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(A) Unusual engorgement of the left external jugular vein noted after creation of an AVF over the left forearm. (B) Venography reveals prominent collateral circulation of the left cervical region (arrows) related to stenosis of the middle portion of the brachiocephalic vein (arrow heads). (C, D) Chest CT performed prior to the closure of the AVF reveals a hypertrophic sternoclavicular joint and degenerative osteophyte compressing the middle portion of the brachiocephalic vein ( V ).
Contexts in source publication
Context 1
... days after the creation of the AVF, we noted After the creation of an arteriovenous fistula (AVF ), an unusually engorged left external jugular vein and a venous outflow may be compromised by stenosis of prominent superficial vein around the left sternoclavic- the subclavian or innominate vein [1,2] and may lead ular joint. There was no evidence of swelling of the to ipsilateral limb oedema [3], swelling of cheeks [4], left upper limb, breast or face ( Figure 1A). Ejection unilateral breast enlargement [5] and benign intracra-fraction (EF ) and wall motion were performed. ...
Context 2
... collateral history of injury to the neck or chest region. There circulation was found in the left neck veins, left upper was also no past history of subclavian or neck vein intercostal veins, left accessory hemiazygos vein and catheterization, collagen vascular disease, diabetes mel-azygos arch ( Figure 1B). Chest computed tomography litus, hypertension, aortic aneurysm or pulmonary (CT ) showed stenosis of the middle portion of the left disease. ...
Context 3
... vein due to external compression Physical findings were unremarkable except for mod-caused by a hypertrophic sternoclavicular joint associ- erate anaemic conjunctiva. Her blood pressure was ated with a degenerative osteophyte ( Figure 1C,D). 120/70 mmHg and her heart rate was 72 beats/min. ...
Citations
... While the exact mechanism in unknown, it is postulated that high flows predispose to endothelial damage and subsequent stenosis (77). One must always rule out external compression of the central veins in these patients (79,80). Unilateral swelling of the arm, breast, face along with dilated veins over the chest and pleural effusions (81) are manifestations of central stenosis. ...
A high-flow access has been defined as one with a flow >1-1.5 l/minute or as one where the access flow is >20% of the cardiac output. Although it may be asymptomatic, it can be associated with cardiopulmonary complications, aneurysms, central vein stenosis and the distal hypoperfusion ischemic syndrome in some patients. The decision for surgical intervention should be made after careful medical optimization especially in patients with high output cardiopulmonary compromise. In this review, we present a summary of current knowledge about the pathophysiology of a high-flow fistula, followed by a concise, comprehensive synopsis of current medical and surgical therapy.
© 2015 Wiley Periodicals, Inc.
We present a dramatic computed tomography scan demonstrating compression of a brachiocephalic graft by a massive sternal osteophyte, coming to light many years after aortic arch replacement surgery.
Complications attributed to central venous stenosis and subsequent thrombosis are increasing in frequency and are most commonly associated with neointimal fibroplasia as well as neoplastic, fibrotic, and traumatic pathologies. We present the successful venous bypass and thoracic wall reconstruction of a fifty-eight year old female with chronic atypical symptoms secondary to brachiocephalic vein occlusion from congenital thoracic dystrophy.
The acromioclavicular (AC) joint is a recognized source of persistent pain following subacromial decompression. However, as both arthroscopic and open lateral clavicle excision may create unacceptable clavicle instability, excision is recommended only if there are preoperative symptoms referable to the AC joint, or if the inferior capsule or clavicle is compromised intraoperatively by subacromial coplaning. The AC joint appears to be less commonly involved in the presence of a cuff tear; however, the presence of an AC joint cyst or effusion is indicative of a rotator cuff tear. Cumulative published experience provides little support for the routine repair of traumatic AC joint disruption. Of the small proportion of patients who remain symptomatic, secondary reconstruction using transferred coracoacromial ligament with artificial or local tissue augmentation provides a predictable recovery of function and stability. Traumatic posterior displacement of the sternoclavicular joint remains an uncommon but potentially serious injury if unrecognized, because of documented mediastinal structure damage. Appropriate imaging (ideally three-dimensional computed tomography scan) is essential where such an injury is suspected, and if the injury is recognized and treated early, closed reduction is usually effective.
Treatment of AC joint injuries and SC joint injuries continues to evolve. The risk of complications of both the operative and nonoperative management of these injuries can be minimized by the treating physician if the physician thoroughly evaluates and understands the problem. Making an accurate diagnosis of the underlying pathology and then selecting the appropriate treatment for this will minimize the risk of an associated complication. Paying attention to detail and using the appropriate technique before any operative intervention is chosen will decrease the risk of failure and complication. Close follow-up and early detection of complications will lead to less severe sequelae. AC joint injuries are more common and operative management is accepted for specific indications. Most Orthopaedic Surgeons are comfortable treating these. SC joint injuries are less common and nonoperative treatment is the mainstay. As our approach to these complex problems evolves, we must keep a wary eye towards avoiding and minimizing the complications of the new techniques.
