Vein Damage Research Articles

Mathematical modeling of 980‐nm and 1320‐nm endovenous laser treatment

Endovenous laser treatment (ELT) has been proposed as an alternative in the treatment of reflux of the great saphenous vein (GSV) and small saphenous vein (SSV). Numerous studies have since demonstrated that this technique is both safe and efficacious. ELT was presented initially using diode lasers of 810 nm, 940 nm, and 980 nm. Recently, a 1,320-nm Nd:YAG laser was introduced for ELT. This study aims to provide mathematical modeling of ELT in order to compare 980 nm and 1,320 nm laser-induced damage of saphenous veins. The model is based on calculations describing light distribution using the diffusion approximation of the transport theory, the temperature rise using the bioheat equation, and the laser-induced injury using the Arrhenius damage model. The geometry to simulate ELT was based on a 2D model consisting of a cylindrically symmetric blood vessel including a vessel wall and surrounded by an infinite homogenous tissue. The mathematical model was implemented using the Macsyma-Pdease2D software (Macsyma, Inc., Arlington, MA). Calculations were performed so as to determine the damage induced in the intima tunica, the externa tunica and inside the peri-venous tissue for 3 mm and 5 mm vessels (considered after tumescent anesthesia) and different linear endovenous energy densities (LEED) usually reported in the literature. Calculations were performed for two different vein diameters: 3 mm and 5 mm and with LEED typically reported in the literature. For 980 nm, LEED: 50 to 160 J/cm (CW mode, 2 mm/second pullback speed, power: 10 W to 32 W) and for 1,320 nm, LEED: 50 to 80 J/cm (pulsed mode, pulse duration 1.2 milliseconds, peak power: 135 W, repetition rate 30 Hz to 50 Hz). Numerical simulations are in agreement with LEED reported in clinical studies. Mathematical modeling shows clearly that 1,320 nm, with a better absorption by the vessel wall, requires less energy to achieve wall damage. In the 810-1,320-nm range, blood plays only a minor role. Consequently, the classification of these lasers into hemoglobin-specific laser wavelengths (810, 940, 980 nm) and water-specific laser wavelengths (1,320 nm) is inappropriate. In terms of closure rate, 980 nm and 1,320 nm can lead to similar results and, as reported by the literature, to similar side effects. This model should serve as a useful tool to simulate and better understand the mechanism of action of the ELT.

Günther Tulip Filter Retrievability Multicenter Study Including CT Follow-up: Final Report

To evaluate the safety and effectiveness of retrieval of the Günther Tulip inferior vena cava (IVC) filter. This was a nonrandomized, single-armed, multicenter prospective investigation. Patients at temporary high risk for pulmonary embolism (PE) or deep vein thrombosis (DVT) who did not require a permanent filter were eligible. Forty-one patients received 42 Günther Tulip filters: 22 men and 19 women with a mean age of 47.7 years. Indications for filter placement included prophylaxis, PE, and DVT. Three months after filter retrieval, contrast agent-enhanced computed tomography of the abdomen, jugular vein ultrasonography, and clinical follow-up were performed. The filter retrieval rate was 57% (23 of 41). Günther Tulip filters were removed at a mean of 11.1 days (range, 2-14 d). The technical and clinical success rates for filter retrieval were both 100%. One placement complication and two protocol deviations occurred. These patients were excluded in terms of retrieval-related outcomes. One case of PE occurred with a filter in place, and one filter migrated to the heart. There were no acute complications caused by filter retrieval. At 3-month follow-up, there was no recurrent PE, DVT, jugular vein occlusion, or IVC stenosis or occlusion. In this multicenter study, retrieval of the Günther Tulip filter was safe and without recurrent thromboembolic events or evidence of IVC or jugular vein damage at 3-month follow-up.

Mathematical modeling of endovenous laser treatment (ELT)

Background and objectivesEndovenous laser treatment (ELT) has been recently proposed as an alternative in the treatment of reflux of the Great Saphenous Vein (GSV) and Small Saphenous Vein (SSV). Successful ELT depends on the selection of optimal parameters required to achieve an optimal vein damage while avoiding side effects. Mathematical modeling of ELT could provide a better understanding of the ELT process and could determine the optimal dosage as a function of vein diameter.Study design/materials and methodsThe model is based on calculations describing the light distribution using the diffusion approximation of the transport theory, the temperature rise using the bioheat equation and the laser-induced injury using the Arrhenius damage model. The geometry to simulate ELT was based on a 2D model consisting of a cylindrically symmetric blood vessel including a vessel wall and surrounded by an infinite homogenous tissue. The mathematical model was implemented using the Macsyma-Pdease2D software (Macsyma Inc., Arlington, MA, USA). Damage to the vein wall for CW and single shot energy was calculated for 3 and 5 mm vein diameters. In pulsed mode, the pullback distance (3, 5 and 7 mm) was considered. For CW mode simulation, the pullback speed (1, 2, 3 mm/s) was the variable. The total dose was expressed as joules per centimeter in order to perform comparison to results already reported in clinical studies.ResultsIn pulsed mode, for a 3 mm vein diameter, irrespective of the pullback distance (2, 5 or 7 mm), a minimum fluence of 15 J/cm is required to obtain a permanent damage of the intima. For a 5 mm vein diameter, 50 J/cm (15W-2s) is required. In continuous mode, for a 3 mm and 5 mm vein diameter, respectively 65 J/cm and 100 J/cm are required to obtain a permanent damage of the vessel wall. Finally, the use of different wavelengths (810 nm or 980 nm) played only a minor influence on these results.Discussion and conclusionThe parameters determined by mathematical modeling are in agreement with those used in clinical practice. They confirm that thermal damage of the inner vein wall (tunica intima) is required to achieve the tissue alterations necessary in order to lead the vein to permanent occlusion. However, in order to obtain a high rate of success without adverse events, the knowledge of the vein diameter after tumescent anesthesia is recommended in order to use the optimal energy. As clearly demonstrated by our calculations, both pulsed and continuous mode operations of the laser can be efficient. An interesting observation in our model is that less amount of energy is required in pulsed mode than in continuous mode. Damaging the vein sequentially along its entire length may lead to permanent occlusion. However, the pulsed mode requires a very precise positioning of the fiber after each pullback and the duration of the treatment is much longer. For these reasons, continuous irradiation seems to be preferred by most clinicians. This model should serve as a useful tool to simulate and better understand the mechanism of action of the ELT

Influence of phlebographic abnormalities on the natural history of venous ulceration

Eighty-five limbs in 73 patients with a healed venous ulcer were assessed by ascending and descending phlebography, foot volume plethysmography and transcutaneous oxygen measurements. Forty-four limbs had post-thrombotic changes on ascending phlebography. In 24 (28 per cent) these extended into the femoral vein, while in 20 (24 per cent) only the calf veins were involved. In the 41 limbs (48 per cent) with normal deep veins on ascending phlebography, 11 had evidence of localized incompetence of the calf communicating veins, 14 had either long saphenous incompetence, deep vein reflux to the level of the knee or below, or both of these abnormalities, and 16 limbs had no phlebographic abnormalities. However all limbs had a decreased half volume refilling time on foot volume plethysmography. Limbs with post-thrombotic changes extending into the femoral vein were associated with a significantly longer history of ulceration and more ulcer recurrences than limbs with calf vein damage (P less than 0.05 for each) and limbs with normal deep veins (P less than 0.01 for each). However, these limbs did not have lower transcutaneous oxygen ratios or longer times to achieve ulcer healing. Ascending phlebography identified a group of limbs with extensive post-thrombotic changes in which there was a higher incidence of ulcer breakdown, but this was not associated with a delay in ulcer healing.

Experience of Treating Gunshot Wounds of Large Vessels in Afghanistan

The problem of treating injuries of large vessels in times of peace has been sufficiently well developed both in theoretical and practical aspects. In times of war, however, due to the large numbers of the wounded, a shortage of expert angiosurgeons, and multiple gunshot wounds, many theoretical tenets lose their academic regularity. The present study is based on the experience of treating 302 patients wounded during the Afghanistan war (1981-1985). Most of the injuries were to the vessels of the extremities. The gunshot wounds were complex. They included extensive destruction of tissue in the damaged segments of the extremities with simultaneous damage of large veins (42.0% of the cases), nerves (45.5%), and bones (47.4%). Multiple-vessel injuries were encountered in 4% of the cases, with combined injuries comprising 17.5%. Most of the wounded (83.7%) were in a state of shock, with 6.4% in a terminal condition. The blood loss amounted to 15% to 65% of the total volume. Ninety percent of the wounded were admitted to hospitals in the first 6 hours. A two-stage method was used to treat 71 of the wounded. The method included temporary bypass of the injured arteries and veins while evacuating the wounded and during surgery. Two hundred ninety-five wounded underwent vessel surgery. Out of the total number of injuries of arteries and veins, vessel sutures were used in 36.9% and 35.9% of the cases, vessel plastics in 41.4% and 7.1% of the cases, and vessel ligation in 21.7% and 60.0% of the cases, respectively. Surgery was completed by fixing the bone fragments externally with the help of special devices using the Ilizarov method. Amputation was performed in 13.9% of the cases. In 7.3% of the cases amputation was performed according to primary indications (no reconstructive surgery attempted on the vessels). In 6.6% of the cases extremities were amputated during the early postoperative period as a result of vessel thrombosis and an increase of tissue ischemia. The mortality rate after vessel surgery was 5.3%. We believe that for patients with gunshot wounds involving vessel injuries, early one-time reconstruction of the destroyed anatomical structures should be performed.

Buprenorphine diversion and injection in Melbourne, Australia: an emerging issue?

To examine indicators of buprenorphine diversion and injection among injecting drug users in Melbourne, Australia and to determine the factors associated with buprenorphine injection. Melbourne arm of the 2002 Illicit Drug Reporting System (IDRS) cross-sectional study. Five Needle and Syringe Programme sites in Melbourne, Australia. A total of 156 current injecting drug users (IDU). Study eligibility criteria were at least monthly injection during the previous 6 months, and Melbourne residence for at least the preceding 12 months. Structured questionnaire covering demographic characteristics, drug use history, the price, purity and availability of drugs, criminal activity, risk-taking behaviours, health-related issues and general drug use trends. Over one-third (37%) of the study sample reported injecting buprenorphine in their life-time and 33% reported injecting the drug in the last 6 months. Recent buprenorphine injection was associated with the injection of other drug types (i.e. polydrug injectors), opioid substitution treatment, injection-related health problems and involvement in crime. Almost half (47%) of those who reported recent buprenorphine injection reported obtaining the drug illicitly at least once during that time. Given the significant health harms associated with intravenous buprenorphine use (e.g. vein damage, abscesses and infections, precipitated withdrawal, blood-borne virus transmission, hospitalization and death), routine monitoring of the misuse of buprenorphine in Melbourne is warranted. These results suggest the need for development of effective countermeasures to address diversion and injection of buprenorphine in this setting.

Histological aspects of the saphenous vein damage with the use of the symmetry® aortic connector system

The purpose of the present study was to analyze the histological aspects of the saphenous veins after the use of the Symmetry aortic connector in off pump coronary artery bypass surgery (OPCAB). Nineteen consecutive patients who underwent OPCAB surgery and who received one proximal saphenous vein anastomosis using the St Jude aortic Symmetry connector system were evaluated. In each patient one small segment of the saphenous vein was cut before the use of the Symmetry connector (V0), then another segment after (V1). All segments were stored in an acetone-formaldehyde-alcohol solution before examination. Examination of the V0 segments showed non-specific media fibrosis. In V1, 11 segments presented with a complete alteration of the endothelial layer (58%) and 8 with severe lesions (more than 80%). Among all the V1 segments, 8 had a dissection of the media (42%) and one presented with a wall thrombus. These results suggest that the use of the aortic connector can be associated with different types of lesions of the venous wall. Thus, further investigation and especially long-term follow-up are mandatory to evaluate the consequences of such lesions upon the grafts' patency.

Preventing hepatitis C: ‘Common sense’, ‘the bug’ and other perspectives from the risk narratives of people who inject drugs

There is little published research about how people who inject drugs are responding to the hepatitis C epidemic. This study seeks to address the prevention of hepatitis C using qualitative interviews with people who inject drugs in London. We explored narratives about risk reduction and hepatitis C in the social and historical context of other risks such as HIV, vein damage and overdose. Themes of the narratives included: the importance of autonomy in the acquisition of safer injecting skills; that safer injection was regarded as ‘common sense’, normalised and predicated on the risk of HIV; that hepatitis C risk was relativised with HIV risk and thereby seen as less important; and that hepatitis C infection was also seen as unavoidable. These narrative forms represent significant challenges for the management of the hepatitis C epidemic, both in terms of the existing risk reduction efforts designed for HIV and in terms of the articulation of risk reduction for injectors with general public health policy.

A new rigid biodegradable anchor for meniscus refixation: biomechanical evaluation.

All-inside repair devices have been developed to overcome the disadvantages of conventional suture techniques (such as vein and nerve damage and increased OR time). The Contour Meniscus Arrow is a second generation of the first biodegradable all-inside implant, the Meniscus Arrow. The aim of this study was to compare the biomechanical properties of the Contour Meniscus Arrow to the first-generation Meniscus Arrow and vertical or horizontal suture techniques. In fresh frozen bovine menisci, initial fixation strength, stiffness and failure mode of four different meniscus refixation techniques (Meniscus Arrow, Contour Meniscus Arrow, vertical and horizontal 2-0 Ethibond suture techniques) were evaluated in a computer-based material-testing machine at a rate of 12.5 mm/s. Vertical meniscus sutures showed the highest initial fixation strength, followed by the horizontal suture technique and the Contour Arrow. The Meniscus Arrow showed inferior pull-out strength. Subjecting the different refixation techniques to cyclic testing decreased the fixation strength in all groups. The modified Meniscus Anchor (Contour Arrow) provides biomechanical properties that are superior (pull-out strength) or similar (stiffness) compared to the first biodegradable all-inside implant, the Meniscus Arrow. The pull-out strength of the Contour Arrow was comparable to the pull-out strength reported for horizontal meniscus sutures in the literature. These biomechanical characteristics of this new implant justify clinical use.

Inhibitory Effect of Sulfobutyl Ether β‐cyclodextrin on DY‐9760e‐Induced Cellular Damage: In vitro and in vivo Studies

The effects of water‐soluble β‐cyclodextrin derivatives (β‐CyDs), such as 2‐hydroxypropyl‐β‐cyclodextrin (HP‐β‐CyD) and sulfobutyl ether β‐cyclodextrin (SBE7‐β‐CyD) on cytotoxicity of DY‐9760e (3‐[2‐[4‐(3‐chloro‐2‐methylphenyl)‐1‐piperazinyl]ethyl]‐5,6‐dimethoxy‐1‐(4‐imidazolylmethyl)‐1H‐indazole dihydrochloride 3.5 hydrate) toward human umbilical vein endothelial cells (HUVECs) in vitro and vascular damage of the auricular vein of rabbits by DY‐9760e in vivo were investigated. The spectroscopic study revealed that of the four β‐CyDs SBE7‐β‐CyD forms the most stable inclusion complex in phosphate‐buffered saline, probably because of a synergetic effect of hydrophobic and electrostatic interactions. β‐CyDs inhibited DY‐9760e‐induced cell death toward HUVECs in an order of G2‐β‐CyD < β‐CyD < HP‐β‐CyD < SBE7‐β‐CyD, which was consistent with the order of the magnitude of stability constants. When the DY‐9760e solution was infused into the auricular vein of rabbits for 24 h, SBE7‐β‐CyD suppressed a DY‐9760e‐induced irritation such as thrombus, desquamation of the endothelium vasculitis, and perivasculitis. The present data indicated that SBE7‐β‐CyD formed an inclusion complex with DY‐9760e in a buffer solution and possessed the protective effect on DY‐9760e‐induced cytotoxicity toward HUVECs and vascular damage in rabbits. These results suggested potential use of SBE7‐β‐CyD as a parenteral carrier for DY‐9760e. © 2003 Wiley‐Liss, Inc. and the American Pharmacists Association J Pharm Sci 92:2466–2474, 2003

Reduction of monocrotaline-induced hepatic injury by deleted variant of hepatocyte growth factor (dHGF) in rats.

Monocrotaline is a hepatotoxic agent which exerts predominant toxicity to central veins and centrilobular sinusoids. In this study, we investigated the effects of deleted variant of hepatocyte growth factor (dHGF) on monocrotaline-induced hepatic injury in rats. 100 mg/kg monocrotaline was gavaged to male rats twice with a 4-days' interval. Treatment of dHGF was started 4 days before the initial administration of monocrotaline and 500 microg/kg was intravenously injected twice daily for 11 days. Monocrotaline induced severe damage of central veins and destruction of central zone of hepatic lobules concurrent with derangement of blood levels of total protein, albumin, alanine-aminotransferase, total bilirubin, direct bilirubin, and hepaplastin time. dHGF reduced the structural and blood-chemical abnormalities induced by monocrotaline. These results suggest that dHGF prevented and repaired the monocrotaline-induced hepatic injury, and could have therapeutic potency in hepatic failure with sever centrilobular destruction.

Laparoscopic ethanol injection therapy for hepatocellular carcinoma

Ethanol injection into HCC tumors is an effective therapy and percutaneous ethanol injection therapy (PEIT) is performed on many HCC patients. However, there are cases in which PEIT becomes difficult because the HCC could not be detected by ultrasonography or the tumor is located in an area where it is impossible to perform PEIT. Nine patients with HCC underwent laparoscopic ethanol injection therapy (LEIT) in our institution. Their tumors were located on the liver surface and could be visualized by laparoscopic examination. Ethanol injection was performed under laparoscopic direct visualization. The total injected ethanol volume required ranged from 4 to 15 ml and in most cases both tumor size and alpha-fetoprotein (AFP) levels decreased after LEIT. Three cases showed a transient complication of abdominal pain or/and portal vein damage. Other severe complications were not observed. All cases required additional therapies, including transcatheter arterial chemoembolization (TAE) or PEIT to complete the tumor necrosis. In conclusion, LEIT is a safe and effective therapy for HCC located on the liver surface, but should be combined with other therapies to facilitate its effect against HCC.

The evolution and function of central venous catheters for dialysis.

The use of central venous catheters (CVC) for acute or chronic dialysis has been a relatively recent innovation in Nephrology. The first problem addressed has been how to allow removal and return of blood at high flow rates throughout a dialysis treatment. Four solutions have emerged: place the lumens within the right atrium; place the removal lumen on the inside of the catheter; use a large catheter size; or provide independent limbs with multiple blood-entry ports to draw and return blood in all directions. Many other requirements include resistance to infection, especially the passage of organisms around the catheter. A subcutaneous Dacron cuff within a tunnel has successfully accomplished this goal for most chronic CVC dialysis catheters, but other immobilizing devices such as plugs have also been successful. Materials for CVC dialysis catheters have improved, providing strength to allow the catheters to last for several years, with flexibility to avoid vein damage (in general). However, component and material failures still occur, and some materials are incompatible with medications placed at the exit site. CVC for dialysis will remain a necessary choice for many patients beginning and continuing dialysis therapy.

Antioxidant and hepatoprotective effects of punicalagin and punicalin on acetaminophen-induced liver damage in rats.

Punicalagin and punicalin were isolated from the leaves of Terminalia catappa L., a Combretaceous plant distributed throughout tropical and subtropical beaches, which is used for the treatment of dermatitis and hepatitis. Our previous studies showed that both of these compounds exert antioxidative activity. In this study, the antihepatotoxic activity of punicalagin and punicalin on acetaminophen-induced toxicity in the rat liver was evaluated. After evaluating the changes of several biochemical functions in serum, the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were increased by acetaminophen administration and reduced by punicalagin and punicalin. Histological changes around the hepatic central vein and oxidative damage induced by acetaminophen were also recovered by both compounds. The data show that both punicalagin and punicalin exert antihepatotoxic activity, but treatment with larger doses enhanced liver damage. These results suggest that even if punicalagin and punicalin have antioxidant activity at small doses, treatment with larger doses will possibly induce some cell toxicities.

Infrainguinal reconstruction with endoscopically harvested saphenous vein

Abstract Background Endoscopic saphenous vein harvesting is gaining popularity in cardiac units because of a perceived reduction in lower limb wound complications. The requirements of the cardiac surgeon for saphenous vein differ from that of the peripheral vascular surgeon in that longer individual vein grafts are required for peripheral reconstruction. Methods Endoscopic vein harvest has been evaluated in the reconstruction of 36 legs. Vein was harvested successfully in all cases, although major vein damage occurred in one patient. All veins were reversed and routed through a new tunnel, and used for 18 above-knee femoropopliteal bypasses, 12 below-knee femoropopliteal bypasses, four distal and two pedal grafts. Mean follow-up was 20 (range 3–36) months. Results There were six graft occlusions, two in the immediate postoperative period, two at 1 month and two late closures at 1 year. Three patients had wound infections, two had significant haematomas and four had problematic oedema after operation. Postoperative stay was 2–18 days, with 17 patients being discharged within 5 days and 28 within 9 days. Conclusion Although this technique can be used successfully for vein harvesting, the immediate impact on patient morbidity and postoperative stay is only marginal and probably does not justify the increased cost of the procedure.

Patients in methadone maintenance treatment who inject methadone syrup: a preliminary study.

An increased awareness of the injection of methadone syrup has been appreciated by methadone treatment clinicians and Needle Exchange outlets which distribute large-volume syringes. This study aimed to identify patterns of use by methadone injectors, and the reasons and perceived risks of this behaviour. Nineteen of 36 attendees at a needle exchange who stated they had injected methadone over the previous 3 months completed a structured interview. Results found a majority were methadone clinic patients. Forty-two percent injected three times a week or more. This practice continued in 58%, despite reported difficult venous access. Subjects' concerns included accelerating vein damage and possible toxicity of syrup additives. Reasons for injecting included immediate drug effect (80%) and 'needle-fixation' (47%). It is concluded that methadone clinic staff need to be aware of such patients who may require additional treatment approaches, and that methadone formulations should minimize harmful consequences if injected.

Complications Associated With Vortex Vein Damage in Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

Purpose: To further understand postoperative complications after vortex vein damage during scleral buckling surgery. Methods: The records of 34 patients (34 eyes) with vortex vein damage during scleral buckling surgery for rhegmatogenous retinal detachment were reviewed and compared with the records of 410 eyes undergoing similar surgery without vortex vein damage. Results: Postoperative complications were noted in 16 eyes (47%) of the damaged vortex vein group. The incidence of choroidal detachment, vitreous opacities, intraocular pressure elevation, and vitreous hemorrhage were 27%, 18%, 9%, and 6%, respectively, with a higher incidence than in the group without vortex vein damage. Other complications included development of epiretinal membrane (9%), subretinal hemorrhage (3%), and anterior segment ischemia (3%). Serous choroidal detachment occurred in the early postoperative days and subsided within 3 weeks. Vitreous opacification became marked in the later periods and continued for 2 months or longer. The incidence of postoperative choroidal detachment in the vortex vein damage group was related to the patient’s age ( P = .002) and the cutting of the vortex veins ( P = .048), but was not related to preoperative conditions of retinal detachment or the number of vortex veins damaged. All the eyes except one achieved retinal reattachment after initial surgery. Conclusions: Choroidal detachment and vitreous opacity are common after scleral buckling surgery with vortex vein damage. Although intervention of the vortex veins during scleral buckling surgery is acceptable when performing otherwise difficult to achieve ample scleral indentation, it should be minimized to avoid increased incidence of postoperative complications.

Importance of prevention of intravenous thrombosis and preservation of the venous collateral flow in bridging vein injury during surgery: An experimental study

Venous infarction (cerebral edema and/or hemorrhage) may occur several hours after sacrifice of the bridging vein during surgery. However, in our experience, severe venous infarction is often produced by prolonged brain retraction in addition to sacrifice of the vein. The experiment was carried out using 20 adult cats. In five cats, all bridging veins were coagulated near the superior sagittal sinus and 12 hours later the surgical wound was closed (group A). In five other cats, a round plate weighing 45 g was placed on the center of the Sylvian fissure for 12 hours and then the wound was closed (group B). In the remaining 10 cats, both of these interventions were performed (group C). All 20 animals were sacrificed 12 hours after the wound closure. The degree of Evans-blue dye leakage and brain edema was much more marked in the group C than in groups A and B. The endothelial intactness of the bridging veins studied by staining with a factor VIII-related antigen was much more disturbed in group C than in the other groups. The endothelium of the cortical veins is damaged much more by the combination of sacrifice of the vein and brain retraction, and this endothelial damage of the cortical vein leads to extensive venous infarction.

Percutaneously Inserted Silastic Jugular Hemodialysis Catheters Seldom Cause Jugular Vein Thrombosis

To find out whether internal jugular vein cannulation with a soft silastic hemodialysis access catheter causes jugular vein thrombosis, the authors carried out Doppler ultrasound examinations on 96 patients receiving hemodialysis who had undergone 144 separate catheter insertion episodes in 116 veins. Two internal jugular vein thromboses were found in 101 veins that had been the site of percutaneous insertions only. In addition, 5 internal jugular vein thromboses were identified in 15 veins that had been cannulated surgically with the Quinton PermCath. The authors conclude that percutaneous internal jugular vein cannulation for hemodialysis access causes an acceptably low incidence of jugular vein damage. This strengthens the case for preferential use of the internal jugular vein for vascular access in patients with end-stage renal failure, and suggests that percutaneous cannulation is less damaging than surgical insertion.

Percutaneously Inserted Silastic Jugular Hemodialysis Catheters Seldom Cause Jugular Vein Thrombosis

To find out whether internal jugular vein cannulation with a soft silastic hemodialysis access catheter causes jugular vein thrombosis, the authors carried out Doppler ultrasound examinations on 96 patients receiving hemodialysis who had undergone 144 separate catheter insertion episodes in 116 veins. Two internal jugular vein thromboses were found in 101 veins that had been the site of percutaneous insertions only. In addition, 5 internal jugular vein thromboses were identified in 15 veins that had been cannulated surgically with the Quinton PermCath. The authors conclude that percutaneous internal jugular vein cannulation for hemodialysis access causes an acceptably low incidence of jugular vein damage. This strengthens the case for preferential use of the internal jugular vein for vascular access in patients with end-stage renal failure, and suggests that percutaneous cannulation is less damaging than surgical insertion.ASAIO Journal1995; 41:169-172.