down, which carried a high incidence of complications,4 such as seromas or lymphoceles,5, 6 wound infection, and nerve injuries 7. A percutaneous technique, first introduced in 1994,8 has been shown to reduce complications related to the surgical cut‐down,9, 10 maintain adequate shunt flow and stable hemodynamics,9, 11 and has become an established alternative method for cannula placement in VVB.…”

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confidence: 99%

Complications associated with percutaneous placement of venous return cannula for venovenous bypass in adult orthotopic liver transplantation

et al. 2007

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Percutaneous large bore cannula placement during orthotopic liver transplantation (OLT) for use in venovenous bypass (VVB) has been reported to be a rapid and simple technique. It is, however, a technique that carries its own risks. The aim of the study was to investigate the incidence of complications related to the placement of a percutaneous venous return cannula and subsequent VVB in OLT. A retrospective review of 360 consecutive adult OLT patients during a period of 18 months (January 1, 2003 to June 30, 2004) was performed. The percutaneous venous cannula (18 Fr) was placed by an attending transplant anesthesiologist. The cannulation was attempted in 326 patients (90.6%). No cannulation was attempted on the subclavian veins. Internal jugular venous cannula placement was attempted but aborted in 6 patients (1.8%) due to technical difficulties. In 320 patients who received an internal jugular venous cannula, 313 (97.8%) underwent OLT without complication. The remaining 7 patients (2.2%) had complications. The operation was delayed for 1 patient due to suspected hemomediastinum. The other 6 complications were related to VVB: air embolism (2 patients), low flow rate (2 patients), hypotension (1 patient), and atrial fibrillation (1 patient). Successful OLT was eventually carried out in all the 7 patients and no mortality associated with internal jugular venous cannula placement or VVB was noted. In conclusion, percutaneous placement of a large bore venous return cannula for VVB during adult OLT can be performed with acceptable risk using a flexible 18-Fr cannula via the right internal jugular vein (IJV) by experienced attending transplant anesthesiologists. Liver Transpl 13: 961-965, 2007.

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confidence: 99%

Complications associated with percutaneous placement of venous return cannula for venovenous bypass in adult orthotopic liver transplantation

et al. 2007

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“…The latter has several options for placement, including the right internal jugular vein, the left internal jugular vein, the subclavian vein, or a combination of neck vessels and the antecubital vein (6). The latter has several options for placement, including the right internal jugular vein, the left internal jugular vein, the subclavian vein, or a combination of neck vessels and the antecubital vein (6).…”

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confidence: 99%

Insertion and management of percutaneous veno‐venous bypass cannula for liver transplantation: a reference for transplant anesthesiologists

Sakai

Gligor²,

Diulus³

et al. 2009

Clinical Transplantation

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Surgical advances using the retrohepatic caval preservation technique in liver transplantation (LT) has significantly decreased the need for veno-venous bypass (VVB). However, VVB still remains a viable adjunct of LT. The venous return cannula has traditionally been inserted using a cut-down technique via the axillary vein, but this technique carries significant risks for lymphorrhea, infection, or nerve damage. Since 2001, our institution has routinely used VVB in adult LT surgery. Percutaneous insertion of an internal jugular venous return cannula is performed by the attending anesthesiologist. The aim of this report is to describe the method of insertion and management of a percutaneous veno-venous return cannula in the internal jugular vein during LT. In-depth detail as well as video clips will provide a reference for LT centers wishing to apply this method in their practice.

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“…The antecubital vein in an adult is 18 mm in diameter, and can expand to 33 mm with maneuvers to increase venous stasis in the arm [17]. The antecubital vein has been reported as a return site for partial veno-venous bypass during liver transplantation, accommodating venous return flow up to 2,400 ml/minute via an 8.5 Fr introducer sheath [18]. …”

Section: The Antecubital Veinmentioning

confidence: 99%

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2006

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Obtaining or maintaining vascular access for continuous hemofiltration can sometimes be problematic, especially in the child or adult in multiple organ failure with edema and/or coagulopathy. Problems commonly encountered include obstruction of the femoral vein by the catheter, insertion difficulties, safety concerns when cannulating the subclavian vein in coagulopathy, and catheter and circuit occlusion due to disseminated intravascular coagulation. For access in infants we describe a technique utilizing two single-lumen thin-walled vascular sheaths. For infants and small children initial access to the vein may be difficult due to edema or poor perfusion. For this situation we describe the 'miniintroducer' technique of securing the vein and facilitating subsequent insertion of a relatively large guide wire. At any age an alternative route to the subclavian vein, from above the clavicle, is potentially 'compressible' in the event of hemorrhage during the procedure. We remind the reader of the utility of ultrasound guidance for cannulation of the internal jugular and subclavian veins. And lastly we review the options for venous return via the umbilical vein in infants, and via the antecubital vein in larger children and adults.

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A new percutaneous technique for establishing venous bypass access in orthotopic liver transplantation

Cited by 26 publications

References 4 publications

Complications associated with percutaneous placement of venous return cannula for venovenous bypass in adult orthotopic liver transplantation

Complications associated with percutaneous placement of venous return cannula for venovenous bypass in adult orthotopic liver transplantation

Insertion and management of percutaneous veno‐venous bypass cannula for liver transplantation: a reference for transplant anesthesiologists

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