Central venous stenosis is a rare cause of unilateral breast edema occurring in hemodialysis patients that needs to be differentiated from other differential diagnoses, including, but not limited to, inflammatory breast carcinoma, mastitis, lymphedema, and congestive heart failure. All reports of similar cases in the available literature have described improvement or resolution of the edema after treatment. Herein, we report and discuss the pathophysiology of breast edema formation in a patient who presented with massive left-sided breast edema 7 years after being diagnosed with central venous stenosis. Medical and minimally invasive therapy had not been successful, so she underwent reduction mammoplasty to relieve the symptoms.
Axillary Vein ; Breast ; Constriction, Pathologic* ; Diagnosis, Differential ; Edema ; Female ; Heart Failure ; Humans ; Inflammatory Breast Neoplasms ; Lymphedema ; Mammaplasty* ; Mastitis ; Renal Dialysis ; Upper Extremity Deep Vein Thrombosis

Lead insertion for cardiac implantable electronic devices requires venous access into the right side of the heart. The access route commonly used is from the axillary vein, through the subclavian vein and the superior vena cava. However, in patients with congenital heart malformations or those with vascular stenosis, and/or those who have undergone previous cardiac surgery, the passage of leads might be difficult, and the implantation procedure would show restricted scope. In such cases, insertion of leads through the hepatic vein is known to be a safe procedure. We report 2 cases of patients with limited vascular access who underwent lead implantation using the transhepatic approach—1 patient who underwent placement of an implantable cardioverter defibrillator and the other who underwent placement of a permanent pacemaker.
Axillary Vein ; Constriction, Pathologic ; Defibrillators ; Defibrillators, Implantable ; Heart ; Hepatic Veins ; Humans ; Subclavian Vein ; Thoracic Surgery ; Vena Cava, Superior

Persistence of jugulocephalic vein is one of the extremely rare variations of the cephalic vein. Knowledge of such a variation is of utmost importance to orthopedic surgeons while treating the fractures of the clavicle, head and neck surgeons, during surgery of the lower part of neck, for cardiothoracic surgeons and radiologists during catheterization and cardiac device placement. We report the persistent jugulocephalic vein in an adult male cadaver, observed during the routine dissection classes. The right cephalic vein ascended upwards, superficial to the lateral part of the clavicle and terminated into the external jugular vein. It also gave a communicating branch to the axillary vein below the clavicle. We discuss the embryological and clinical importance of this rare variation.
Adult ; Axillary Vein ; Cadaver ; Catheterization ; Catheters ; Clavicle ; Head ; Humans ; Jugular Veins ; Male ; Neck ; Orthopedics ; Subclavian Vein ; Surgeons ; Veins*

BACKGROUNDThe conventional venous access for cardiovascular implantable electronic device (CIED) is the subclavian vein, which is often accompanied by high complication rate. The aim of this study was to assess the efficacy and safety of optimized axillary vein technique.

METHODSA total of 247 patients undergoing CIED implantation were included and assigned to the axillary vein group or the subclavian vein group randomly. Success rate of puncture and complications in the perioperative period and follow-ups were recorded.

RESULTSThe overall success rate (95.7% vs. 96.0%) and one-time success rate (68.4% vs. 66.1%) of punctures were similar between the two groups. In the subclavian vein group, pneumothorax occurred in three patients. The subclavian gaps of three patients were too tight to allow operation of the electrode lead. In contrast, there were no puncture-associated complications in the axillary vein group. In the patient follow-ups, two patients in the subclavian vein group had subclavian crush syndrome and both of them received lead replacement. The incidence of complications during the perioperative period and follow-ups of the axillary vein group and the subclavian vein group was 1.6% (2/125) and 8.2% (10/122), respectively (χ2 = 5.813, P = 0.016).

CONCLUSIONOptimized axillary vein technique may be superior to the conventional subclavian vein technique for CIED lead placement.

TRIAL REGISTRATIONwww.clinicaltrials.gov, NCT02358551; https://clinicaltrials.gov/ct2/show/NCT02358551?term=NCT02358551& rank=1.

Aged ; Axillary Vein ; Defibrillators, Implantable ; adverse effects ; Electrodes, Implanted ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Pacemaker, Artificial ; adverse effects ; Perioperative Care ; Pneumothorax ; diagnosis ; etiology ; Postoperative Complications ; Prosthesis Implantation ; adverse effects ; Subclavian Vein

A 64-year-old male patient underwent cardiac resynchronization therapy (CRT) device implantation via the axillary venous approach. Two weeks later, the patient started complaining of "electric shock-like" pain in the left axillary area. During physical examination, typical pain in the left axillary area was reproduced whenever his left shoulder was passively abducted more than 60 degrees. Fluoroscopic examination showed that the left ventricle (LV) and right atrium (RA) leads were positioned at an acute angle directing towards the left brachial plexus whenever the patient's shoulder was passively abducted. Brachial plexus irritation by the angulated CRT leads was strongly suspected. To relieve the acute angulation, we had to adjust the entry site of the LV and RA leads from the distal to the proximal axillary vein using the cut-down method. After successful lead repositioning, the neuropathic pain improved rapidly. Although transvenous pacing lead-induced nerve injury is not a frequent complication, this possibility should be kept in mind by the operators.
Axillary Vein ; Brachial Plexus* ; Cardiac Resynchronization Therapy ; Heart Atria ; Heart Ventricles ; Humans ; Male ; Middle Aged ; Neuralgia ; Peripheral Nerve Injuries ; Physical Examination ; Shoulder

Knowledge of anatomic variants of veins in the arm and axilla play a key role in planning of successful venous access. Possible anatomic variants of axillary vein, brachial vein and basilic vein and their clinical implications have been well described in the literature. We report a rare case of formation of a short axillary vein associated with complex venous communications between the basilic and brachial veins forming a venous ladder in the axilla, in formalin embalmed male cadaver. Axillary vein was formed in the upper part of the axilla by the fusion of basilic vein and unpaired brachial vein, and it was about 3cm in length. The higher-up confluence of basilic and brachial veins was also associated with presence of three communicating veins between the basilic and brachial veins in the axilla. Knowledge of reported venous variations is very useful during preoperative venous mapping and also for planning and execution of various surgical invasive procedures involving these veins.
Axillary Vein

During gross anatomy dissection, variation in the formation of median nerve of the upper limb was discovered in the right upper extremity of a 57-year-old male cadaver. Three roots contributed to the formation of median nerve instead of usual two roots i.e. two lateral roots and one medial root. After being formed the median nerve descended medial to the axillary artery. Between the two lateral roots brachial vein passed to open into the axillary vein. Anatomical variations in the formation of nerves and their unusual relationship to the surrounding structures can be the cause of nerve compression syndromes and vascular problems.
Axillary Artery ; Axillary Vein

Traumatic arteriovenous fistula between the axillary artery and vein may present a difficult problem in treatment. There are few reports demonstrating the endovascular repair of this challenge. Herein, we present such a case of endovascular repair of traumatic arteriovenous fistula between the axillary artery and vein with false aneurysm formation. The patient was discharged 11 days after successful operation. Oral clopidogrel and aspirin were administered for 18 months. At one year follow-up, the patient was in good condition and showed no evidence of neurological deficit in the left upper limb.
Adult ; Arteriovenous Fistula ; surgery ; Axillary Artery ; injuries ; surgery ; Axillary Vein ; injuries ; surgery ; Endovascular Procedures ; methods ; Humans ; Male

BACKGROUND: The ability to explore the anatomy has improved our appreciation of the brachial anatomy and the quality of regional anesthesia. Using real-time ultrasonography, we investigated the cross-sectional anatomy of the brachial plexus and of vessels at the axillary fossa in Koreans. METHODS: One hundred and thirty-one patients scheduled to undergo surgery in the region below the elbow were enrolled after giving their informed written consent. Using the 5-12 MHz linear probe of an ultrasound system, we examined cross-sectional images of the brachial plexus in the supine position with the arm abducted by 90degrees, the shoulder externally rotated, and the forearm flexed by 90degrees at the axillary fossa. The results of the nerve positions were expressed on a 12-section pie chart and the numbers of arteries and veins were reported. RESULTS: Applying gentle pressure to prevent vein collapse, the positions of the nerves changed easily and showed a clockwise order around the axillary artery (AA). The most frequent positions were observed in the 10-11 section (79.2%) for the median, 1-2 section (79.3%) for the ulnar, 3-5 section (78.4%) for the radial, and 8-9 section (86.9%) for the musculocutaneous nerve. We also noted anatomical variations consisting of double arteries (9.2%) and multiple axillary veins (87%). CONCLUSIONS: Using real-time ultrasonography, we found that the anatomical pattern of the major nerves in Koreans was about 80% of the frequent position of individual nerves, 90.8% of the single AA, and 87% of multiple veins around the AA.
Anatomy, Cross-Sectional ; Anesthesia, Conduction ; Arm ; Arteries ; Axilla ; Axillary Artery ; Axillary Vein ; Brachial Plexus* ; Elbow ; Forearm ; Humans ; Musculocutaneous Nerve ; Shoulder ; Supine Position ; Ultrasonography* ; Veins

Anatomical variations of the nerves, muscles, and vessels in the upper limb have been described in many anatomical studies; however, the occurrence of 6 variations in an ipsilateral limb is very rare. These variations occur in the following structures: the pectoralis minimus muscle, the communication between the external jugular vein and cephalic vein, axillary arch, the Struthers ligament, the medial, lateral, and posterior cords of the brachial plexus, and the common arterial trunk from the third part of the axillary artery. The relationship of these variations to each other and their probable clinical presentation is discussed.
Axillary Artery ; Axillary Vein ; Brachial Plexus ; Cadaver ; Extremities ; Humans ; Jugular Veins ; Ligaments ; Male ; Median Nerve ; Muscles ; Upper Extremity