A case of superior vena cava syndrome due to extensive venous thrombosis of an idiopathic nature]

A 37-year-old man was admitted with facial edema and right arm swelling. Venography, computed tomography and magnetic resonance imaging showed massive organizing thrombi in the superior vena cava and bilateral internal jugular as well as subclavian veins, and showed no mass lesions occluding the veins in the mediastinum. Angioscopy demonstrated a white thrombus at the entrance of the right subclavian vein. All results of blood coagulation tests were normal. The patient was diagnosed as having superior vena cava syndrome caused by idiopathic venous thrombosis. Anti-coagulant therapy with intravenous tissue plasminogen activator injection and continuous urokinase and heparin infusion into the thrombi through a catheter were not effective in lysing the thrombi. Collateral circulation gradually developed and his symptoms decreased. We decided to follow this patient on warfarin medication because of the difficulty in removing the thrombi surgically.     

Horner's syndrome secondary to Swan-Ganz catheterization

A preganglionic Horner's syndrome developed shortly after ipsilateral percutaneous insertion of a Swan-Ganz catheter in the internal jugular vein for management of pulmonary edema. There were no other neurologic findings nor evidence of mass lesions in the neck or pulmonary apex. This is believed to be the first reported case of Horner's syndrome complicating Swan-Ganz catheterization, which may occur more commonly than is generally appreciated.     

Access in therapeutic apheresis

Various modes may be used to perform apheresis, such as plasma exchange, plasmapheresis, immunoadsorption, and blood perfusion. The vascular access used for acute procedures may be sufficiently supplied by two peripheral veins or catheters placed in the femoral vein or the right internal jugular vein. For chronic treatment it might be necessary to place an arteriovenous fistula or graft. The risks involved when using the various accesses is discussed, as is the insertion technique of the femoral vein catheter. The insertion of catheters into larger vessels is preferably controlled by ultrasound guidance. The incidence of adverse events due to access problems is about 0.4%. Once in every 1000 planned procedures, a problem with the access will cause an interruption of apheresis. Other complications that may occur are infections and thrombosis. Long-term use of particularly subclavian vein catheters more frequently results in stenosis than the use of other accesses. The placement of a femoral vein catheter is facilitated by outward rotation of the leg. In addition, other practical suggestions are given.     

Diagnostic importance of the jugular veins

Inspection, auscultation and doppler-sonographic examination of the jugular veins may give a clue for diagnosis of cardiac diseases. Angiological diseases include isolated thrombosis of the jugular vein and congenital ectasia. The neck veins are enlarged with thrombosis of the major upper extremity veins, if the orifice of the subclavian vein is also occluded and the normal outflow of the jugular vein is impeded. Thrombosis of the superior vena cava, compression of the mediastinal trunks by tumors, fibrosis or pericardial alterations causes dilatation of neck veins on both sides, best seen in the jugular veins.     

Technic of venous access for infusion therapy and parenteral nutrition

The creation of a secure venous access is the basis of the infusion therapy and the parenteral nutrition. As ways of access are suited above all the subclavian vein, the internal jugular vein and the basilic vein. Taking into consideration the contraindications and the exact performance of the various methods early complications such as punctures of the arteries, pneumothorax, rupture of the catheter and extended haematomata may be reduced to a minimum. Abnormal positions are avoided by control of the position by means of endo-ECG via steel mandrin. As late complications are observed infections at the place of puncture, unclear, partly septic temperatures and clinically manifest thromboses. Own experiences with 3,282 central venous catheters (2,057 subclavian catheters, 63 catheter into the internal jugular vein and 1,162 central catheters with access via arm veins) are taken into consideration.     

Experience with a double-lumen central venous catheter for hemodialysis

We reviewed retrospectively our experience with the transcutaneous placement of 77 double-lumen hemodialysis catheters in the jugular or subclavian veins in 65 patients. The catheters remained in place for an average of 20.7 days. Three unrelated deaths occurred within 30 days of insertion. Post-insertion chest roentgenograms were made on all patients. One pneumothorax and one misplacement into the carotid artery were noted. Five patients developed blood-culture-substantiated sepsis that required hospitalization. Deep-vein thrombosis occurred in one patient and subclavian-vein stenosis was found in two other patients. Various mechanical difficulties such as kinking, cracking, and thrombosis were encountered. The use of this catheter provides immediate access for hemodialysis with a minimum of complications. However, its disadvantages include its length, tendency to kink, and the requirement for a separate venous cannula to be used with each hemodialysis.     

Lemierre's syndrome: unusual cause of internal jugular vein thrombosis--a case report

Lemierre's syndrome is an uncommon septic thrombophlebitis of the internal jugular vein. The authors present the case of a 52-year-old woman with literature review. She developed flu-like symptoms and fever, and then painful swelling of the left side of her neck and left arm. Contrast-enhanced computed tomography of the neck revealed thrombosis in the left internal jugular vein, subclavian vein, and brachiocephalic vein and diffuse soft tissue inflammation around the veins. No microorganism was identified in the blood and venous thrombus, which was obtained by percutaneous aspiration thrombectomy. Systemic antibiotics and anticoagulation therapy achieved complete resolution of the symptoms. Recanalization of the thrombosed veins with no residual thrombi was observed on duplex scanning after 3 months. No pulmonary embolism or other metastatic infection was observed. Clinical suspicion seems to be essential to make an accurate diagnosis during the early stage of the disease, which is critical to obtain a successful outcome for Lemierre's syndrome.     

经静脉植入起搏器术后静脉血栓的发生率及其可能的相关因素

目的 初步探讨经静脉植入起搏器后静脉血栓的发生情况及可能影响因素。 方法 入选我科2017.5~2017.11起搏器程控门诊随访时复查了植入侧静脉超声（锁骨下静脉、腋静脉和颈内静脉）的起搏器植入患者84例，收集其术前临床资料、实验室检查、心脏影像学及双侧锁骨下静脉、腋静脉和颈内静脉的超声结果以及服用抗凝抗血小板药物的情况，术后起搏器程控门诊随访时复查的植入侧的上述静脉超声结果，进行统计分析。 结果 3例（4%）患者发生了静脉血栓事件，分别是扩张性心肌病并发重度心功能减低和阵发性房颤，单腔起搏器升级为双腔起搏器，先天性三尖瓣下移畸形伴大量返流并发Ⅲ°AVB、起搏器植入术后电极穿孔行新电极植入和穿孔电极的拔除。 结论 经静脉植入起搏器术后发生静脉血栓的风险相对较小，最多见于手术较复杂、患者心功能较低、并发心脏结构异常、术中出现电极穿孔等并发症的患者。      

心脏临时起搏支持严重心率缓慢患者的血液净化

目的观察心脏临时起搏对严重心率缓慢患者血液净化的作用。方法7例因各种病因引起的急慢性肾功能衰竭患者伴严重心率缓慢时,经右颈内静脉、左锁骨下静脉途径穿刺置管行气囊电极床边紧急心脏临时起搏,支持血液净化。结果7例中5例行右颈内静脉置管,2例行左锁骨下静脉置管,起搏均成功,效果肯定,起搏时间2～16天,支持血液净化共32次,其中连续性静脉血液滤过(CVVH)2次,8例次行血液透析滤过(HDF),22例次行常规血透(HD),未发现心脏穿孔、气胸、血胸,1例发生导管感染。1例扩张型心肌病患者因低血压心力衰竭不能控制自动出院,其余6例均抢救成功。结论球囊电极床边心脏临时起搏,操作简便快捷,安全有效,可以提高严重心动过缓合并有肾功能不全的重危患者的抢救成功率。     

Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital

OBJECTIVE: The goal of this study was to characterize the spectrum of upper-extremity deep venous thrombosis in a community teaching hospital. DESIGN AND SETTING: A retrospective analysis was used at a large urban teaching hospital. MATERIAL AND METHODS: We reviewed the records of 90 patients with ultrasound-documented thrombosis of the internal jugular, subclavian, axillary, or brachial veins to determine clinical characteristics, risk factors, and outcome. RESULTS: The most common underlying conditions associated with upper-extremity deep venous thrombosis were the presence of a central venous catheter in 65 patients (72%), infection in 25 (28%), extrathoracic malignancy in 20 (22%), thoracic malignancy in 19 (21%), renal failure in 19 (21%), and a prior lower-extremity deep venous thrombosis in 16 (18%). Pain was noted in 31 (34%) patients, and 76 patients (84%) had edema of the involved extremity. The left subclavian vein was involved in 44 patients (49%), and 35 patients (39%) had a central venous catheter in the left subclavian vein. When a central venous catheter was present, the deep venous thrombosis was usually ipsilateral (P <.001). Heparin and warfarin were administered to 65 (72%) and 53 (59%) of the patients, respectively. Eleven patients (12%) died. Of these patients, 8 (73%) had an underlying infection, whereas only 22% of survivors had an infection (P =.0012). CONCLUSION: Upper-extremity deep venous thrombosis typically occurs in patients with a systemic illness in the presence of a central venous catheter. The left subclavian vein is frequently involved because this is a common site for placement of a central venous catheter. Pain is uncommon, but edema of the involved extremity is noted in the majority of patients. The mortality rate of patients in this study with an upper-extremity deep venous thrombosis was 12%; most patients who died had a central venous catheter and an underlying infection.     

Use of subclavian vein for permanent cardiac pacing.

The subclavian vein has been used to implant permanent pacing catheters in 40 patients with symptomatic heart block. Though the cephalic and external jugular veins are usually preferred for this purpose in Britain, the use of these veins has certain disadvantages. In this study subclavian venepuncture by the infraclavicular approach was performed without diffculty and found to be a safe procedure. Three months after implantation, 7.5 per cent of patients had developed catheter tip dislocation and 87.5 per cent of patients were entirely free of complications.     

Use of subclavian vein for permanent cardiac pacing

The subclavian vein has been used to implant permanent pacing catheters in 40 patients with symptomatic heart block. Though the cephalic and external jugular veins are usually preferred for this purpose in Britain, the use of these veins has certain disadvantages. In this study subclavian venepuncture by the infraclavicular approach was performed without diffculty and found to be a safe procedure. Three months after implantation, 7.5 per cent of patients had developed catheter tip dislocation and 87.5 per cent of patients were entirely free of complications.     

Short-term central venous catheter complications in patients with sickle cell disease who undergo apheresis

Patients with sickle cell disease (SCD) are prone to develop thrombosis and infection due to their inflammatory and immune deficiency state. These patients require red cell exchange therapy for treatment or prevention of hemoglobin S associated complications. Owing to vascular access problems, adult patients need central venous catheterization (CVC) for exchange procedures. Procedure related complications have been reported for long-term CVCs in pediatric patients. However, short-term CVC complications in adult patients are not clear. This report represents the results of documented complications of short-term CVCs in patients with SCD who undergo apheresis. A total of 142 non-tunneled catheters with average median diameter of 9 F (range 8–16 F) were implanted for apheresis. The catheters were mainly inserted through the right internal jugular vein (66.2 %). Total days of catheter were 412. Results were reported as a complication rate and event according to 1,000 catheter days and compared to a control group including 37 healthy stem cell donors. In the patient group, 1 (1 %) hematoma and 1 (1 %) infection were observed for internal jugular vein catheterization (3.7 hemorrhages and 3.7 infections according to 1,000 catheter days), whereas four (8.9 %) cases of thrombosis and 1 (2.2 %) infection (27 and 6.9 according to 1,000 catheter days) developed in femoral vein. There was a significant difference in terms of thrombosis (P = 0.009). In the control group, only individual developed thrombosis in internal jugular vein. Short-term CVC inserted through to the internal jugular vein seems to be safer than femoral vein in patients with SCD.     

Acute Budd-Chiari syndrome, portal and splenic vein thrombosis in a patient with ulcerative colitis associated with antiphospholipid antibodies and protein C deficiency

We report the case of a female patient who had severe thrombotic complications in peripheral (V. jugularis, subclavia, brachialis, poplitea) and visceral (portal and splenic) veins 4 years after the first diagnosis of severe ulcerative pancolitis. A thrombolysis therapy for subclavian and jugular vein thrombosis was performed without complication, but she soon developed acute thrombosis of the hepatic veins (acute Budd-Chiari syndrome). She quickly recovered after liver transplantation and now - 6 years later - she lives a normal life with continuous anticoagulation and medical therapy of the colitis.3 possible causes for the severe coagulation defect in this patient can be supposed: Thrombocytosis, protein C deficiency and an antiphospholipid antibody syndrome.     

Is chest radiography necessary after uncomplicated insertion of a triple-lumen catheter in the right internal jugular vein, using the anterior approach?

STUDY OBJECTIVES: Chest radiographs are required in many institutions by protocol after the insertion of a right internal jugular vein triple-lumen catheter (TLC), even if the anterior approach is used. This study investigates whether correct placement can be predicted during insertion and whether a "routine" postprocedural chest radiograph can be safely omitted. DESIGN: The operators included 18 first-, second-, or third-year medical residents, 3 pulmonary fellows, and a board-certified pulmonary medicine and critical care attending, with at least 1 certified physician present during the procedure. All operators were trained in the "seven number rule." PATIENTS: One hundred consecutive patients who required central venous access. Patients with left internal jugular vein or subclavian catheters were excluded. SETTING: Single institution, medical ICU, step-down unit, and floors. INTERVENTIONS: Right internal jugular vein TLC insertion, anterior approach, with subsequent chest radiograph. MEASUREMENTS AND RESULTS: Eighty-eight patients had uncomplicated insertions, as defined by fewer than four sticks with a 22-gauge pathfinder needle and fewer than four slides with the 18-gauge introducer needle. Ninety-eight catheters were in accurate position, 1 catheter was in the distal superior cava vein, and 1 catheter was in an S-shaped position. CONCLUSIONS: It is safe to omit the routine chest radiograph after uncomplicated insertion of a TLC. i.v. treatment can be initiated early. However, if there is any doubt about the correct position, a chest radiograph should be obtained.     

Left internal mammary artery perforation during Swan-Ganz catheter insertion

A wide spectrum of complications is associated with invasive hemodynamic monitoring. We report an unusual case of perforation of the left internal mammary artery that occurred during percutaneous insertion of a Swan-Ganz catheter using the subclavian vein approach. To the best of our knowledge, this complication has not been previously reported. Cathet. Cardiovasc. Diagn. 44:317–319, 1998. © 1998 Wiley-Liss, Inc.     

Superior vena cava thrombosis and paradoxical embolic stroke due to collateral drainage from the brachiocephalic vein to the left atrium

Thrombosis involving a permanent infusion catheter in the subclavian vein and superior vena cava is relatively common, especially in cancer patients. Edema of the arms and head is a well-known clinical consequence of this thrombosis, with an intrinsic risk of pulmonary embolism; however, systemic embolization into the cerebral circulation has not been reported as a sequela. Herein, we describe the case of a 56-year-old man with metastatic prostate cancer who developed superior vena cava syndrome due to extensive thrombosis in the presence of a central venous catheter that was used for long-term chemotherapy. The patient's case was complicated by a cerebrovascular accident that was most likely caused by a paradoxical air embolism. A clear mechanism for the embolism was provided by a network of collateral veins, which developed between the brachiocephalic vein and the left atrium due to the superior vena cava obstruction and resulted in a right-to-left shunt. We discuss diagnosis and treatment of the condition in our patient and in general terms.     

Transesophageal Echocardiographic Identification of Neck Veins: Value of Contrast Echocardiography

We describe the technique for identification of innominate veins, azygos vein, and left subclavian and internal jugular veins during transesophageal echocardiography. Validation was provided with contrast echocardiography.     

Transesophageal Echocardiographic Identification of Neck Veins

We describe the technique for identification of innominate veins, azygos vein, and left subclavian and internal jugular veins during transesophageal echocardiography. Validation was provided with contrast echocardiography.     

Vascular access for apheresis in intensive care patients

In the intensive care unit, apheresis therapy (including plasma exchange, selective immunoadsorption and -affinity and detoxification by hemoperfusion) is limited to certain disease entities. Temporary insertion of large-bore central venous catheters is necessary for efficient performance of apheresis therapy. The choice of the optimal catheter insertion site (femoral, subclavian or internal jugular vein route) depends on the individual situation, the experience of the operator and the anticipated treatment period. Morbidity and mortality of the patients concerned can be substantially increased by insertion and use of central venous catheters. Early and delayed complications are briefly discussed. Appropriate selection of the catheter insertion site, the catheter type, strictly aseptic insertion procedures and optimal care of catheter and insertion site are essential to avoid complications.