Subclavian and Internal Jugular Veins at Doppler US: Abnormal Cardiac Pulsatility and Respiratory Phasicity as a Predictor of Complete Central Occlusion

Abstract

In 21 consecutive patients, the authors analyzed changes in venous Doppler waveforms of damped or diminished cardiac pulsatility and respiratory phasicity. Each patient was suspected of having upper limb venous thrombosis, but thrombus was not visible at gray-scale ultrasonography (US) in the subclavian and brachiocephalic veins. US findings were compared with phlebographic findings. The results show that US can be used to establish the presence or absence of thrombosis in the distal portion of the brachiocephalic or subclavian veins, which are inaccessible to direct insonation.

Diagnosis of DVT

“…Table 11 summarizes the quality of evidence and frequency of potential clinical outcomes for the various diagnostic strategies. [217][218][219][220][221][222][223][224][225][226][227][228] …”

“…216,219,[223][224][225][226][227] Only two studies (total of 65 patients) have evaluated the accuracy of a single CUS compared with venography. 216,219 Although the pooled sensitivity and specifi city were 97% (95% CI, 90%-100%) and 94% (95% CI, 80%-99%), respectively, the studies were of low quality and the CIs are wide.…”

“…[222][223][224][225][226][227][228] All of the available accuracy studies have signifi cant limitations. No management studies using these techniques have been performed.…”

Prevalence of inherited prothrombotic abnormalities and central venous catheter-related thrombosis in haematopoietic stem cell transplants recipients

“…[17][18] For veins inaccessible to direct insonation (middle part of the subclavian vein, brachiocephalic vein, and superior caval vein), the criterion of monophasic flow to detect occlusive thrombosis was used. 19 All CVCs were removed before discharge. Clinical follow-up took place for 8 weeks after CVC removal.…”

Beware: The femoral haemodialysis catheter – a surgeon’s perspective

“…Several imaging modalities (including duplex ultrasound, [13,14] computed tomography venography and (3-D) MR venography [15] ) have been validated in the diagnosis and exclusion of postcatheterisation venous stenosis. However, exclusion of significant stenosis (accepted as ≥50%) does not necessarily predict successful transplantation.…”