-
Experimental Physiology May 2021What is the central question of this study? Recently, an internal jugular venous thrombus was identified during spaceflight: does microgravity induce venous and/or... (Review)
Review
NEW FINDINGS
What is the central question of this study? Recently, an internal jugular venous thrombus was identified during spaceflight: does microgravity induce venous and/or coagulation pathophysiology, and thus an increased risk of venous thromboembolism (VTE)? What is the main finding and its importance? Whilst data are limited, this systematic review suggests that microgravity and its analogues may induce an enhanced coagulation state due to venous changes most prominent in the cephalad venous system, as a consequence of changes in venous flow, distension, pressures, endothelial damage and possibly hypercoagulability in microgravity and its analogues. However, whether such changes precipitate an increased VTE risk in spaceflight remains to be determined.
ABSTRACT
Recently, an internal jugular venous thrombus was identified during spaceflight, but whether microgravity induces venous and/or coagulation pathophysiology, and thus, an increased risk of venous thromboembolism (VTE) is unclear. Therefore, a systematic (Cochrane compliant) review was performed of venous system or coagulation parameters in actual spaceflight (microgravity) or ground-based analogues in PubMed, MEDLINE, Ovid EMBASE, Cochrane Library, European Space Agency, National Aeronautics and Space Administration, and Deutsches Zentrum für Luft-und Raumfahrt databases. Seven-hundred and eight articles were retrieved, of which 26 were included for evaluation with 21 evaluating venous, and five coagulation parameters. Nine articles contained spaceflight data, whereas the rest reported ground-based analogue data. There is substantial variability in study design, objectives and outcomes. Yet, data suggested cephalad venous system dilatation, increased venous pressures and decreased/reversed flow in microgravity. Increased fibrinogen levels, presence of thrombin generation markers and endothelial damage were also reported. Limited human venous and coagulation system data exist in spaceflight, or its analogues. Nevertheless, data suggest spaceflight may induce an enhanced coagulation state in the cephalad venous system, as a consequence of changes in venous flow, distension, pressures, endothelial damage and possibly hypercoagulability. Whether such changes precipitate an increased VTE risk in spaceflight remains to be determined.
Topics: Blood Coagulation; Humans; Jugular Veins; Space Flight; Thrombosis; Weightlessness
PubMed: 33704837
DOI: 10.1113/EP089409 -
Internal and Emergency Medicine Aug 2022Accurate volume status assessments allow physicians to rapidly implement therapeutic measures in acutely unwell patients. However, existing bedside diagnostic tools are... (Meta-Analysis)
Meta-Analysis
Accurate volume status assessments allow physicians to rapidly implement therapeutic measures in acutely unwell patients. However, existing bedside diagnostic tools are often unreliable for assessing intravascular volume. We searched PUBMED, EMBASE, CENTRAL, and Web of Science for English language articles without date restrictions on January 20, 2022. Studies reporting the diagnostic accuracy of IJV-US for hypovolemia and/or hypervolemia in an acute care setting were screened for inclusion. We included studies using any method of IJV-US assessment as the index test, compared against any reference standard. We fitted hierarchical summary receiver operating characteristic (HSROC) models for meta-analysis of diagnostic test accuracy, separately for hypovolemia and hypervolemia. Two reviewers independently extracted data and assessed risk of bias using QUADAS-2. We assessed certainty of evidence using the GRADE approach. A total of 26 studies were included, of which 19 studies (956 patients) examined IJV-US for hypovolemia and 13 studies (672 patients) examined IJV-US for hypervolemia. For the diagnosis of hypovolemia, IJV-US had a pooled sensitivity of 0.82 (95% CI 0.76 to 0.87; moderate-certainty evidence) and specificity of 0.82 (95% CI 0.73 to 0.88; moderate-certainty evidence). Measurement of IJV collapsibility indices had higher diagnostic accuracy (sensitivity 0.85, 95% CI 0.80 to 0.89; specificity 0.78, 95% CI 0.64 to 0.88) than static IJV indices (sensitivity 0.73, 95% CI 0.60 to 0.82; specificity 0.70, 95% CI 0.48 to 0.86). For the diagnosis of hypervolemia, IJV-US had a pooled sensitivity of 0.84 (95% CI 0.70 to 0.92; moderate-certainty evidence) and specificity of 0.70 (95% CI 0.55 to 0.82; very low-certainty evidence). IJV-US has moderate sensitivity and specificity for the diagnosis of hypervolemia and hypovolemia. Randomized controlled trials are needed to determine the role of IJV-US for guiding therapeutic interventions aimed at optimizing volume status.
Topics: Adult; Humans; Hypovolemia; Jugular Veins; ROC Curve; Sensitivity and Specificity; Ultrasonography
PubMed: 35718838
DOI: 10.1007/s11739-022-03003-y -
Indian Journal of Anaesthesia Jun 2023Subclavian vein catheterisation (SVC) is more effective than internal jugular or femoral catheterisation and is linked to a lesser incidence of infection and patient...
Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterisation: An updated systematic review and meta-analysis of randomised controlled trials.
BACKGROUND AND AIMS
Subclavian vein catheterisation (SVC) is more effective than internal jugular or femoral catheterisation and is linked to a lesser incidence of infection and patient discomfort. Whether the supraclavicular (SC) or infraclavicular (IC) approach is more effective for SVC is unclear in the previous systematic review. This updated review is designed to search the efficacy and safety of both approaches adopting the Grading of Recommendations Assessment, Development and Evaluation approach.
METHODS
In May 2022, we explored the databases of Embase, MEDLINE, CENTRAL, ClinicalTrials.gov and WHO-ICTRP for randomised controlled trials to compare the two approaches.
RESULTS
Seventeen trials (2482 cases) were included. In the primary outcomes, the SC approach likely reduces the failure proportion (relative risk [RR], 0.63; 95% confidence interval [CI], 0.47-0.86; = 5%) and the incidence of malposition (RR, 0.23; 95% CI, 0.13-0.39; = 0%) with moderate evidence and may slightly reduce the incidence of arterial puncture and pneumothorax (RR, 0.59; 95% CI, 0.29-1.22; = 0%) with low evidence. In the secondary outcomes, the SC approach may decrease the access time and may increase the first-attempt success proportion.
CONCLUSION
The SC approach for SVC should be selected after considering the clinician's expertise.
PubMed: 37476443
DOI: 10.4103/ija.ija_837_22 -
Journal of Ultrasound Jun 2024Vascular access in neonates and small infants is often challenging. Ultrasound (US) screening and guidance improves its safety and efficacy. The advantages of a... (Review)
Review
Vascular access in neonates and small infants is often challenging. Ultrasound (US) screening and guidance improves its safety and efficacy. The advantages of a pre-implantation ultrasound examination are intuitive; it is a practical and safe technique that doesn't use radiation, allowing static and dynamic evaluations to be carried out and identifying anatomical variations, the caliber and depth of the vessel, the patency of the entire course and attached structures (nerves, etc.). Optimization of the image is a crucial aspect in achieving a clear view of all anatomical structures while avoiding complications. The goal of this review was to look into the benefits of using US in invasive catheter insertion procedures, especially in pediatric patients. Ultrasonography is used to visualize vessels and related structures in two dimensions (2D), sometimes with the help of color Doppler to detect the presence of intraluminal thrombi by applying gentle compression to assess vessel collapse and evaluate morphologic changes in the internal jugular vein (IJV) who had undergone central venous catheter (CVC) insertion during the neonatal period (Montes-Tapia et al. in J Pediatr Surg 51:1700-1703, 2016).
Topics: Humans; Infant, Newborn; Catheterization, Central Venous; Ultrasonography, Interventional; Ultrasonography; Jugular Veins
PubMed: 37801208
DOI: 10.1007/s40477-023-00832-1 -
Clinical Anatomy (New York, N.Y.) Jan 2020The objective of this study was to identify and analyze the anatomical variations in the termination of the thoracic duct (TD) in cadavers or patients by anatomical...
The objective of this study was to identify and analyze the anatomical variations in the termination of the thoracic duct (TD) in cadavers or patients by anatomical dissections and surgical or radiological procedures for better knowledge of the interindividual variations through a systematic review. The search strategy included PubMed and reference tracking. Studies were identified by searching the electronic Medline databases. The search terms included "TD," "Jugular Vein," "Subclavian Vein," or "Cervical," and the protocol used is reported herein. These search results yielded 20 qualitative review articles out of the 275 articles consulted. We collected all the important data from these 20 articles with 1,352 TD analyzed by varying sources in our search. Regarding the characteristics of the studies and the anatomy of the TD, the results were heterogeneous. The TD most commonly terminates in the internal jugular vein in 54.05% of cases (95% confidence interval [CI]: 54.03; 54.07), in the jugular-venous angle in 25.79% (95% CI: 25.77; 25.81), and in the subclavian vein in 8.16% of cases (95% CI: 8.14;8.18). Other terminations were found in 12% of cases. This systematic review provided an overview of the variations in the distal portion of the TD. This study can be helpful for surgeons in selecting the most appropriate methods to achieve successful surgical results and avoid complications, such as chylothorax; it also offers detailed information on the cervical termination of the TD in new diagnostic and therapeutic methods involving the TD. Clin. Anat. 32:99-107, 2019. © 2019 Wiley Periodicals, Inc.
Topics: Anatomic Variation; Cadaver; Humans; Jugular Veins; Subclavian Vein; Thoracic Duct
PubMed: 31576619
DOI: 10.1002/ca.23476 -
Frontiers in Medicine 2022Central venous catheterization is a commonly performed procedure, accounting for approximately 8% of hospitalized patients. Based on the current literatures, the most...
INTRODUCTION
Central venous catheterization is a commonly performed procedure, accounting for approximately 8% of hospitalized patients. Based on the current literatures, the most acceptable site for central venous catheterization is inconclusive, considering various complications in hospitalized patients. Herein, we conducted a network meta-analysis to assess the clinically important complications among internal jugular, subclavian, femoral, and peripheral insertion.
MATERIALS AND METHODS
The Cochrane Central Register of Controlled Trials, MEDLINE, Web of Science, Ichushi databases, Clinicaltrials.gov, and International Clinical Trials Registry Platform were searched. Studies including adults aged ≥ 18 years and randomized control trials that compared two different insertion sites (internal jugular, subclavian, femoral, and peripheral vein) were selected. The primary outcomes were clinically important infectious, thrombotic, and mechanical complications.
RESULTS
Among the 5,819 records initially identified, 13 trials (6,201 patients) were included for a network meta-analysis. For clinically important infectious complication, subclavian insertion decreased the complication risk, compared with internal jugular [risk ratio (RR), 0.30; 95% confidence interval (CI), 0.11-0.81; moderate certainty], and femoral insertion increased than subclavian insertion (RR 2.56; 95% CI, 1.02-6.44; moderate certainty). Peripheral insertion was also significantly associated with a lower risk compared with internal jugular (RR 0.06; 95% CI, 0.01-0.32; low certainty); subclavian (RR 0.21; 95% CI, 0.05-0.77; moderate certainty); and femoral insertion (RR 0.08; 95% CI, 0.02-0.40; low certainty). For clinically important thrombotic complication, we did not find significant differences between insertion sites. For clinically important mechanical complication, femoral insertion decreased the complication risk, compared with internal jugular (RR 0.42; 95% CI, 0.21-0.82; moderate certainty) and subclavian insertion (RR 0.33; 95% CI, 0.16-0.66; moderate certainty). Peripheral insertion was also associated with the lower complication risk compared with internal jugular (RR 0.39; 95% CI, 0.18-0.85; low certainty) and subclavian insertion (RR 0.31; 95% CI, 0.13-0.75; moderate certainty).
CONCLUSION
The insertion site of the central venous catheter, which is most likely to cause the fewest complications, should be selected. Our findings can provide the rationale for deciding the insertion site for a central venous catheter.
SYSTEMATIC REVIEW REGISTRATION
[www.protocols.io], identifier [61375].
PubMed: 36106316
DOI: 10.3389/fmed.2022.960135 -
Journal of Vascular Surgery Oct 2020Transcervical carotid artery stenting (CAS) has emerged as an alternative to transfemoral CAS. An earlier systematic review from our group (n = 12 studies; 739... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Transcervical carotid artery stenting (CAS) has emerged as an alternative to transfemoral CAS. An earlier systematic review from our group (n = 12 studies; 739 transcervical CAS procedures [489/739 with flow reversal]) demonstrated that transcervical CAS is a safe procedure associated with a low incidence of stroke and complications. Since then, new studies have been published adding nearly 1600 patients to the literature. We aimed to update our early systematic review and also to perform a meta-analysis to investigate outcomes specifically after transcervical CAS with flow reversal.
METHODS
An electronic search of PubMed/MEDLINE, Embase, and the Cochrane databases was carried out to identify studies reporting outcomes after transcervical CAS with flow reversal. Crude event rates for outcomes of interest were estimated by simple pooling of data. A proportion meta-analysis was also performed to estimate pooled outcome rates.
RESULTS
A total of 18 studies (n = 2110 transcervical CAS procedures with flow reversal) were identified. A high technical success (98.25%) and a low mortality rate (0.48%) were recorded. The crude rates of major stroke, minor stroke, transient ischemic attack, and myocardial infarction (MI) were 0.71%, 0.90%, 0.57%, and 0.57%, respectively; a cranial nerve injury occurred in 0.28% of the procedures. A neck hematoma was reported in 1.04% of the procedures, and a carotid artery dissection occurred in 0.76% of the interventions; in 1.09% of the cases, conversion to carotid endarterectomy was required. After a meta-analysis was undertaken, the pooled technical success rate was 98.69% (95% confidence interval [CI], 97.19-99.70). A pooled mortality rate of 0.04% (95% CI, 0.00-0.29) was recorded. The pooled rate of any type of neurologic complications was 1.88 (95% CI, 1.24-2.61), whereas the pooled rates of major stroke, minor stroke, and transient ischemic attack were 0.12% (95% CI, 0.00-0.46), 0.15% (95% CI, 0.00-0.50), and 0.01% (95% CI, 0.00-0.22), respectively. The pooled rate of bradycardia/hypotension was 10.21% (95% CI, 3.99-18.51), whereas the pooled rate of MI was 0.08% (95% CI, 0.00-0.39). A neck hematoma after transcervical CAS was recorded in 1.51% (95% CI, 0.22-3.54) of the procedures; in 0.74% (95% CI, 0.05-1.95) of the interventions, conversion to CEA was required. Finally, a carotid artery dissection during transcervical CAS occurred in 0.47% (95% CI, 0.00-1.38) of the procedures.
CONCLUSIONS
This updated systematic review and meta-analysis demonstrated that transcervical CAS with flow reversal is associated with high technical success, almost zero mortality, and low rates of major stroke, minor stroke, MI, and complications.
Topics: Arteriovenous Shunt, Surgical; Carotid Artery, Common; Carotid Stenosis; Femoral Vein; Humans; Incidence; Ischemic Attack, Transient; Jugular Veins; Myocardial Infarction; Postoperative Complications; Risk Assessment; Risk Factors; Stents; Stroke; Treatment Outcome
PubMed: 32422272
DOI: 10.1016/j.jvs.2020.04.501 -
Journal of Anesthesia Dec 2021Internal jugular vein catheterization (IJVC) and subclavian vein catheterization (SCVC) have been the most preferred central venous catheterizations (CVC) clinically.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Internal jugular vein catheterization (IJVC) and subclavian vein catheterization (SCVC) have been the most preferred central venous catheterizations (CVC) clinically. Individual preference and institutional routine dominate the traditional CVC choice; however, it is lack of high-level evidence. We sought to provide better clinical strategy for CVC site choice based on anatomical landmark technique between IJVC and SCVC.
METHODS
We systematically reviewed eligible studies from PubMed, OVID, Cochrane and ClinicalTrials.Gov till February 2020. The primary outcomes were catheterization time and overall success rate, and the secondary outcomes were the first-attempt success rate and the instant mechanical complications. Ethical problems are not applicable.
RESULTS
A total of 3378 patients from 7 studies were included in the analyses. Neither difference was found on the catheterization time (SMD 95% CI: -0.095-0.124, p = 0.792), nor any difference on the overall success rate (RR = 1.017, 95% CI: 0.927-1.117, p = 0.721, I = 89.6%) between the 2 procedures. However, subgroup analyses showed overall success rate of IJVC was significantly lower than that of SCVC (RR = 0.906, 95% CI: 0.850-0.965, p = 0.002) in adults. The first-attempt success rate of IJVC group was higher in the adults (RR = 1.472, 95% CI: 1.004-2.156, p = 0.047). No significance was detected in arterial injury (RR = 1.137, 95% CI: 0.541-2.387, p = 0.735) and pneumothorax (RR = 0.600, 95% CI: 0.32-1.126, p = 0.112) between the two procedures. Hematoma was significantly more in IJVC group than that in SCVC group (RR = 2.824, 95% CI: 1.181-6.751, p = 0.02).
CONCLUSIONS
Compared with IJVC, SCVC shows a higher overall success rate while a lower first-attempt success rate in adults, and has involved with less hematoma.
PROSPERO REGISTRATION
CRD42020165444.
Topics: Adult; Catheterization, Central Venous; Humans; Jugular Veins; Pneumothorax
PubMed: 34341863
DOI: 10.1007/s00540-021-02976-y -
JA Clinical Reports Sep 2022Thyrocervical trunk rupture is an unusual, but critical, complication associated with central venous catheter (CVC) placement. The management of this complication has...
BACKGROUND
Thyrocervical trunk rupture is an unusual, but critical, complication associated with central venous catheter (CVC) placement. The management of this complication has not been fully determined because it is rare.
CASE PRESENTATION
A 53-year-old Japanese woman with anorexia nervosa developed refractory ventricular fibrillation. After returning spontaneous circulation, a CVC was successfully placed at the initial attempt in the right internal jugular vein using real-time ultrasound guidance. Immediately after CVC placement, she developed enlarging swelling around the neck. Contrast-enhanced computed tomography showed massive contrast media extravasation around the neck and mediastinum. Brachiocephalic artery angiography showed a "blush" appearance of the ruptured right thyrocervical trunk. After selective arterial embolization with 33% N-butyl-2-cyanoacrylate, the extravasation completely disappeared and hemostasis was achieved.
CONCLUSION
Our findings suggest that severe vascular complications arising from CVC placement can occur in patients with a fragile physiological state. Endovascular embolization is an effective treatment for such complications.
PubMed: 36109440
DOI: 10.1186/s40981-022-00565-w -
Indian Journal of Anaesthesia Nov 2023There are two approaches for ultrasound (US)-guided vessel cannulation: the short axis (SA) approach and the long axis (LA) approach. However, it remains to be seen...
BACKGROUND AND AIMS
There are two approaches for ultrasound (US)-guided vessel cannulation: the short axis (SA) approach and the long axis (LA) approach. However, it remains to be seen which approach is better. Therefore, we performed the present updated systematic review and meta-analysis to assess the effectiveness and safety of US-guided vascular cannulation between the SA and LA techniques.
METHODS
We performed a comprehensive electronic database search in PubMed, Embase, Cochrane Library and Web of Science for the relevant studies from inception to June 2022. Randomised controlled trials comparing the SA approach and the LA approach for US-guided vascular access were incorporated in this updated meta-analysis. The first-attempt success rate was the primary outcome. The secondary outcomes were the overall success rate, cannulation time, number of attempts and the incidence of complications. The statistical analysis was conducted using RevMan software (version 5.4; the Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark). The Cochrane risk of bias tool was used to evaluate each study's potential risk for bias.
RESULTS
In total, 16 studies consisting of 1885 participants were incorporated in this updated meta-analysis. No statistically significant difference was found between the SA and LA vascular access techniques for first-pass success rate (risk ratio = 1.07, 95% confidence interval: 0.94-1.22). The overall cannulation success rate, complication rate, average cannulation time and average number of attempts were not significantly different between the SA and LA groups.
CONCLUSION
This updated meta-analysis demonstrated that the SA and LA approaches of US-guided vessel cannulation are similar regarding first-pass success, overall cannulation success rate, total complication rate, cannulation time and the number of attempts.
PubMed: 38187975
DOI: 10.4103/ija.ija_965_22