Central venous recanalization in patients with short gut syndrome: restoration of candidacy for intestinal and multivisceral transplantation.
OBJECTIVE
To assess feasibility and success of venous recanalization in patients with short gut syndrome who have lost their traditional central venous access and required intestinal or multivisceral transplantation.


METHODS
Twelve patients between the ages of 7 and 55 years with short gut syndrome and long-standing total parenteral nutrition (TPN) dependency and/or hypercoagulability were treated. All had extensive chronic central venous occlusions and survival was dependent on restoration of access and planned transplantation. Central venous recanalizations were obtained via sharp needle recanalization techniques, venous reconstructions with stents, and/or extraanatomic access to the central venous system for placement of central venous tunneled catheters.


RESULTS
Central venous access was restored in all patients without operative-related mortality. Three major hemodynamic perioperative technical complications were recorded and successfully treated. There were three self-limited early infectious complications. With a mean follow-up of 22 months, eight of the 12 patients were alive with successful small bowel or multivisceral transplantation; six of those became independent of TPN. The remaining four patients died of complications related to TPN (n = 3) or transplantation (n = 1). With a mean follow-up of 20 months, all but two of the recanalized venous accesses were maintained, for a success rate of 83%.


CONCLUSIONS
Recanalizations of extensive chronic vein occlusions are feasible but associated with high risk. The technique is life-saving for TPN-dependent patients and can restore candidacy for intestinal and multivisceral transplantation. This approach is likely to be increasingly requested because of the current clinical availability of the transplant procedure.
Lang
Elvira V
EV
Department of Radiology, Beth Israel Deaconess Medical Center-Harvard Medical School, 330 Brookline Avenue, West CC 308, Boston, Massachusetts 02215, USA. elang@bidmc.harvard.edu
Reyes
Jorge
J
Faintuch
Salomao
S
Smith
Amy
A
Abu-Elmagd
Kareem
K
D000293:Adolescent; D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D002648:Child; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging / Q000473:pathology / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome