{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:24:45Z","timestamp":1790799885453,"version":"4.1.0"},"reference-count":52,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,1,6]],"date-time":"2020-01-06T00:00:00Z","timestamp":1578268800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Anatomy"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Most hemodialysis patients start renal replacement therapy with a central venous catheter (CVC). The left internal jugular vein (LIJV) is the second\u2010choice vein for CVC positioning, after the right IJV. However, to reach the right atrium, the CVC must pass through the left brachiocephalic vein (LBV), which also drains blood from the left arm through the subclavian vein. The purpose of this study is to describe how the anatomy of the central venous system and in particular that of the LBV affects vascular access in hemodialysis patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Three\u2010dimensional (3D) virtual model reconstructions of the central thoracic veins of three hemodialysis patients were obtained from contrast\u2010enhanced computed tomography scans acquired in the venous phase. The images were exported as DICOM files and loaded on open\u2010source software for visualizing and analyzing the medical imaging (3D Slicer, Windows version 4.8.1).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>As expected, the 3D reconstructions showed that the LBV has a tortuous path with three main angulations that could be associated with external compression and stenosis. These could determine the difficulties and increased risks of venous injury during CVC placement, and an increased risk of medium to long\u2010term catheter\u2010associated vein thrombosis and stenosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The anatomical features of the LBV indicate that the path of a CVC from the LIJV to the right atrium is tortuous and can easily be complicated by vein injury, negatively affecting the creation of future arterio\u2010venous vascular accesses in the left arm.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ca.23549","type":"journal-article","created":{"date-parts":[[2019,12,31]],"date-time":"2019-12-31T11:08:32Z","timestamp":1577790512000},"page":"1120-1129","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical relevance of the left brachiocephalic vein anatomy for vascular access in dialysis patients"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0012-1366","authenticated-orcid":false,"given":"Maurizio","family":"Vertemati","sequence":"first","affiliation":[{"name":"Institute of Human Anatomy, Department of Biomedical and Clinical Sciences \u201cLuigi Sacco\u201d Universit\u00e0 degli Studi di Milano  Milan Italy"},{"name":"CIMaINa (Interdisciplinary Centre for Nano structured Materials and Interfaces) Universit\u00e0 degli Studi di Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Rizzetto","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Biomedical and Clinical Sciences \u201cLuigi Sacco\u201d Universit\u00e0 degli Studi di Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Cassin","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Biomedical and Clinical Sciences \u201cLuigi Sacco\u201d Universit\u00e0 degli Studi di Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Zerbi","sequence":"additional","affiliation":[{"name":"Pathology Unit, Department of Biomedical and Clinical Sciences \u201cLuigi Sacco\u201d Universit\u00e0 degli Studi di Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Giordano","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Cariati","sequence":"additional","affiliation":[{"name":"Department of Radiology Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2011-2160","authenticated-orcid":false,"given":"Maurizio","family":"Gallieni","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Biomedical and Clinical Sciences \u201cLuigi Sacco\u201d Universit\u00e0 degli Studi di Milano  Milan Italy"},{"name":"Nephrology and Dialysis Unit ASST Fatebenefratelli Sacco  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,1,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.07010618"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-139X.2007.00242.x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.114.3.820"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2007.09.005"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/1129729818791409"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1985.03350300079024"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.101.6.1633"},{"key":"e_1_2_7_9_1","first-page":"85","article-title":"Inside\u2010out upper body venous access: The first\u2010in\u2010human experiences with a novel approach using the Surfacer inside\u2010out access catheter system","volume":"2013","author":"Ebner A.","year":"2013","journal-title":"Endovascular Today"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mri.2012.05.001"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.3322\/CA.2008.0015"},{"key":"e_1_2_7_12_1","first-page":"326","article-title":"Vessel perforation after catheterization of the left internal jugular vein","volume":"56","author":"Garc\u00eda P\u00e9rez A. 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