Selective jugular cannulation for safer retrograde cerebral perfusion

Okamoto, Hiroshi; Sato, Kimihide; Matsuura, Akio; Ogawa, Yutaka; Asakura, T; Hoshino, M; Seki, Akira; Abe, Toshio; Yasuura, K

doi:10.1016/0003-4975(93)91042-l

Cited by 35 publications

(11 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This competence has been indirectly corroborated by the fact that retrograde brain perfusion to protect the brain performed during aortic arch surgery has been shown to occur mostly through azygos collaterals and can be rendered more efficient with the selective, retrograde catheterization of the IJ veins across the distal valves [14,15]. Developmentally, one may speculate that these valves may have a more pertinent function in quadrupeds since such animals do not benefit from man's erect posture creating a hydrostatic pressure gradient which naturally drains intracranial blood.…”

Section: Discussionmentioning

confidence: 93%

High-resolution ultrasound evaluation of internal jugular venous valves

et al. 1999

View full text Add to dashboard Cite

Although the presence of valves in the distal portion of the internal jugular veins has been widely described by anatomists and pathologists, their existence remains underscored in the medical literature. We set out to demonstrate their sonographic aspect and to evaluate their morphology, location and prevalence. Seventy-five cadavers were evaluated for the presence and aspect of such valves through neck dissections. Concurrent evaluation of the sonographic character of these structures was performed in another cohort of 75 adults. Valves of the distal portion of the internal jugular veins were found in 93 % of the cadaveric studies. Ultrasonography easily demonstrated the valve leaflets in 87 % of patients; all were observed in the distal portion of the internal jugular (IJ) veins. Sixty percent were bilateral with the majority of unilateral veins found on the right side. High-resolution ultrasonography easily demonstrates valves in the distal portion of the IJ veins which are present in the great majority of persons. Their evaluation may be of use in percutaneous procedures using this venous access.

show abstract

Section: Discussionmentioning

confidence: 93%

High-resolution ultrasound evaluation of internal jugular venous valves

et al. 1999

View full text Add to dashboard Cite

show abstract

“…Competent venous valves in experimental models, and even in patients, impede perfusion and may require special cannulation techniques beyond the valves to ensure adequate retrograde perfusion flows. 45 Additional retrograde perfusion of the whole body has also been used in an attempt to preserve the spinal cord and distal organs during operations on the arch and on the thoracic aorta. 46 The value of retrograde cerebral perfusion in the treatment of air embolism was pointed out by Mills and Ochsner in 1980,39 and more recently by others47 with regard to operations on the aortic arch.…”

Section: Retrograde Cerebral Perfusionmentioning

confidence: 99%

Hypothermic Circulatory Arrest and Other Methods of Cerebral Protection During Operations on the Thoracic Aorta

et al. 1994

View full text Add to dashboard Cite

Current surgical techniques in operations on the thoracic aorta frequently require exclusion of the cerebral circulation for varying periods. During these periods, hypothermic circulatory arrest (HCA), selective cerebral perfusion (SCP), and retrograde cerebral perfusion (RCP) can be used for cerebral protection. Hypothermia is the principle component of these methods of protection. The main protective effect of hypothermia is based on reduction of cerebral energy expenditures and largely depends on adequate suppression of cerebral function. It is most effective at deep hypothermic levels (13 degrees C to 15 degrees C). Measures that preserve autoregulation of cerebral blood flow help increase the margin of safety with all methods of protection. There is solid experimental and clinical data indicating the safe limits and outcome following HCA. Current applications of SCP and RCP are fairly recent developments and do not have comparable supporting data. SCP can be used without deep hypothermia and allows prolonged periods of cerebral protection, but is complex in application. RCP is simpler, but always requires deep hypothermia. Present clinical data do not allow separation of its protective effect from that of HCA alone. Recent modifications in the application of HCA include monitoring of cerebral O2 extraction, and selective use of supplemental SCP to limit arrest times to less than 50 minutes, or RCP to prevent embolic strokes, as indicated. These changes appear to have reduced the overall mortality, the severity of embolic strokes, and stroke-related mortality.

show abstract

“…In patients reported to have sustained serious neurological damage despite a relatively short duration of RCP, the cause was possibly due to the impediment of retrograde flow to the brain because of these valves. A technique of selective jugular cannulation through the right atrium using a central venous catheter and a guidewire has been described; 18 however, as previously mentioned, almost all valves are incompetent and a slight elevation of the SVC pressure does not usually cause any problems. Usui et al reported that 20% of perfused blood from the SVC returned to the aorta, and the rest was drained from the inferior vena cava (IVC), 19 which suggests that most retrograde perfused blood passes through veno-venous or veno-capillary-venous connections and drains into the IVC.…”

Section: Discussionmentioning

confidence: 97%

Postoperative brain complications following retrograde cerebral perfusion

et al. 1999

View full text Add to dashboard Cite

This study was undertaken to investigate the neurological risk factors associated with the retrograde cerebral perfusion (RCP) technique, by examining the relationship between intraoperative parameters and post-operative brain complications. A total of 12 patients who underwent surgery for thoracic aortic aneurysms using the RCP technique were included in this study. Profound hypothermia was induced through cardiopulmonary bypass which was established with a femoral arterial cannula and bicaval return. During RCP, a venous drainage cannula from the superior vena cava (SVC) was switched over to the arterial return circuit, and oxygenated blood was retrogradely infused through the SVC. The perfusion flow rate was maintained at 273 +/- 113 ml/min and the SVC pressure was maintained at 15 +/- 6 mmHg. The RCP time was 68 +/- 27 min with a range of 27-130 min, and the lowest rectal temperature was 16 +/- 1 degrees C. The total elapsed time until emergence from anesthesia after the operation was 12 +/- 6 h. The operation time correlated with the awakening time (r = 0.729, P = 0.0088). Longer RCP times of up to 101 and 130 min tended to result in post-operative brain damage. The lowest rectal temperature also correlated with the awakening time (r = 0.697, P = 0.0149), and an inverse correlation between the SVC pressure and the awakening time was observed (r = -0. 727, P = 0.0091). These findings demonstrate the importance of reducing both the RCP and operation times to decrease the incidence of brain damage. If carried out under optimal conditions, including perfusion pressure and brain temperature, RCP could be marginally prolonged safely without causing major neurological complications.

show abstract

Selective jugular cannulation for safer retrograde cerebral perfusion

Cited by 35 publications

References 5 publications

High-resolution ultrasound evaluation of internal jugular venous valves

High-resolution ultrasound evaluation of internal jugular venous valves

Hypothermic Circulatory Arrest and Other Methods of Cerebral Protection During Operations on the Thoracic Aorta

Postoperative brain complications following retrograde cerebral perfusion

Contact Info

Product

Resources

About