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Subclavian Vein (subclavian + vein)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Opening an Occluded Subclavian Vein with a Screw-Like Flexible Hollow Guide-wire and Venoplasty

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2007
SETH JOSEPH WORLEY M.D.
Patients with existing internal cardioverter defibrillators (ICDs) often require upgrading to a biventricular ICD for treatment of congestive heart failure (CHF). Placement of a left ventricular (LV) lead can be technically challenging in the best of circumstances. A subclavian vein stenosis or occlusion related to previously placed leads adds a major obstacle to a successful implant. We report a technique of implanting an LV lead from the same side as the existing ICD system despite complete occlusion of the subclavian vein. [source]

Laser Recanalization of the Subclavian Vein

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2006
CHARLES A. HENRIKSON
We report the use of a long wire and introducer as a rail for the laser recanalization of a chronically occluded subclavian vein following extraction of a fractured permanent pacing lead. This allowed new pacing leads to be placed through the previously occluded vessel. [source]

Impact of a regional anesthesia rotation on ultrasonographic identification of anatomic structures by anesthesiology residents

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009
S. L. OREBAUGH
Objective: The specific aim of this study was to determine the ability of anesthesiology residents to independently identify a series of anatomic structures in a live model using ultrasound, both before and after a 4-week regional anesthesia rotation that incorporates a standardized ultrasound training curriculum for peripheral nerve blockade. Methods: Ten CA2 and CA3 anesthesiology residents volunteered to participate in this study. Each resident was subjected to a pre-rotation practical exam, in which he attempted to identify 15 structures at four sites of peripheral nerve blockade, in a test subject. Each resident then received specific training for ultrasound-guided nerve blocks during a 4-week regional anesthesia rotation, and then completed a post-rotation exam. The mean number of structures correctly identified on the exams was compared for significant differences utilizing a paired t -test. Results: Residents were able to identify significantly more anatomic structures on the post-rotation exam as compared with the pre-rotation exam (mean 14.1 vs. 9.9, P<.001), as well as more peripheral nerve targets. The most frequently misidentified structures on the pre-rotation exam were the subclavian vein, the sciatic nerve in the popliteal fossa, and the femur. Conclusions: Ultrasound-naïve anesthesiology residents, who received instruction and experience with ultrasound-guided peripheral nerve blocks on a 4-week regional anesthesia rotation, significantly improved their ability to independently identify relevant anatomic structures with ultrasonography. [source]

Importance of downward bevel direction during central venous cannulation through subclavian vein

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2006
M. Gurjar
No abstract is available for this article. [source]

Severe Venous and Lymphatic Obstruction after Single-Chamber Pacemaker Implantation in a Patient with Chest Radiation Therapy

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2010
JOSHUA M. DIAMOND M.D.
A 73 - year - old woman with a history of paroxysmal atrial fibrillation, sinus node dysfunction, bilateral breast cancer, and extensive chest radiation developed progressive edema, dyspnea, and recurrent pleural effusions soon after single - chamber pacemaker implantation. Thoracentesis yielded a diagnosis of chylothorax, and progressive refractory anasarca developed. A computed tomography angiogram suggested obstruction of the superior vena cava and left subclavian vein despite outpatient therapeutic anticoagulation. Autopsy confirmed venous thrombosis, along with mediastinal fibrosis. The presumed etiology of the chylothorax and anasarca was obstruction of the atretic central venous structures following pacemaker implantation, critically impairing the already tenuous venous and lymphatic drainage. (PACE 2010; 520,524) [source]

Opening an Occluded Subclavian Vein with a Screw-Like Flexible Hollow Guide-wire and Venoplasty

Noncatheter-Based Delivery of a Single-Chamber Lumenless Pacing Lead in Small Children

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2007
DAMIEN KENNY M.B.Ch.B., M.R.C.P.C.H.
Objectives:The model 3830 lead (SelectSecureÔ Medtronic, Minneapolis, MN, USA) is a bipolar, fixed-screw, 4.1-F pacing lead designed for site-selective pacing. Implantation is usually performed using an 8-F deflectable catheter system. This catheter is not ideal for smaller children because of both the sheath size and the relatively large deflected curves. We describe a simpler noncatheter-based delivery system in seven children. Methods:A 4.1-F SelectSecure lead was introduced via a 5-F SafeSheath (Thomas Medical, Malvern, PA, USA) placed in the left subclavian vein. The SelectSecure lead was passed into the inferior vena cava (IVC) and a loop created, which was then withdrawn into the right atrium. Once in position, the lead was screwed into the myocardium, the SafeSheath was peeled off, and the lead connected to the generator. Results:From March 2005 until September 2006, five right atrial leads and two right ventricular leads were implanted in seven patients (six female) with a median weight of 15 kg (8.1,19.4). All leads were successfully placed with excellent pacing thresholds. The median screening time was 7.1 minutes (4.8,11.4) with a median radiation dose of 83 cGy cm2. There were no procedural complications and no lead displacements seen on a median follow-up of 10 months. Conclusions:Delivery of the 4.1-F SelectSecure pacing lead to the right heart is possible using a noncatheter-based delivery system. This is effective and safe and does not require the use of a larger delivery system. This allows these thin isodiametric pacing leads to be used advantageously in small children. [source]

Pacemaker Lead Endocarditis Caused by Staphylococcus Hominis

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2006
MUSTAFA SUNBUL
Infective endocarditis related to pacemaker is a rare but serious condition in permanent venous tracing. A 65-year-old man was admitted to the hospital with high fever and chills. A DDD pacemaker had been implanted via the right subclavian vein because of sick sinus syndrome 6 years earlier. Transesophageal echocardiogram identified an oscillating round hyperechoic mass with a stalk near the tricuspid valve. Blood cultures grew Staphylococcus hominis. The patient was treated with antibiotics and operated on after the acute phase of the illness had subsided. We hereby report a case of lead endocarditis caused by S. hominis in a patient with pacemaker, which has been rarely reported in the English literature. [source]

Laser Recanalization of the Subclavian Vein

Venous Occlusion of the Access Vein in Patients Referred for Lead Extraction:

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2003
Influence of Patient, Lead Characteristics
The aim of this study was to determine the effect of patient and lead characteristics on occlusion of the access vein in pacemaker and ICD patients. Contrast venography of the access vein was obtained in 89 patients (17 patients with an ICD) scheduled for lead extraction. The indication for extraction was infection in 57 patients (systemic infection in 9) and lead malfunction in 32 patients. In 6 of the 89 patients, leads were introduced in both the right and left subpectoral area, resulting in a total of 95 venous entry sites. In 22 of these entry sites one lead was present, in 61 two leads, in 11 three, and in 1 four leads. The vessel patency was graded open or occluded. Occlusion of the subclavian vein occurred in four (13%) patients with lead malfunction versus 18 (32%) patients with infection (P = 0.07). In patients with systemic infection, 5 of 9 showed venous occlusion (P = 0.01 when compared to patients with malfunction, odds ratio 8.75, 95% confidence interval 1.21,64.11). Considered per entry site, the incidence of occlusion was 7 of 22 with one lead present, 17 of 61 with two leads, 0 of 11 with three leads, and 0 of 1 with four leads (P = 0.13). No patient had a superior vena caval occlusion. Patients with systemic infection have an increased risk of occlusion of the access vein. On the contrary, the study found no support for the concept that the risk of venous occlusion increases with a higher number of leads present. (PACE 2003; 26:1649,1652) [source]

Anesthesia-Related Complications in Living Liver Donors: The Experience from One Center and the Reporting of One Death

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2008
S. Ozkardesler
Living donor liver transplantation has become an alternative therapy for patients with end-stage liver disease. Donors are healthy individuals and donor safety is the primary concern. The objective of this study was to evaluate the anesthetic complications and outcomes for our donor cases; we report one death. The charts of the patients who underwent donor hepatectomy from February 1997 to June 2007 were retrospectively reviewed. Right hepatectomy (resection of segments 5,8) was done in 101 donors, left lobectomy (resection of segments 2,3) in 11 donors, and left hepatectomy (resection of segments 2,4) in one donor. Minor anesthetic complications were shoulder pain, pruritus and urinary retention related to epidural morphine, and major morbidity included central venous catheter-induced thrombosis of the brachial and subclavian vein, neuropraxia, foot drop and prolonged postdural puncture headache. One of 113 donors died from pulmonary embolism on the 11th postoperative day. This procedure has some major risks related to anesthesia and surgery. Although careful attention will lower complication rate, we have to keep in mind that the risks of donor surgery will not be completely eliminated. [source]

Use of an Embalming Machine to Create a Central Venous Access Model in Human Cadavers

ACADEMIC EMERGENCY MEDICINE, Issue 2009
Lee Wilbur
Background:, Human cadavers provide an effective model for procedural training; however, inconsistent blood return during central venous cannulation compromises the overall reliability of this procedure. Objective:, To create and quantitatively assess a human cadaver central venous access model using a continuously-run embalming machine. Curriculum:, Emergency medicine (EM) faculty at Indiana University created this model for a procedure lab designed for EM residents. The right femoral artery was identified by superficial dissection and cannulated distally towards the lower leg. This cannula was connected to a Duotronic embalming machine with a solution composed of 16 oz of 24-index fluid and 3 gallons of tap water at a fixed output of 13 pounds per square inch (psi). Next, the left subclavian vein and artery were identified by dissection and each was cannulated with an 18 gauge angiocath connected to a continuous pressure monitor. Pressures (mmHg) in the subclavian vein and artery were measured continuously while study personnel cannulated the left femoral, right subclavian, right supraclavicular, and right internal jugular veins. This model was assessed for dual sessions lasting two hours each with a two hour break in-between. Results:, During the first session, subclavian pressures were measured at 3 mmHg venous and 22 mmHg arterial, increasing to 11 mmHg venous and 27 mmHg arterial during the second session. Residents were able to withdraw at least 5 milliliters at each central venous site in the embalmed cadaver. Conclusions:, We created a reliable and measurable central venous access model in a fresh-frozen human cadaver using a standard embalming machine. [source]

Resynchronization with Left Ventricle Lead Placement Through the Foramen Ovale

CLINICAL CARDIOLOGY, Issue 6 2009
Christophe D'Ivernois MD
Left ventricle (LV) lead placement in a coronary sinus branch for cardiac resynchronization therapy may fail because of anatomical variants, phrenic nerve stimulation, and/or lead instability. We report a case of successful resynchronization from a lead inserted from the left subclavian vein and positioned through a patent foramen ovale (PFO). In conclusion, endocardial LV lead insertion through a PFO enables effective resynchronization delivery without the risks associated with a thoracotomy or atrial transseptal puncture. Copyright © 2009 Wiley Periodicals, Inc. [source]