Acute and Critical Care

Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access: Pil Young Jung, Hoon Ryu, Jae Hung Jung, Eunbi Lee, Joong Hwan Oh, Chun Sung Byun, Il Hwan Park; Korean J Crit Care Med. 2015;30(4):365-365. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.365; Corrects: Acute Crit Care 2015;30(1):13

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Cardiology/Thoracic Surgery
Cardiac Rupture of the Junction of the Right Atrium and Superior Vena Cava in Blunt Thoracic Trauma: Chun Sung Byun, Il Hwan Park, Tae Hoon Kim, Eunbi Lee, Joong Hwan Oh; Korean J Crit Care Med. 2015;30(1):27-30. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.27

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Abstract PDF: Cardiac rupture following blunt thoracic trauma is rarely encountered, since it commonly causes death at the scene. With advances in critical care, blunt cardiac rupture has been successfully treated with well-organized team approach including an emergency physician, anesthesiologist, and cardiac surgeon. We encountered a patient with blunt cardiac rupture of the junction of the superior vena cava and right atrium that extended 7 cm to the right ventricular junction. The patient was successfully resuscitated after a closed thoracostomy and pericardiocentesis with fluid loading. Cardiac injury was repaired via mid-sternotomy without cardiopulmonary bypass. The patient recovered without complications and was discharged on the 7th day after surgery.

Thoracic Surgery
Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access: Pil Young Jung, Hoon Ryu, Jae Hung Jung, Eunbi Lee, Joong Hwan Oh, Chun Sung Byun, Il Hwan Park; Korean J Crit Care Med. 2015;30(1):13-17. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.13; Correction in: Acute Crit Care 2015;30(4):365

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Background
Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. Methods: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. Results: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax (n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complication free probability is significantly higher in group 1 (p = 0.040). Conclusions: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.

Citations

Citations to this article as recorded by

Internal jugular vein versus subclavian vein as the percutaneous insertion site for totally implantable venous access devices: a meta-analysis of comparative studies
Shaoyong Wu, Jingxiu Huang, Zongming Jiang, Zhimei Huang, Handong Ouyang, Li Deng, Wenqian Lin, Jin Guo, Weian Zeng
BMC Cancer.2016;[Epub] CrossRef

Esophageal-Retroesophageal Right Subclavian Artery Fistula: A Case Report: Jin Ho Choi, Chun Sung Byun, Seong Min Kim, Jung Joo Hwang; Korean J Crit Care Med. 2012;27(3):179-181.; DOI: https://doi.org/10.4266/kjccm.2012.27.3.179

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Abstract PDF: Fistula between retroesophageal subclavian artery and esophagus is rare but a fatal complication. The purpose of this case study is to describe a case of 47-year old male presented with intracranial hemorrhage being required a long stay in the intensive care unit and to demonstrate the importance of surveillance patients requiring prolonged nasogastric tube. Recognition of this aberrant artery is critical for the prevention of these catastrophic events.

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