Experience at a single institution with endovascular treatment of mechanical complications caused by implanted central venous access devices in pediatric and adult patients
Experience at a single institution with endovascular treatment of mechanical complications caused by implanted central venous access devices in pediatric and adult patients
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DOI：
10.2214/ajr.180.2.1800527
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发表时间：
2003-02-01
影响因子：
5
通讯作者：
Roche, A
中科院分区：
文献类型：
--
作者：
Bessoud, B;de Baere, T;Roche, A
目标。我们的目标是描述与植入中心静脉装置相关的机械并发症的技术方面，并评价血管内治疗的可行性、安全性和有效性。156例癌症患者，年龄3个月~75岁(平均+/-SD，47+/-18岁)，在中心静脉置入器放置后290200d(平均+/-SD；范围0-1202d)接受中心静脉装置置入时取出破裂的中心静脉装置导管(n=100)，取回中心静脉装置时栓塞的导丝(n=2)，重新定位中心静脉装置导管的移位裂口(n=38)，剥离纤维蛋白鞘(n=16)。除8例儿科患者外，所有手术均在门诊局部麻醉下完成。结果：100例患者中95例成功取回导管和两根导丝。其中48例在取材前用猪尾导管重新定位栓塞管。大多数手术是使用标准的血管工具(圈套和猪尾导管)进行的；使用更复杂的工具(抓钳、篮子或气球)很难克服圈套的失败。在38次尝试中，32次使用猪尾导管实现了移位的导管尖端的重新定位。在重新定位的导管中，只有24根可以使用。在11例重新定位和取回失败中，大多数是因为导管缺乏自由端。纤维蛋白鞘剥离在技术上总是成功的：所有这些导管在3个月的随访中都获得了专利。无手术相关并发症发生。结论：血管内途径是处理中心静脉装置机械并发症的一种非常可行、安全和有效的方法。对于更换起来比较麻烦的导管和更换简单的导管，保留血管内重新定位可能是明智的。
OBJECTIVE. Our objective was to describe the technical aspects and evaluate the feasibility, safety, and efficacy of endovascular management of mechanical complications related to implanted central venous devices.MATERIALS AND METHODS. One hundred fifty-six patients with cancer, who ranged in age from 3 months to 75 years (mean +/- SD, 47 +/- 18 years), were referred 290 200 days (mean +/- SD; range, 0-1202 days) after central venous device placement for retrieval of a fractured and embotized central venous device catheter (n = 100), retrieval of a guidewire embolized during placement of a central venous device (n = 2), repositioning of the migrated rip of a central venous device catheter (n = 38), and fibrin-sheath stripping (n = 16). All procedures were performed with the patient under local anesthesia on an outpatient basis, except for the eight pediatric patients.RESULTS. Ninety-five of the 100 embolized catheters and both of the guidewires were successfully retrieved. Retrieval was preceded by repositioning the embolized catheter with a pigtail catheter in 48 of these cases. Most of the procedures were performed with standard vascular tools (loop snares and pigtail catheters); the use of more sophisticated devices (grasping forceps, baskets, or balloons) rarely overcame the failure of a loop snare. Repositioning a migrated catheter tip was achieved with a pigtail catheter in 32 of 38 attempts. Of the repositioned catheters, only 24 could be used. Most of the 11 repositioning and retrieval failures were encountered because the catheter lacked a free end. Fibrin-sheath stripping was always technically successful: all these catheters were patent at 3-month follow-up. No procedure-related complications occurred.CONCLUSION. The endovascular approach is highly feasible, safe, and effective for the management of mechanical complications of central venous devices. It is probably advisable to reserve endovascular repositioning for port catheters that are cumbersome to exchange and to replace simple catheters.