Angiotomographically‐proven Left Innominate Vein Occlusion in Dialysis Patients With Prior Left Internal Jugular Vein Catheterization Presenting With Arm Swelling After Ipsilateral Access Creation: Report of Four Cases

Salgado, O; Chacón, Rosa E.; Mora, Edunice; Mora-LaCruz, Eduardo

doi:10.1111/j.1744-9987.2007.00502.x

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…The crossing of the brachiocephalic vein over the origin of the aortic arch and a reduced space between the aortic arch and sternum were predictors of stenosis (Guo et al, ). Extrinsic compression of the LBV was also demonstrated in hemodialysis patients after angiographic studies of diagnostic AV access (Itkin, Kraus, & Trerotola, ; Salgado, Chacón, Mora, & Mora La Cruz, ; Shi, Cheng, Song, & Zhang, ). Some degree of extrinsic compression was observed in 44% of patients.…”

Section: Discussionmentioning

confidence: 87%

Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients

et al. 2020

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Introduction: Most hemodialysis patients start renal replacement therapy with a central venous catheter (CVC). The left internal jugular vein (LIJV) is the second-choice vein for CVC positioning, after the right IJV. However, to reach the right atrium, the CVC must pass through the left brachiocephalic vein (LBV), which also drains blood from the left arm through the subclavian vein. The purpose of this study is to describe how the anatomy of the central venous system and in particular that of the LBV affects vascular access in hemodialysis patients. Materials and methods: Three-dimensional (3D) virtual model reconstructions of the central thoracic veins of three hemodialysis patients were obtained from contrastenhanced computed tomography scans acquired in the venous phase. The images were exported as DICOM files and loaded on open-source software for visualizing and analyzing the medical imaging (3D Slicer, Windows version 4.8.1). Results: As expected, the 3D reconstructions showed that the LBV has a tortuous path with three main angulations that could be associated with external compression and stenosis. These could determine the difficulties and increased risks of venous injury during CVC placement, and an increased risk of medium to long-term catheterassociated vein thrombosis and stenosis. Conclusions: The anatomical features of the LBV indicate that the path of a CVC from the LIJV to the right atrium is tortuous and can easily be complicated by vein injury, negatively affecting the creation of future arterio-venous vascular accesses in the left arm.

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Section: Discussionmentioning

confidence: 87%

Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients

et al. 2020

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“…Salgado et al [7], in 2007, presented a case series of four symptomatic central vein occlusions occurring only after ipsilateral dialysis access had been formed. This small series again demonstrates the presence of pre-existing but asymptomatic central vein obstruction that only becomes clinically apparent when AV access is created and the circuit is placed under pressure.…”

Section: Search Outcomementioning

confidence: 99%

Is it safe to divide and ligate the left innominate vein in complex cardiothoracic surgeries?

McPhee

Shaikhrezai

Berg

2013

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is safe to divide the left innominate vein (LIV) in aortic arch surgery to improve access. Altogether, 228 relevant papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Following LIV division, the venous drainage takes place via multiple collateral systems such as the azygous/hemiazygous, the internal mammary veins, the lateral thoracic and superficial thoracoabdominal veins, vertebral venous plexus as well as the transverse sinus. The possible complications are mainly left upper limb swelling and neurological symptoms. In one case series of 14 patients, the LIV was divided and ligated to facilitate the exposure for aortic arch surgery. More than 2-year follow-up did not reveal upper limb oedema or neurological symptoms. In two cohorts of 52 patients, the LIV was ligated prior to the superior vena cava (SVC) resection for malignancy. During the mid-term follow-up, no neurological or upper limb symptoms were reported. Although in two studies with 72 and 70 patients undergoing SVC resection it was not specified how many of them had LIV ligation, no relevant complications were reported. In a report, LIV occlusion was observed in 4 patients undergoing left internal jagular vein catheterization for haemodialysis. The reported symptom was left arm swelling with no neurological problems. In a cohort of 18 patients undergoing SVC resection for malignancy and major vein reconstruction, 7 patients underwent ligation of the LIV with no neurological symptoms. It was also concluded that reconstruction of the LIV is not consistent with favourable patency. In a case series of 10 patients with central venous obstruction, collateral pathways to conduct efficient venous drainage were mapped. We conclude that division of the LIV is safe in selected patients and operations. Patients will initially have symptoms of central vein obstruction, but these will decrease with conservative management as collaterals form.

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“…The preferred insertion site is the right internal jugular vein (IJV) mainly because in a great majority of cases it does not interfere with ulterior AV access creation on the ipsilateral upper extremity [4]. On the contrary, catheterization of the left IJV is not equally safe as the right one and is associated with left innominate vein stenosis or thrombosis [2,5]. Femoral veins are safer vein accesses in emergency settings particularly in patients with high risk of bleeding [6].…”

Section: Insertion Sitesmentioning

confidence: 99%

Vascular Access for Hemodialysis - Overview and Emphasis on Complications

Salgado¹

2013

Hemodialysis

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Angiotomographically‐proven Left Innominate Vein Occlusion in Dialysis Patients With Prior Left Internal Jugular Vein Catheterization Presenting With Arm Swelling After Ipsilateral Access Creation: Report of Four Cases

Cited by 4 publications

References 14 publications

Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients

Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients

Is it safe to divide and ligate the left innominate vein in complex cardiothoracic surgeries?

Vascular Access for Hemodialysis - Overview and Emphasis on Complications

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