Peripherally inserted central catheter placement in patients with unsuspected central venous obstruction.
OBJECTIVE
To evaluate the feasibility and clinical usefulness of peripherally inserted central catheter (PICC) placement in patients with unsuspected central venous obstruction.


METHODS
Of 3,272 PICC procedures performed from January 1999 to July 2006, 57 patients had central venous stenosis or obstruction during placement of the PICC. Sixty PICC placements were performed in 57 patients (30 male and 27 female patients; mean age, 59 years). The PICC placements in 57 patients were evaluated with regard to the location and severity of venous disease, underlying causes of venous stenosis or obstruction, catheter placement technique, technical success rate, catheter dwelling time, and complication rate.


RESULTS
There were 48 complete obstructions and 12 stenoses. Ipsilateral lesion passage was attempted in 31 patients and was successful in 26 (84%) and unsuccessful in five (16%). Over-the-wire PICC placement was performed in 16 patients, and PICC placement after angioplasty was performed in 10. Contralateral PICC placement without a trial of traversing the lesion was done in 26 patients. The PICC dwell time ranged from 2 to 150 days (median, 25.5 days). Complications occurred in four of the 57 patients (7%) and included tube tip migration (n = 1), catheter occlusion (n = 1), and catheter infection (n = 2).


CONCLUSIONS
PICCs can be safely placed across central venous lesions in patients with asymptomatic central venous stenosis or obstruction. Contralateral placement is favorable in cases of ipsilateral passage failure.
Park
Kwang Bo
KB
Department of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, 135-710, Irwon-Dong, Gangnam Gu, Seoul, Korea.
Choo
Sung Wook
SW
Do
Young Soo
YS
Shin
Sung Wook
SW
Cho
Sung Ki
SK
Choe
Yeon Hyeon
YH
Yoo
So-Young
SY
Kim
Ji Hye
JH
Choo
In-Wook
IW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000379:methods*; D003251:Constriction, Pathologic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014654:Vascular Patency