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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 -
Surgical Neurology International 2019Internal jugular phlebectasia (IJP), the abnormal dilatation of internal jugular vein, is generally considered a benign anomaly. However, because IJP is uncommon, little... (Review)
Review
BACKGROUND
Internal jugular phlebectasia (IJP), the abnormal dilatation of internal jugular vein, is generally considered a benign anomaly. However, because IJP is uncommon, little is known about its natural history, and currently, no consensus on the best treatment modality is available.
METHODS
The purpose of this article is to conduct a systematic review of available literature on recently reported IJP cases to understand the main characteristics of IJP and its most frequent therapeutic approaches. Following the preferred reporting items for systematic reviews and meta-analyses guidelines, literature search for IJP cases was conducted in the COCHRANE, PUBMED, EBSCOHOST, SCOPUS, OVID, and SCIELO databases.
RESULTS
A total of 97 original articles were found, with a total of 247 IJP cases reported including both pediatric and adult patients.
CONCLUSIONS
To the best of our knowledge, this study is the largest systematic review analyzing all the reported cases of IJP. IJP is considered by most authors as a benign abnormality that predominantly affects the right jugular vein. It is most commonly diagnosed in children. At present, conservative treatment is preferred for pediatric but not for adult patients. Multicenter randomized prospective studies are required to further understand this rare anomaly.
PubMed: 31528444
DOI: 10.25259/SNI-217-2019 -
The Journal of Vascular Access Mar 2020Comparison between various approaches of ultrasound (USG)-guided internal jugular vein cannulation, that is, short-axis out-of-plane approach, long-axis in-plane... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Comparison between various approaches of ultrasound (USG)-guided internal jugular vein cannulation, that is, short-axis out-of-plane approach, long-axis in-plane approach, and oblique-axis approach, is sparse. In this network meta-analysis of randomized controlled trials, all three approaches were evaluated to identify the best technique for USG-guided internal jugular vein cannulation.
METHODS
Randomized controlled trials comparing short-axis out-of-plane approach, long-axis in-plane approach, and oblique-axis approach in any combination (i.e. comparison of any two or all three) for USG-guided internal jugular vein cannulation were included in this meta-analysis. Bayesian network meta-analysis was conducted with a non-informative prior effect size and heterogeneity, and all results were reported as posterior median odds ratio with 95% credible interval.
RESULTS
Data of 658 patients from five randomized controlled trials were included in this meta-analysis. No difference was obtained in first attempt success rate of cannulation in three approaches (posterior median odds ratio between long-axis and short-axis view, oblique-axis and short-axis view, and long-axis and oblique-axis view were 0.67 (0.20, 2.08), 0.92 (0.09, 4.790), and 1.3420 (0.1680, 6.7820), respectively). No difference was seen in the incidence of carotid artery puncture and overall success rate of cannulation.
CONCLUSION
All three commonly used approaches for USG-guided internal jugular vein cannulation, that is, short axis, long axis, and oblique axis, are comparable in terms of clinical utility and safety. There is insufficient evidence to recommend one approach over another for this purpose.
Topics: Catheterization, Central Venous; Humans; Jugular Veins; Network Meta-Analysis; Punctures; Randomized Controlled Trials as Topic; Risk Factors; Ultrasonography, Interventional
PubMed: 31423893
DOI: 10.1177/1129729819868927 -
Annals of Anatomy = Anatomischer... Sep 2019To provide a systematic literature review on effectiveness of arteriovenous fistula (AVF) and Shunt (AVS) research animal models.
PURPOSE
To provide a systematic literature review on effectiveness of arteriovenous fistula (AVF) and Shunt (AVS) research animal models.
BACKGROUND
Due to advancing human population age, there is increased incidence of patients suffering from vascular and renal diseases leading to dialysis access using AVF and/or AVS. During those interventions native venous or synthetic grafts are arterialized. Despite temporary good patency, complications are a consequence of neointimal hyperplasia (NIH) development that contributes to patients' morbidity and mortality. Basic research attempts to elucidate the pathomechanisms, therefore the small and large animal models are becoming attractive.
METHODS
Medline search (within 1966-2018) was performed on AVF/AVS animal models. Studies fulfilled following criteria: (1) reported complete material-methods-results section, (2) included statistically significant number of animals, (3) provided statistically significant results. 55 articles were identified encompassing six animal species used.
RESULTS
Large animal models include creation of AVF and AVS in pig, sheep and dog. Porcine animal models use pelvic or femoral vessels, ovine use the common carotid artery (CCA) and jugular vein (JV). Canine animal models use the femoral vessels. Small animal models use rabbit (CCA/JV), rat (JV/CCA, abdominal aorta /Vena cava inferior and femoral artery/femoral vein) and mouse (aortocaval and supraortic AVF models).
CONCLUSIONS
Large animal models are best for haemodynamic shear stress studies and in vivo evaluation of new synthetic vascular grafts. Small animal models, especially the genetically manipulated ones, are ideal for analysis of molecular and cellular pathomechanisms. The selection of animal species to be used depends on the addressed research question.
Topics: Animals; Arteriovenous Fistula; Arteriovenous Shunt, Surgical; Dogs; Hyperplasia; Mice; Models, Animal; Neointima; Rabbits; Rats; Renal Dialysis; Renal Insufficiency, Chronic; Sheep; Swine; Vascular Access Devices; Vascular Diseases
PubMed: 31279868
DOI: 10.1016/j.aanat.2019.06.002 -
Journal of Acute Medicine Jun 2019Few studies have tested the role of the internal jugular vein (IJV) ultrasonographic (US) diameters in the assessment of central venous pressure (CVP) in spontaneously...
BACKGROUND
Few studies have tested the role of the internal jugular vein (IJV) ultrasonographic (US) diameters in the assessment of central venous pressure (CVP) in spontaneously breathing patients. No review or meta-analysis is currently available on the role of IJV assessment in this setting. The aim of this systematic review is to check the reliability and accuracy of IJV US diameters in predicting CVP and to evaluate its correlation with CVP in spontaneously breathing patients.
METHODS
This systematic review was based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We included studies on the accuracy and reliability of the IJV ultrasound measures and studies exploring its correlation with CVP in adult spontaneously breathing patients. The studies' report quality was assessed by Standards for Reporting of Diagnostic Accuracy (STARD) and Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 scales.
RESULTS
A total of five studies was eligible for final analysis. The studies on IJV ultrasound measures showed a good quality in reporting. The anterior-posterior diameter maximum of IJV (AP-IJV Dmax) showed the best correlation with the CVP with a good inter-rater reliability and validity in predicting CVP. All measures showed good inter-rater reliability and validity in predicting CVP, but only the AP-IJV Dmax showed good correlation with CVP.
CONCLUSIONS
The AP-IJV Dmax could be a potential surrogate of CVP because of its good reliability and validity in predicting CVP value and its fair-moderate correlation with CVP. Anyway, further research should confi rm these conclusions.
PubMed: 32995230
DOI: 10.6705/j.jacme.201906_9(2).0001 -
The Cochrane Database of Systematic... May 2019Multiple sclerosis (MS) is a leading cause of neurological disability in young adults. The most widely accepted hypothesis regarding its pathogenesis is that it is an...
BACKGROUND
Multiple sclerosis (MS) is a leading cause of neurological disability in young adults. The most widely accepted hypothesis regarding its pathogenesis is that it is an immune-mediated disease. It has been hypothesised that intraluminal defects, compression, or hypoplasia in the internal jugular or azygos veins may be important factors in the pathogenesis of MS. This condition has been named 'chronic cerebrospinal venous insufficiency' (CCSVI). It has been suggested that these intraluminal defects restrict the normal blood flow from the brain and spinal cord, causing the deposition of iron in the brain and the eventual triggering of an auto-immune response. The proposed treatment for CCSVI is venous percutaneous transluminal angioplasty (PTA), which is claimed to improve the blood flow in the brain thereby alleviating some of the symptoms of MS. This is an update of a review first published in 2012.
OBJECTIVES
To assess the benefit and safety of venous PTA in people with MS and CCSVI.
SEARCH METHODS
We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group's Specialised Register up to 30 August 2018, CENTRAL (in the Cochrane Library 2018, issue 8), MEDLINE up to 30 August 2018, Embase up to 30 August 2018, metaRegister of Controlled Trials, ClinicalTrials.gov., the Australian New Zealand Clinical Trials Registry, and the World Health Organization (WHO) International Clinical Trials Registry platform. We examined the bibliographies of the included and excluded studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) in which PTA and sham interventions were compared in adults with MS and CCSVI.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed study eligibility and risk of bias, and extracted data. We reported results as risk ratios (RR) with 95% confidence intervals (CI). We performed statistical analyses using the random-effects model; and we assessed the certainty of the evidence using GRADE.
MAIN RESULTS
We included three RCTs (238 participants) in this update. One hundred and thirty-four participants were randomised to PTA and 104 to sham treatment. We attributed low risk of bias to two (67%) studies for sequence generation and two (67%) studies for performance bias. All studies were at a low risk of detection bias, attrition bias, reporting bias and other potential sources of bias.There was moderate-quality evidence to suggest that venous PTA did not increase the proportion of patients who had operative or post-operative serious adverse events compared with the sham procedure (RR 3.33, 95% CI 0.36 to 30.44; 3 studies, 238 participants); nor did it increase the proportion of patients who improved on a functional composite measure including walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity over 12-month follow-up (RR 0.84, 95% CI 0.55 to 1.30; 1 study, 110 participants); nor did it reduce the proportion of patients who experienced new relapses at six- or 12-month follow-up (RR 0.87, 95% CI 0.51 to 1.49; 3 studies, 235 participants). There was no effect of venous PTA on disability worsening measured by the Expanded Disability Status Scale, which was reported at follow-up intervals of six months (one study), 11 months (one study) and 12 months (one study). Quality of life was reported in two studies with no difference between treatment groups. Moderate or severe pain during or post venography was reported in both PTA and sham-procedure participants in all included studies. Venous PTA was not effective in restoring blood flow assessed at one-month (one study) or 12-month follow-up (one study).
AUTHORS' CONCLUSIONS
This systematic review identified moderate-quality evidence that, compared with sham procedure, venous PTA intervention did not provide benefit on patient-centred outcomes (disability, physical or cognitive functions, relapses, quality of life) in people with MS. Venous PTA has proven to be a safe technique but in view of the available evidence of its ineffectiveness, this intervention cannot be recommended in people with MS. All ongoing trials were withdrawn or terminated and hence this updated review is conclusive. No further randomised clinical studies are needed.
Topics: Angioplasty; Cerebrovascular Circulation; Humans; Multiple Sclerosis; Randomized Controlled Trials as Topic; Venous Insufficiency
PubMed: 31150100
DOI: 10.1002/14651858.CD009903.pub3 -
European Review For Medical and... Nov 2018We performed a systematic review of the literature starting from a real case of venous air embolism (VAE) in a young infant undergoing central catheterization during...
We performed a systematic review of the literature starting from a real case of venous air embolism (VAE) in a young infant undergoing central catheterization during procedural sedation. Air embolism due to internal jugular vein catheterization during procedural sedation is very rare, but it is a potentially life-threatening complication of central catheterization that warrants attention. To our knowledge, this is the first case published in a similar scenario.
Topics: Catheterization, Central Venous; Deep Sedation; Embolism, Air; Humans; Infant; Male; Pulmonary Embolism
PubMed: 30536338
DOI: 10.26355/eurrev_201811_16418 -
Pediatrics Nov 2018: media-1vid110.1542/5828324804001PEDS-VA_2018-1719 CONTEXT: Central venous catheterization is routinely required in patients who are critically ill, and it carries an... (Meta-Analysis)
Meta-Analysis
UNLABELLED
: media-1vid110.1542/5828324804001PEDS-VA_2018-1719 CONTEXT: Central venous catheterization is routinely required in patients who are critically ill, and it carries an associated morbidity. In pediatric patients, the procedures can be difficult and challenging, predominantly because of their anatomic characteristics.
OBJECTIVE
To determine whether ultrasound-guided techniques are associated with a reduced incidence of failures and complications when compared with the anatomic landmark technique.
DATA SOURCES
We conducted a systematic search of PubMed and Embase.
STUDY SELECTION
We included randomized controlled trials and nonrandomized studies in which researchers compare ultrasound guidance with the anatomic landmark technique in children who underwent central venous catheterization.
DATA EXTRACTION
Study characteristics, sample sizes, participant characteristics, settings, descriptions of the ultrasound technique, puncture sites, and outcomes were analyzed. Pooled analyses were performed by using random-effects models.
RESULTS
A total of 23 studies (3995 procedures) were included. Meta-analysis revealed that ultrasound guidance significantly reduced the risk of cannulation failure (odds ratio = 0.27; 95% confidence interval: 0.17-0.43), with significant heterogeneity seen among the studies. Ultrasound guidance also significantly reduced the incidence of arterial punctures (odds ratio = 0.34; 95% confidence interval: 0.21-0.55), without significant heterogeneity seen among the studies. Similar results were observed for femoral and internal jugular veins.
LIMITATIONS
Potential publication bias for cannulation failure and arterial puncture was detected among the studies. However, no publication bias was observed when analyzing only the subgroup of randomized clinical trials.
CONCLUSIONS
Ultrasound-guided techniques are associated with a reduced incidence of failures and inadvertent arterial punctures in pediatric central venous catheterization when compared with the anatomic landmark technique.
Topics: Anatomic Landmarks; Catheterization, Central Venous; Child; Critical Illness; Humans; Incidence; Treatment Failure; Ultrasonography, Interventional
PubMed: 30361397
DOI: 10.1542/peds.2018-1719 -
Hamostaseologie Feb 2019Lemierre syndrome usually affects otherwise healthy adolescents or young adults and occurs at an overall rate of 1 to 10 cases per million person-years with an estimated... (Meta-Analysis)
Meta-Analysis
Lemierre syndrome usually affects otherwise healthy adolescents or young adults and occurs at an overall rate of 1 to 10 cases per million person-years with an estimated fatality rate of 4 to 9%. Diagnostic criteria remain debated and include acute neck/head bacterial infection (often tonsillitis caused by anaerobes at high potential for sepsis and vascular invasion, notably ) complicated by local vein thrombosis, usually involving the internal jugular vein, and systemic septic embolism. Medical treatment is based on antibiotic therapy with anaerobic coverage, anticoagulant drugs and supportive care in case of sepsis. Surgical procedures can be required, including drainage of the abscesses, tissue debridement and jugular vein ligation. Evidence for clinical management is extremely poor in the absence of any adequately sized study with clinical outcomes. In this article, we illustrate two cases of Lemierre syndrome not caused by and provide a clinically oriented discussion on the main issues on epidemiology, pathophysiology and management strategies of this disorder. Finally, we summarize the study protocol of a proposed systematic review and individual patient data meta-analysis of the literature. Our ongoing work aims to investigate the risk of new thromboembolic events, major bleeding or death in patients diagnosed with Lemierre syndrome, and to better elucidate the role of anticoagulant therapy in this setting. This effort represents the starting point for an evidence-based treatment of Lemierre syndrome built on multinational interdisciplinary collaborative studies.
Topics: Adult; Anti-Bacterial Agents; Anticoagulants; Fusobacterium necrophorum; Humans; Lemierre Syndrome; Male; Prognosis; Venous Thrombosis; Young Adult
PubMed: 30071559
DOI: 10.1055/s-0038-1654720 -
Der Anaesthesist Jul 2018Correct positioning of a central venous catheter (CVC) tip in pediatric patients is very important. Malpositioning may lead to direct complications, such as arrhythmia... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Correct positioning of a central venous catheter (CVC) tip in pediatric patients is very important. Malpositioning may lead to direct complications, such as arrhythmia and increase the risk of thrombosis, infections, valve failures or pericardial tamponade.
OBJECTIVE
The aim of this review was to identify and summarize published formulae for the correct positioning of the CVC tip in children and to discuss the benefits of these formulae for the daily routine.
MATERIAL AND METHODS
A systematic and standardized search in Medline and PubMed was performed to identify published formulae. Formulae for insertion depth of the CVC tip over the right internal jugular vein are discussed. The keywords "pediatric" or "pediatric", "children", "central venous catheter", "CVC", "central venous", "length", "insertion", "optimal", "formula", "depth", "correct position" and "right position", "internal jugular vein" were used to identify the formulae.
RESULTS
A total of 854 publications were found and 127 publications were analyzed. The publications were subsequently assessed and classified independently by a specialist in anesthesiology and a specialist in pediatrics. A total of six publications described different body height-based formulae for calculation of a CVC insertion depth. No prospective evaluation of these formulae was performed to show if it is possible to place a CVC tip at the optimal position.
CONCLUSION
The benefit of a formula for daily practice is very limited due to the problem of choosing the right insertion point. The recommended insertion depth should be considered as an indicator and a verification of the CVC tip position should be done using an imaging technique.
Topics: Catheterization, Central Venous; Central Venous Catheters; Child; Humans; Infant; Jugular Veins
PubMed: 29736556
DOI: 10.1007/s00101-018-0446-1