Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
Health Innovations Coordinating Center (MHICC), Montreal Heart Institute, Montreal, QC, Canada.
Can J Anaesth. 2018 Apr;65(4):350-359. doi: 10.1007/s12630-017-1032-8. Epub 2017 Dec 5.
The primary objective of this study was to define the ultrasound-derived anatomy of the axillary/subclavian vessels. As a secondary objective, we evaluated the relationship between the vascular anatomy and demographic, anthropometric, and hemodynamic data of patients.
This observational anatomical study used bedside ultrasound with 150 cardiac surgical patients in the operating room. Bilateral axillary and subclavian anatomy was determined using a high-frequency ultrasound probe with fixed reference points. Images were recorded and analyzed, and correlation with demographic, anthropometric, and hemodynamic data was performed.
The images were adequate to evaluate potential anatomical variations in 97.4% of patients with a body mass index as high as 46.4 kg·m. The mean (standard deviation) diameter of the axillary vein was 1.2 (0.3) cm on the right side and 1.1 (0.2) cm on the left side. The dimensions of the axillary vein were larger on the right side in 69% of patients. The vein was located directly over the artery in the mid-clavicular view in 67% of the patients and in lateral-clavicular view in only 7% of the patients. As we moved the probe laterally, the vein was lateralized in relation to the artery in 89% of patients. There was no significant correlation between the hemodynamic data and vessel size, although direct correlation was found between body mass index and the depth of the vessel (P < 0.001). The axillary vein area was smaller in females than in males (P < 0.002), and in 4% of patients, the axillary vein was in an aberrant position.
In patients undergoing cardiac surgery, axillary vessel anatomy varied considerably, and the patients' hemodynamics could not predict the size of the axillary vessels. Only the patients' weight correlated moderately with the depth of the vein.
本研究的主要目的是确定腋窝/锁骨下血管的超声解剖结构。作为次要目标，我们评估了血管解剖结构与患者的人口统计学、人体测量学和血液动力学数据之间的关系。
这是一项观察性解剖研究，在手术室对 150 例心脏外科患者进行床边超声检查。使用高频超声探头和固定参考点确定双侧腋窝和锁骨下解剖结构。记录并分析图像，并与人口统计学、人体测量学和血液动力学数据进行相关性分析。
在高达 46.4kg·m2 的体重指数的 97.4%的患者中，图像足以评估潜在的解剖变异。右侧腋静脉的平均（标准差）直径为 1.2（0.3）cm，左侧为 1.1（0.2）cm。在 69%的患者中，右侧静脉直径较大。在锁骨中视图，静脉位于动脉正上方的比例为 67%，而在锁骨外侧视图仅为 7%。当我们将探头向外侧移动时，89%的患者静脉相对于动脉向外侧移位。尽管发现了体重指数与血管深度之间的直接相关性，但血流动力学数据与血管大小之间没有显著相关性（P<0.001）。女性的腋静脉面积小于男性（P<0.002），在 4%的患者中，腋静脉位置异常。
在接受心脏手术的患者中，腋血管解剖结构差异很大，患者的血液动力学不能预测腋血管的大小。只有患者的体重与静脉的深度中度相关。
