Method for installing venous port system in case of single persistent left superior vena cava

Abstract

FIELD: cardiovascular surgery; oncology.SUBSTANCE: used to install a venous port system in the presence of a single persistent left superior vena cava. To achieve a technical result, under local anesthesia and ultrasound control, a puncture of the internal jugular vein on the right is performed, and a diagnostic guide is inserted through the puncture needle to the level of the lower edge of the left main bronchus. After this, an X-ray control is performed in the anteroposterior projection of the X-ray apparatus detector relative to the anterior surface of the chest, the location of the conductor in the projection of the left borders of the heart is noted, an X-ray control with angulation of the detector by 90 degrees to the left relative to the anterior surface of the chest is noted, the S-shaped course of the conductor is noted. Next, an introducer is installed along the diagnostic guidewire. Then the vascular dilator is removed from it along with the diagnostic guidewire, and a venous catheter is inserted along the entire length of the introducer. After which, slowly pulling the introducer “towards oneself”, the venous catheter is advanced forward. X-ray control is performed in the anteroposterior projection of the X-ray apparatus detector relative to the anterior surface of the chest with the catheter tip positioned at the level of the left main bronchus and a test blood sample is taken. Next, a subcutaneous “pocket” is formed for the port system in the deltoid-thoracic groove, the port system is connected to the catheter and implanted.EFFECT: method allows for the reliable installation of a venous port system in the presence of a single persistent left superior vena cava.1 cl, 1 ex

Description

[0001] The invention relates to the field of medicine, namely to cardiovascular surgery and oncology, and can be used to install a venous port system in the presence of a single persistent left superior vena cava.

[0002] A port system is a medical device designed for long-term access to central veins during multiple infusions. In oncology, it is most often used for systemic chemotherapy and for difficult access to peripheral veins. Installation of a port system involves catheterization of one of the central veins: the internal jugular or subclavian, with preference given to veins located on the right side due to their anatomical structure [1].

[0003] It is important to note that the anatomy of the veins of the superior vena cava system is always sufficient and structural anomalies are rare, but they can create difficulties during the implantation of a venous port system [1-3].

[0004] Persistent left superior vena cava is the most common congenital anomaly of the superior vena cava system. Two variants of persistent left superior vena cava are distinguished: the presence of a single persistent left superior vena cava and the presence of two vena cava [4-7]. In 90% of cases, both the left and right superior vena cava are present [7]. Much less frequently, regression of the caudal right superior cardinal vein occurs, which leads to the presence of a single persistent left superior vena cava.

[0005] The technique of installing the port system and positioning the tip of the venous catheter is well described in the literature for normal anatomy of the superior vena cava basin:

[0006] 1. Initially, a puncture of one of the central veins is performed, followed by fluoroscopic control of the position of the conductor and the installation of a catheter in it.

[0007] 2. After bluntly dissecting the skin, the covering tissues of the chest are spread apart, thereby forming a “pocket” for the capsule of the venous port system.

[0008] 3. Catheter positioning is monitored using fluoroscopy or ECG changes. A "blind" method, in which the catheter length is calculated before surgery, is also possible.

[0009] 4. Attaching the port system capsule to the catheter.

[0010] However, there is no data on the method of installation in the case of a single persistent left superior vena cava, namely the features of the passage and positioning of the proximal edge of the venous catheter [1].

[0011] The technical result is the development of an effective method for installing a venous port system in the case of a single persistent left superior vena cava.

[0012] Implementation of the invention

[0013] To achieve the technical result, under local anesthesia and ultrasound guidance, a puncture of the internal jugular vein on the right is performed. A diagnostic guidewire is inserted through the puncture needle to the level of the lower edge of the left main bronchus. An X-ray is then taken in the anteroposterior projection of the X-ray detector relative to the anterior chest surface. The position of the guidewire is noted in the projection of the left borders of the heart. An X-ray is taken with the detector angulated 90 degrees to the left relative to the anterior chest surface, and the S-shaped course of the guidewire is noted. An introducer sheath is then inserted along the diagnostic guidewire. The vascular dilator and the diagnostic guidewire are then removed, and a venous catheter is inserted to the full length of the introducer sheath. The venous catheter is then advanced by slowly pulling the introducer sheath toward you.An X-ray is taken in the anteroposterior projection of the X-ray machine's detector relative to the anterior chest wall, with the catheter tip positioned at the level of the left main bronchus and a blood sample collected. Next, a subcutaneous "pocket" is created for the port system in the deltopectoral groove, the port system is connected to the catheter, and implanted.

[0014] Three patients were operated on using this technique; the venous port system functioned in the postoperative period, and no complications were identified.

[0015] Clinical example

[0016] A 50-year-old woman diagnosed with a malignant neoplasm in her left breast was referred for placement of a subcutaneous venous port system. The patient had no history of cardiovascular disease, and upon examination, she reported no cardiovascular complaints.

[0017] Surgical protocol. Under local anesthesia and ultrasound guidance, the right internal jugular vein was punctured, and a diagnostic guidewire was advanced through the puncture needle to the intersection with the left main bronchus. After X-ray control in the anteroposterior projection of the X-ray detector, it was revealed that the guidewire was located to the left of the trachea and left bronchus. X-ray control with the detector angulated at 90 degrees on the left revealed an S-shaped course of the guidewire.

[0018] Next, an introducer sheath was inserted along the diagnostic guidewire. The vascular dilator and the diagnostic guidewire were then removed, and a venous catheter was inserted along the entire length of the introducer sheath. Slowly pulling the introducer sheath toward you, the venous catheter was advanced, positioning the catheter tip at the level of the left main bronchus, and a blood sample was collected. A subcutaneous pocket for the port system was then created in the deltopectoral groove, connected to the catheter, and implanted (Fig. 1).

[0019] Bibliography

[0020] 1. Dolgushin B.I. Interventional radiology in oncology. VIDAR; 2022.

[0021] 2. Litvinenko L.M. Vascular and nervous complexes of the human body. - M.: ZAO Business Olympus; 2011.

[0022] 3. Lubotsky D.N. Fundamentals of topographic anatomy / D.N. Lubotsky - M: Medgiz, 1953.

[0023] 4. Goyal SK, Punnam SR, Verma G, Ruberg FL. Persistent left superior vena cava: a case report and review of literature. Cardiovasc Ultrasound. 2008; 6: 50. doi: 10.1186 / 1476-7120-6-50.

[0024] 5. Roberts D, Bellamy C, Ramsdale D. Implantation of a dual chamber pacemaker in a patient with persistent left superior vena cava. Int J Cardiol. 1992; 36(2): 242-243. doi: 10.1016 / 0167-5273(92)90017-w.

[0025] 6. Tak T, Crouch E, Drake GB. Persistent left superior vena cava: incidence, significance and clinical correlates. Int J Cardiol. 2002; 82: 91-3. doi: 10.1016 / s0167-5273(01)00586-1.

[0026] 7. Echeverry DR, Buitrago JG, Restrepo AA, Morales CD. Persistent left superior vena cava as an incidental finding in the introduction of a transient pacemaker: A case report. Biomedica. 2022; 42(3): 440-444. doi: 10.7705 / biomedica.6505.

Claims

A method for installing a venous port system with a single persistent left superior vena cava, characterized in that under local anesthesia, a puncture of the internal jugular vein is performed on the right, a diagnostic conductor is inserted through the puncture needle to the level of the lower edge of the left main bronchus, after which X-ray control is carried out in the anteroposterior projection of the detector of the X-ray apparatus relative to the anterior surface of the chest, the location of the conductor in the projection of the left borders of the heart is noted, then X-ray control is carried out with angulation of the detector of the X-ray apparatus by 90 degrees to the left relative to the anterior surface of the chest, the S-shaped course of the conductor is noted, then an introducer is installed along the diagnostic conductor, after which a venous catheter is inserted to the full length of the introducer, and then the introducer is pulled up, while the venous catheter is advanced forward,X-ray control is carried out in the anterior-posterior projection of the X-ray apparatus detector relative to the anterior surface of the chest with the tip of the catheter positioned at the level of the left main bronchus and a test blood sample is taken, then a subcutaneous pocket is formed in the area of ​​the deltoid-thoracic groove, and the port system is connected to the catheter and implanted.

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