title: Placement of a port catheter through collateral veins in a patient with central venous occlusion.
abstract: Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. ulf.teichgraeber@charite.de
authors.forename: Ulf Karl-Martin
authors.initials: UK
authors.lastname: Teichgräber
authors.forename: Florian
authors.initials: F
authors.lastname: Streitparth
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gebauer
authors.forename: Thomas
authors.initials: T
authors.lastname: Benter
mesh_terms: D000328:Adult; D002404:Catheterization / Q000379:methods*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects; D003097:Collateral Circulation / Q000502:physiology; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010690:Phlebography / Q000379:methods; D018570:Risk Assessment; D012778:Short Bowel Syndrome / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*