title: Computed tomography (CT) venography using a multidetector CT prior to the percutaneous external jugular vein approach for an implantable venous-access port.
abstract: OBJECTIVE
  The objective of this study was to determine the success rate and complications of using the percutaneous approach of the external jugular vein (EJV) for placement of a totally implantable venous-access port (TIVAP) with a preoperative estimate of the detailed anatomical orientation of the cervical venous plexus using computed tomography venography (CT-V).
  
  
  METHODS
  A prospective cohort study of 45 patients in whom placement of a TIVAP was attempted via the right EJV was conducted. The preoperative anatomical estimation of the cervical venous plexus was performed with CT-V using a Multidetector Helical 16-section CT. The angulation between the right EJV and the right subclavian vein, anterior jugular vein, transverse cervical vein, and suprascapular vein was estimated.
  
  
  RESULTS
  CT-V success was achieved in 45 of 45 patients (100 %). A plexus of veins under the clavicle was most commonly responsible for the insertion of the central venous catheter. The EJV approach resulted in a successful cannulation rate of 93 %. No initial complications of pneumothorax or carotid artery puncture occurred during insertion procedures. Late complications occurred in three patients. These included one port erosion (2 %), one catheter occlusion (2 %), and one wound hematoma (2 %). Catheter-related infections were observed in one patient (2 %).
  
  
  CONCLUSIONS
  The percutaneous EJV approach with CT-V guidance is an optional method for patients with multiple central venous cannulations, those in hemodialysis, or those with long catheter indwelling periods.
authors.affiliation: Department of Surgery, Pippu Clinic, Kamikawa-gun, Hokkaido, Japan, pippuclinickato@gold.ocn.ne.jp.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kato
authors.forename: Masahiko
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Keita
authors.initials: K
authors.lastname: Sasahara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nagase
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Onodera
authors.forename: Minoru
authors.initials: M
authors.lastname: Matsuda
authors.forename: Mineko
authors.initials: M
authors.lastname: Higuchi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kobashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Furukawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D010690:Phlebography; D011379:Prognosis; D011446:Prospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*