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J Pediatr Surg 2020 Mar 5. Epub 2020 Mar 5.

Department of Surgery, New York Medical College, Maria Fareri Children's Hospital, 100 Woods Road, Valhalla, NY 10595.

Decannulation from pediatric veno-arterial extracorporeal membrane oxygenation (VA-ECMO) involves the removal of large arterial perfusion cannulas from relatively small lower extremity arteries. While these challenging repairs are frequently performed by general pediatric surgeons, there is little standardization with regard to vascular techniques within the pediatric surgery training paradigm, resulting in variability in the repair of these arteriotomies and potential future consequences for lower extremity perfusion and growth. Herein we present a technique for repair of large common femoral arteriotomies following removal of ECMO perfusion cannulas utilizing a dual-layer patch of ipsilateral saphenous vein harvested via the arterial cutdown incision. Read More

Ann Vasc Surg 2018 Aug 7;51:327.e15-327.e19. Epub 2018 Jun 7.

Internal Medicine, Angiology and Coagulation Unit, University Hospital of Parma, Parma, Italy.

Background: We report the surgical treatment of a high-flow femoro-femoral arteriovenous fistula (AVF), a rare complication of intravenous drug abuse.

Methods: A 36-year-old woman with history of intravenous heroin and cocaine abuse presented with right lower limb edema, inguinal bruit, and heart failure. Duplex ultrasound examination (DUS) and computed tomography angiography showed a large, high-flow AVF involving the common femoral vein and the superficial femoral artery, which is associated with thrombosis of the great saphenous vein and an important inflammation in the right groin, without active bleeding. Read More

Cochrane Database Syst Rev 2015 Feb 26(2):CD011386. Epub 2015 Feb 26.

Cochrane Injuries Group, London School of Hygiene & TropicalMedicine, Room 186, Keppel Street, London, WC1E 7HT, UK.

Background: Dehydration is an important cause of death in patients with Ebola virus disease (EVD). Parenteral fluids are often required in patients with fluid requirements in excess of their oral intake. The peripheral intravenous route is the most commonly used method of parenteral access, but inserting and maintaining an intravenous line can be challenging in the context of EVD. Read More

J Emerg Med 2012 Jul 5;43(1):87-92. Epub 2011 Oct 5.

Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.

Background: Saphenous vein cutdown is a rare venous access procedure. Ultrasound (US) can assist with many vascular access procedures.

Objectives: Our objective was to identify the saphenous veins (SVs) using US in pediatric emergency department (ED) patients, and to determine if the SV size allows for potential cannulation by different standard-size intravenous (i. Read More

Angiol Sosud Khir 2011 ;17(4):77-82

Presented in the article are the results of endovenous laser coagulation of the greater saphenous vein in a total of ony hundred seventeen patients suffering from varicose disease. Favourable outcomes consisted in achieving complete removal of the vertical reflux, accompanied and followed by rapid rehabilitation, an utterly low complication rate, and an excellent cosmetic effect obtained. Read More

J Med Primatol 2009 Jun 10;38(3):204-12. Epub 2009 Feb 10.

Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.

Background: Two novel approaches to implanting a central venous catheter port in non-human primates (NHPs) using peripheral insertion are presented and compared.

Methods: Sixty vascular access port (VAP) implants were attempted in 52 NHPs by saphenous vein puncture (n = 20) or saphenous vein cutdown (n = 40).

Results: Fifty eight procedures were successful. Read More

J Emerg Med 2006 Nov;31(4):411-6

Department of Emergency Medicine, Temple University School of Medicine, 3401 N. Broad Street, Philadelphia, PA 19004, USA.

Timely establishment of vascular access is a critical component of the care of the acutely ill or injured patient. Peripheral venous cutdown, once a mainstay in the care of the severely traumatized patient, has progressively lost favor since the introduction of the Seldinger technique of central venous line placement. In fact, recent editions of the Advanced Trauma Life Support (ATLS) text refer to saphenous venous cutdown as an optional skill to be taught at the discretion of the instructor. Read More

Burns 2006 Mar 30;32(2):267-8. Epub 2006 Jan 30.

G Chir 2005 Jun-Jul;26(6-7):282-5

Azienda Ospedaliera Cannizzaro, Dipartimento di Scienze Chirurgiche, Trapianti d'Organo e Tecnologie Avanzate, Divisione Clinicizzata di Chirurgia d'Urgenza, Università degli Studi di Catania.

Background: When venous system of superior vena cava is not useful or when chest wall is not utilizable to place a reservoir, saphenous vein can be utilized for totally implantable venous access device (TIVAD) placement. Aim of this work is to establish the best location of the reservoir for the function and the comfort of the patient.

Patients And Methods: All the patients submitted to TIVAD placement from January 1995 to October 2004 at the Department of Surgical Science, Organs Transplantations and Advanced Technologies of University of Catania have been considered to the present study. Read More

J Emerg Med 2005 Oct;29(3):347-52

Emergency Medical Associates, Livingston, New Jersey, USA.

The objectives of this project were to establish a practical model for the review of clinical anatomy relevant to the assessment and care of the ill and injured patient, and to design practice models for invasive procedures using human cadaver, porcine cadaver, and plastic model material. A practical course based on the human gross anatomy of the face, neck, thorax, airway, arm, and leg was designed. Regional anesthesia techniques, arthrocentesis, saphenous vein cutdown, central venous and arterial cannulation, surgical airway, thoracostomy tube placement and thoracotomy were integrated into the appropriate practice stations. Read More

Acad Emerg Med 2005 Aug;12(8):782-5

Department of Medicine, University of California, San Francisco, CA, USA.

Background: Preparing medical students for residency in emergency medicine involves education in many areas of knowledge and skill, including instruction in advanced emergency procedures.

Objectives: To outline the logistics involved in running a training course in advanced emergency procedures for fourth-year medical students and to report students' perceptions of the impact of the course.

Methods: The course is a cadaver-based training laboratory that utilizes several teaching modalities, including a Web-based syllabus and online streaming video, didactic lecture, hands-on practice with models and ultrasound, and hands-on practice with unembalmed (fresh) cadavers. Read More

Crit Care 2004 Dec 3;8(6):478-84. Epub 2004 Jun 3.

Paediatric Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia.

The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. Read More

ANZ J Surg 2004 Aug;74(8):639-42

Department of Anatomy and Histology, University of Sydney, Sydney, New South Wales, Australia.

Background: Increasing constraints on operative training in the clinical setting provide impetus for the development of alternative training models. Anatomy dissection courses utilizing human cadavers have been useful in imparting knowledge of human anatomy for surgical trainees. The present study evaluates the impact of competency-based technical skills instruction as an adjunct to cadaveric dissection courses on the procedural skills of basic surgical trainees (BST). Read More

Acad Emerg Med 2002 Jun;9(6):575-86

Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA.

Unlabelled: Certain resuscitative procedures can be lifesaving, but are performed infrequently by emergency medicine (EM) residents on human subjects. Alternative training methods for gaining procedural proficiency must be explored and tested.

Objective: To test whether animal laboratory training (ALT) is associated with sustained improvement in procedural competency and speed. Read More

Prehosp Emerg Care 2001 Apr-Jun;5(2):181-9

Emergency Medical Care Program, Western Carolina University, Cullowhee, North Carolina 28723, USA.

Objective: To compare the success rates, complication rates, and times required for paramedic students to perform saphenous vein cutdown and adult intraosseous infusion using the bone injection gun (BIG).

Methods: This was a prospective, randomized crossover study of 13 senior-level students in a baccalaureate degree paramedic program. Study subjects were instructed in adult intraosseous and saphenous vein cutdown techniques through lecture and laboratory exercises and then randomized into two groups. Read More

J Vasc Surg 2000 Jan;31(1 Pt 1):50-9

Division of Vascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.

Purpose: The absence of an adequate ipsilateral saphenous vein in patients requiring lower-extremity revascularization poses a difficult clinical dilemma. This study examined the results of the use of autogenous arm vein bypass grafts in these patients.

Methods: Five hundred twenty lower-extremity revascularization procedures performed between 1990 and 1998 were followed prospectively with a computerized vascular registry. Read More

Chirurg 1999 Sep;70(9):1036-40

Service de Chirurgie, Hôpital de la Ville, La Chaux-de-Fonds.

An easy venous access improves the quality of life of patients who need prolonged intravenous therapy. In the case of vena cava superior syndrome the classic access in the jugular or subclavian vein can be difficult or even impossible. We report on seven implantations of Port-a-Cath in the inferior vena cava for patients presenting contra-indications to classic venous access to the vena cava superior (five cases of vena cava superior compression syndrome, one tracheostomy and one extended tumor of thoracic wall). Read More

J Trauma 1997 Dec;43(6):985-7

Department of Surgery, Stanford University, California 94305-5239, USA.

The saphenous vein cutdown has long been a mainstay for venous access in the trauma patient. During the past several years, however, its popularity and frequency of use have declined markedly. Percutaneous femoral catheterization using the Seldinger approach has essentially replaced the cutdown as the method of choice for gaining vascular access in most circumstances. Read More

Minerva Chir 1997 Jul-Aug;52(7-8):937-42

Istituto di I Clinica Chirurgica, Università degli Studi di Roma, La Sapienza.

Unlabelled: Totally implantable central venous access devices (Port-a-Cath, PaC) allow better treatment of cancer patients, with safe administration of chemotherapeutic agents, and are well accepted by the patients. The aim of the present paper is to analyze the complications of the different implant techniques on the basis of a personal experience of 92 central venous access devices.

Material And Methods: A total of 92 PaC (Port-a-Cath, Pharmacia: Celsite Braun) have been implanted in 88 patients between August 1992 and June 1995 for cancer treatment. Read More

J Clin Oncol 1995 Jan;13(1):233-8

Department of Surgery, University of Maryland, Baltimore.

Purpose: We undertook this study to review our experience with indwelling vascular access devices in cancer patients to identify factors associated with complications.

Patients And Methods: A total of 322 indwelling devices were placed in 274 cancer patients by a single surgeon. Devices were placed via percutaneous insertion in 72% (231 of 322) and via venous cutdown in 28% (91 of 322). Read More

J Pediatr Surg 1994 Sep;29(9):1218-9

Division of General Surgery, Izaak Walton Killam Hospital for Children, Halifax, Nova Scotia, Canada.

Authors of recent publications advocate central venous access by saphenous vein cutdown in the thigh. Even relatively inert SILASTIC catheters are recognized to convey a risk of large vein thrombosis when maintained for long periods. Thrombosis of the inferior vena cava (IVC) and tributaries place the patient at risk for a spectrum of problems not associated with superior vena cava (SVC) cannulation. Read More

Ann Emerg Med 1994 Mar;23(3):541-5

Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, Illinois.

Study Objective: To compare the speed of IV access and the rate of infusion for saphenous venous cutdown and percutaneous femoral catheterization.

Design: Prospective, randomized, multicentered trial. Patient enrollment occurred from September 1990 through September 1991. Read More

S Afr J Surg 1993 Sep;31(3):120-1

Trauma Unit, Groote Schuur Hospital, Cape Town.

Central venous cannulation is often performed in patients with penetrating wounds of the chest as an aid to diagnosis, and is sometimes also used as a volume infusion resuscitation line in an emergency. The traditional signs of successful central venous cannulation--free aspiration of blood from the exploring needle and inserted cannula, free infusion flow and backflow of blood when the set is lowered below the patient--may all give a false impression of correct placement if there is a significant haemothorax on the same side. Two cases are described where the cannula was sited in a pleural cavity which contained blood, leading to inadequate resuscitation of the patient. Read More

Cancer 1993 Aug;72(3):760-5

Division of Surgery, USC/Kenneth Norris Jr. Cancer Hospital and Research Institute, Los Angeles.

Background: Dependable chronic venous access is an important aspect of supportive care for patients requiring chemotherapy or other long-term therapy because it enables such patients to be treated on an outpatient basis.

Methods: The authors studied 56 patients with cancer requiring chronic venous access who had an infusion catheter placed into the inferior vena cava (IVC) through open saphenous venotomy, most commonly because superior vena cava (SVC) occlusion, severe chest wall infection, or chest wall malignancy precluded standard subclavian or jugular cannulation.

Results: The 56 catheters were in place for 12-550 days. Read More

J Trauma 1993 Jan;34(1):142-3

Department of Surgery, University of Vermont College of Medicine, Burlington 05405.

The procedure described here for rapid venous access is simple, involves minimal dissection, and is highly reliable. Difficulty in defining the saphenous vein in the groin is alleviated by the forceful separation of the subcutaneous tissues, which invariably reveals the vein at the base of the wound. The only materials required are a scalpel, surgical ties, and IV tubing. Read More

Crit Care Clin 1992 Oct;8(4):807-18

Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan.

Critically ill patients who are not candidates for percutaneously placed arterial and venous lines require surgical cutdown. Although significant complications may arise from inadvertent injury to the vessel or associated structures during arterial and venous cutdown, these complications can be minimized by meticulous technique. With attention to site selection and catheter care, the useful life of these complex catheters approaches that of percutaneously placed devices. Read More

Ann Thorac Surg 1992 Sep;54(3):580-1

Department of Cardiothoracic Surgery, Geisinger Medical Center, Danville, Pennsylvania 17822-1343.

Intraoperative placement of catheters to monitor pulmonary artery pressure and cardiac output by oximetry can easily be accomplished under direct vision. The insertion through a saphenous vein cutdown assures a much safer removal, eliminating the risk of bleeding, tamponade, and catheter entrapment. Read More

J Pediatr Surg 1992 Feb;27(2):155-63; discussion 163-4

Children's Hospital of Pittsburgh, PA.

This is an interval analysis of the 2-year prospective multicenter Childrens Cancer Study Group study of 1,141 chronic venous access devices in 1,019 children with cancer. Device type was external catheter (EC) 72%, totally implantable (TID) 28%, and did not differ for diagnosis or age except more double-lumen devices in bone marrow transplant protocols (77%) and more TIDs in children less than 1 year old (17.7%). Read More

J Am Podiatr Med Assoc 1991 Aug;81(8):425-8

California College of Podiatric Medicine, San Francisco.

Distal saphenous vein cutdown is an excellent method for intravenous access. It allows for a rapid infusion of fluids. Although the saphenous vein cutdown is not commonly performed, the podiatrist should be familiar with this procedure, as it may be necessary during an emergency situation. Read More

Aust Fam Physician 1990 Dec;19(12):1874

Am J Emerg Med 1990 Mar;8(2):176-7

Am J Emerg Med 1989 May;7(3):263-6

Department of Internal Medicine, University of California-Davis.

Injured adults can usually be treated adequately with peripheral intravenous lines. However, in hypotensive patients, alternative techniques such as venous cutdown may be necessary. There are no adult studies that document the success rate or time required to complete this procedure in the emergent situation. Read More

Emerg Med Clin North Am 1989 Feb;7(1):65-82

Harbor/UCLA Medical Center.

Emergency Department physicians must be expert in rapidly obtaining adequate intravenous access. Cutdown techniques are an essential part of this endeavor. We have described the step-by-step techniques of placement of a variety of upper- and lower-extremity cutdowns in the Emergency Department. Read More

Ann Emerg Med 1988 Jan;17(1):38-42

Department of Emergency Medicine, Olive View Medical Center, Los Angeles, California.

We first developed a technique for cutdown of the cephalic vein at the wrist. We then conducted a prospective cross-over cadaver study comparing the ability of medical students to perform this technique with that of the standard saphenous vein cutdown at the ankle. All students had a previous course in anatomy but had never performed a cutdown. Read More

Ann Emerg Med 1987 Jan;16(1):44-9

We studied the venous system at the groin, ankle, and antecubital area in relationship to easily palpable or visible surface landmarks, and developed new approaches or modifications of existing approaches to localize the saphenous vein at the groin, ankle, and the basilic vein in the antecubital area. A prospective crossover study comparing these new cutdown techniques with the most commonly described traditional techniques was performed, using inexperienced medical personnel. They were divided into two groups, and the average time to successful venous isolation with each method at each of the three sites was studied. Read More

JPEN J Parenter Enteral Nutr 1986 Nov-Dec;10(6):659-61

A key factor in the success of a home parenteral nutrition program is prolonged and safe access to the central venous system. There are some patients, however, in whom the cephalic, external jugular, internal jugular, subclavian, and saphenous veins cannot be used. In these patients, cannulation of an intercostal vein can be useful for central venous access. Read More

J Pediatr Surg 1986 Apr;21(4):341-3

Thirty-five preterm neonates that had 42 central venous lines placed via saphenofemoral cutdown in the groin are reviewed. The mean gestational age was 29 weeks; mean birth weight 1,320 g. There were no catheter-associated deaths. Read More

Am J Dis Child 1986 Feb;140(2):132-4

Effectiveness of a protocol for intravenous (IV) access during pediatric resuscitation was prospectively evaluated to determine whether utilization of a specified sequence of measures would reduce IV access time compared with resuscitations deviating from the protocol. The protocol involved rapid sequential attempts at percutaneous femoral vein catheterization, saphenous vein cutdown, and intraosseous infusions if initial percutaneous peripheral IV insertion failed. While no single technique provided completely reliable and rapid IV access, utilization of all techniques per protocol significantly improved IV access time. Read More

Aviat Space Environ Med 1985 Dec;56(12):1213-5

Traumatized patients may be transported by a variety of aeromedical transport teams. Frequently, the skills of physicians, nurses, and paramedical personnel overlap. This study was undertaken to determine if nurses used on hospital aeromedical evaluation services perform advanced trauma life support (ATLS) procedures usually reserved for physicians. Read More

J Emerg Med 1985 ;3(5):395-9

Rapid fluid administration is essential for the successful resuscitation of hemorrhagic shock. Distal greater saphenous vein cutdown provides quick venous access for rapid volume repletion. The advantages of this simple technique include the physical characteristics of the vessel and its location. Read More

Nurs Mirror 1984 May;158(22):23-8

J Trauma 1983 Mar;23(3):231-4

The establishment of immediate venous access and rapid fluid administration remains of paramount importance in the treatment of hypovolemic shock. We describe a technique for placement of a recently available 10-gauge catheter via venous cutdown. This technique is simpler and quicker than placing intravenous tubing directly into the vein, and we show that flow rates through the catheter with both saline and blood are equivalent to rates obtained through intravenous extension tubing. Read More

Ann Emerg Med 1982 Mar;11(3):167-8

Ann Emerg Med 1981 Jun;10(6):328-30

An anatomical review and venesection technique for the proximal greater saphenous vein is described. It is recommended as an additional intravenous approach for rapid volume resuscitation in the patient with profound hypovolemic shock. Read More

Cathet Cardiovasc Diagn 1981 ;7(2):209-12

When percutaneous vascular access for cardiac catheterization of small infants fails, necessitating a cutdown approach, we cannulate the isolated vein (usually the great saphenous vein) with a guidewire, dilator, and sheath with subsequent introduction of the catheter through the indwelling sheath. We have used this technique in sixty-one infants without complications and recommend this modified sheath approach because of the following advantages: ease of introduction of the introducer set and catheter, the ability to change catheters quickly, elimination of distal vascular spasm, reduction of vascular trauma induced by catheter manipulation, prevention of backflow bleeding at the catheter entry site, and possible reduction of catheterization time. Read More

J Foot Surg 1980 ;19(3):155-8

J Pediatr 1978 Jul;93(1):97-101

This study evaluated three methods of catheter entry for cardiac catheterization in neonates less than one week of age. Eighty-five neonates underwent venous catheterization through the umbilical vein, 77 by saphenous or femoral cutdown, and 31 by femoral percutaneous entry. Of these 194 neonates, 128 also had an aortic catheter introduced via the umbilical artery. Read More

J Med Assoc State Ala 1978 Jun;47(12):21

JACEP 1976 Aug;5(8):596-8

In pediatric patients, percutaneous venipuncture is preferable to cutdown, especially in inexperienced hands. The best route for maintenance fluid administration is a No. 19, No. Read More