Journal of cardiothoracic and vascular anesthesia · 2025
Prospective Evaluation of Thrombotic Complications After Internal Jugular Vein Cannulation for External Bypass.
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Flinspach Armin Niklas, Zacharowski Kai, Raimann Florian Jürgen, Piekarski Florian
Аннотация
OBJECTIVES: To determine the incidence and subsequent complications of internal jugular vein (IJV) thrombosis after cannulation performed during cardiopulmonary bypass (CPB) to ensure adequate venous drainage during minimally invasive cardiac surgery.
DESIGN: Single-center observational trial SETTINGS: Intensive care postoperative monitoring of cardiac surgery patients and diagnosis of IJV thrombi at a university tertiary hospital during the 13-month study period from December 1, 2022, to January 11, 2024.
PARTICIPANTS: 44 patients undergoing catheterization of the IJV for total CPB.
INTERVENTION: Structured ultrasound of the IJV at 12 to 16 hours after removing the cannula, in the context of intensive care therapy.
MEASUREMENTS & MAIN RESULTS: The incidence of ultrasound-detected IJV thrombi was 79.5%. Thrombi located at the insertion site were smaller compared to those located distally. No major complications were observed during cannula insertion or removal, and none of the patients had clinical symptoms related to IJV thrombi. There were no correlations between cannula size (p = 0.886), intravascular insertion length (p = 0.086), duration of CPB (p = 0.094), or body weight (p = 0.590).
CONCLUSIONS: Although IJV thrombosis was frequent, all cases remained clinically silent. These findings suggest that although thrombus formation is common, the risk of symptomatic or obstructive thrombosis may be low. Structured ultrasound follow-up and a risk-adapted anticoagulation strategy, as suggested by recent ESVS guidelines, may optimize postoperative management and outcomes.
DESIGN: Single-center observational trial SETTINGS: Intensive care postoperative monitoring of cardiac surgery patients and diagnosis of IJV thrombi at a university tertiary hospital during the 13-month study period from December 1, 2022, to January 11, 2024.
PARTICIPANTS: 44 patients undergoing catheterization of the IJV for total CPB.
INTERVENTION: Structured ultrasound of the IJV at 12 to 16 hours after removing the cannula, in the context of intensive care therapy.
MEASUREMENTS & MAIN RESULTS: The incidence of ultrasound-detected IJV thrombi was 79.5%. Thrombi located at the insertion site were smaller compared to those located distally. No major complications were observed during cannula insertion or removal, and none of the patients had clinical symptoms related to IJV thrombi. There were no correlations between cannula size (p = 0.886), intravascular insertion length (p = 0.086), duration of CPB (p = 0.094), or body weight (p = 0.590).
CONCLUSIONS: Although IJV thrombosis was frequent, all cases remained clinically silent. These findings suggest that although thrombus formation is common, the risk of symptomatic or obstructive thrombosis may be low. Structured ultrasound follow-up and a risk-adapted anticoagulation strategy, as suggested by recent ESVS guidelines, may optimize postoperative management and outcomes.