The anatomic factors and the clinical significance of left innominate vein stenosis due to anatomic compression on CT
Dong Junxiu1, Ke Dong2, Hu Liangzhu3, Liu Yangdong3, Fu Qining3
1Department of Nephrology, the Second Hospital of Yinzhou, Ningbo 315000, China; 2Department of Vascular Surgery, Hua Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315000, China; 3Department of Vascular Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Abstract:Objective This study aimed to evaluate the anatomic factors and the clinical significance of left innominate vein(LIV) stenosis due to anatomic compression in the population detected by CT scan.Methods A retrospective study was conducted. A total of 107 hemodialysis patients with left upper limb functional hemodialysis access (i.e., arteriovenous fistula or arteriovenous graft) and chest enhanced CT obtained at the First Affiliated Hospital of Chongqing Medical University from January 2018 to September 2019 were enrolled as the observation group. Another 758 non-hemodialysis patients with chest enhanced CT obtained between July and September 2019 were enrolled as the control group. The observation indices were as follows: minimum anteroposterior diameter of the left brachiocephalic vein (D1), shortest anteroposterior distance between the sternum and aortic arch (or brachiocephalic trunk) (D2), and anteroposterior inner diameter of thoracic cage (D3). In this work: (1)the relationships among D1, D2, and D3 were analyzed; (2) the relationships between D1 and D2 and height, body weight, age, sex, and history of hypertension were determined; (3) the influence of the duration of functional hemodialysis access on D1 and D2 was explored; and (4) to analyzed the patients with D1≤2 mm.Results Compared with patients in the control group, those in the observation group were older and more likely to have a history of hypertension (all P values<0.01). No significant difference in terms of gender, height, and body weight (all P values>0.05) was observed among the groups. (1) D1 in the observation group ([8.513±3.337] mm) was greater than that in the control group ([7.812±3.176] mm), and the difference between groups was statistically significant (P<0.05). D2 comparison showed no significant difference between the two groups (P>0.05). D1 and D2 in the observation and control groups presented normal distributions and significant linear correlations (r=0.663, 0.694; all P values<0.01), and no significant linear correlation with D3 was observed. (2) Height and body weight were not significantly related to D1 or D2 (P>0.05). D1 and D2 in males were higher than those in females. D2 of the observation group and D1,D2 of the control group were compared between males and females, and the differences were statistically significant (t=3.323, 2.048, 5.721; all P values<0.01). D1 and D2 in the control group decreased with age and history of hypertension, and differences observed were statistically significant (F=14.025, 11.822; all P values<0.01). (3) D1 and D2 were correlated with the duration of functional hemodialysis access (r= 0.471, 0.223; all P values>0.05). (4) The proportion of patients with D1 ≤ 2 mm was similar between the two groups (observation group, 2.8%[3/107]; control group, 3.6%[27/758]). Three patients in the observation group with left upper limb functional hemodialysis access did not report symptoms of left upper limb swelling. Three patients in the control group developed varying degrees of left upper extremity swelling after catheter placement through the left side, and two were diagnosed with deep vein thrombosis.Conclusions The minimum LIV diameter is closely related to the shortest distance between the sternum and aortic arch/brachial trunk. Anatomical compression LIV stenosis could increase the risk of left upper limb swelling after functional left hemodialysis access and promote deep venous thrombosis following catheter implantation from the left side.
董俊秀, 柯栋, 胡良柱, 刘杨东, 傅麒宁. 基于CT评估解剖压迫性左头臂静脉狭窄的解剖学因素及临床意义[J]. 中华解剖与临床杂志, 2021, 26(6): 616-622.
Dong Junxiu, Ke Dong, Hu Liangzhu, Liu Yangdong, Fu Qining. The anatomic factors and the clinical significance of left innominate vein stenosis due to anatomic compression on CT. Chinese Journal of Anatomy and Clinics, 2021, 26(6): 616-622.
Rozmus G, Daubert JP, Huang DT, et al. Venous thrombosis and stenosis after implantation of pacemakers and defibrillators[J]. J Interv Card Electrophysiol, 2005, 13(1): 9-19. DOI:10.1007/s10840-005-1140-1.
[3]
Shi Y, Cheng J, Song Y, et al. Anatomical factors associated with left innominate vein stenosis in hemodialysis patients[J]. Hemodial Int, 2014, 18(4): 793-798. DOI:10.1111/hdi.12131.
Chinese Chapter of the International of Angiology, Peripheral Vascular Disease Chapter, Chinese Geriatrics Society. Chinese expert consensus on prevention and treatment catheter related venous thrombosis (2020 edition)[J]. Chinese Journal of Practical Surgery, 2020, 40(4): 377-383. DOI:10.19538/j.cjps.issn1005-2208.2020.04.03.
[5]
Komutrattananont P, Mahakkanukrauh P, Das S. Morphology of the human aorta and age-related changes: anatomical facts[J]. Anat Cell Biol, 2019, 52(2): 109-114. DOI:10.5115/acb.2019.52.2.109.
[6]
Mulè G, Nardi E, Morreale M, et al. The relationship between aortic root size and hypertension: an unsolved conundrum[J]. Adv Exp Med Biol, 2017, 956: 427-445. DOI:10.1007/5584_2016_86.
[7]
Guo X, Shi Y, Xie H, et al. Left innominate vein stenosis in an asymptomatic population: a retrospective analysis of 212 cases[J]. Eur J Med Res, 2017, 22(1): 3. DOI:10.1186/s40001-017-0243-3.
[8]
Viecelli AK, Mori TA, Roy-Chaudhury P, et al. The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: optimism unfulfilled[J]. Semin Dial, 2018, 31(3): 244-257. DOI:10.1111/sdi.12658.
[9]
Brahmbhatt A, Misra S. The biology of hemodialysis vascular access failure[J]. Semin Intervent Radiol, 2016, 33(1): 15-20. DOI:10.1055/s-0036-1572355.
Itkin M, Kraus MJ, Trerotola SO. Extrinsic compression of the left innominate vein in hemodialysis patients[J]. J Vasc Interv Radiol. 2004; 15(1 Pt 1): 51-56. DOI:10.1097/01.rvi.0000106393.63463.de.
[12]
Van Tricht I, De Wachter D, Tordoir J, et al. Hemodynamics and complications encountered with arteriovenous fistulas and grafts as vascular access for hemodialysis: a review[J]. Ann Biomed Eng, 2005, 33(9): 1142-1157. DOI:10.1007/s10439-005-5367-x.
[13]
Rawat V, Browne M, Bellringer M, et al. A tale of two countries: comparing disability weights for gambling problems in New Zealand and Australia[J]. Qual Life Res, 2018, 27(9): 2361-2371. DOI:10.1007/s11136-018-1882-8.
[14]
Chopra V, Ratz D, Kuhn L, et al. Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors[J]. J Thromb Haemost, 2014, 12(6): 847-854. DOI:10.1111/jth.12549.
[15]
Gorski LA. The 2016 infusion therapy standards of practice[J]. Home Healthc Now, 2017, 35(1): 10-18. DOI:10.1097/NHH.0000000000000481.
[16]
Song MG, Seo TS, Kim YH, et al. Effect of catheter diameter on left innominate vein in breast cancer patients after totally implantable venous access port placement[J]. J Vasc Access, 2018, 19(6): 615-619. DOI:10.1177/1129729818765062.
[17]
Song MG, Seo TS, Kang EY, et al. Innominate vein stenosis in breast cancer patients after totally implantable venous access port placement[J]. J Vasc Access, 2015, 16(4): 315-320. DOI:10.5301/jva.5000387.
[18]
Bakhshoude B, Ravari H, Kazemzadeh GH, et al. Diagnostic value of computerized tomography venography in detecting stenosis and occlusion of subclavian vein and superior vena in chronic renal failure patients[J]. Electron Physician, 2016, 8(8): 2781-2786. DOI:10.19082/2781.