Kinney Thomas B
Department of Radiology (8756), UCSD Medical Center, 200 W. Arbor Drive, San Diego, CA 92103, USA.
J Vasc Interv Radiol. 2003 Dec;14(12):1563-8. doi: 10.1097/01.rvi.0000099523.51935.65.
Venous access is a dire necessity in some patients such as those with end-stage renal disease or short gut syndrome. The right internal jugular vein is the preferred entry site for tunneled central venous catheters. Alternatively, the left internal jugular is considered next, with the external jugular and subclavian veins being considered later. Catheter-related venous stenosis approaches 40% in certain sites, resulting in loss of access sites. As sites are lost, insertion of functional long-term central venous catheters becomes challenging. Translumbar inferior vena cava (IVC) access created in two patients with limited venous access sites who had thrombosed IVCs containing IVC filters is described. Because of the higher IVC punctures in these cases, procedural planning with cross-sectional imaging is crucial to avoid puncturing the right renal artery as it passes posterior to the IVC.
静脉通路对于一些患者来说是绝对必要的,比如那些患有终末期肾病或短肠综合征的患者。右侧颈内静脉是隧道式中心静脉导管的首选置入部位。其次可考虑左侧颈内静脉,之后再考虑颈外静脉和锁骨下静脉。在某些部位,导管相关的静脉狭窄发生率接近40%,导致可用的置管部位减少。随着可用部位的减少,插入功能性长期中心静脉导管变得具有挑战性。本文描述了在两名静脉置管部位有限且下腔静脉(IVC)内有IVC滤器形成血栓的患者中创建经腰部下腔静脉通路的情况。由于这些病例中下腔静脉穿刺位置较高,因此利用横断面成像进行程序规划对于避免在右肾动脉经过下腔静脉后方时将其穿刺至关重要。