Endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization.
OBJECTIVE
This study was designed to assess endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization.


METHODS
Patients referred for endovascular management of central venous occlusion during a 42-month period were identified from a regional endovascular database, providing prospective information on techniques and clinical outcome. Corresponding patient records, angiograms, and radiographic reports were analyzed retrospectively.


RESULTS
Sixteen patients aged 48 years (range 0.5-76), including 11 females, were included. All patients but 1 had had multiple central venous catheters with a median total indwelling time of 37 months. Eleven patients cannulated for hemodialysis had had significantly fewer individual catheters inserted compared with 5 patients cannulated for nutritional support (mean 3.6 vs. 10.2, p<0.001) before endovascular intervention. Preoperative imaging by magnetic resonance tomography (MRT) in 8 patients, computed tomography (CT) venography in 3, conventional angiography in 6, and/or ultrasonography in 8, verified 15 brachiocephalic, 13 internal jugular, 3 superior caval, and/or 3 subclavian venous occlusions. Patients were subjected to recanalization (n=2), recanalization and percutaneous transluminal angioplasty (n=5), or stenting for vena cava superior syndrome (n=1) prior to catheter insertion. The remaining 8 patients were cannulated by avoiding the occluded route.


CONCLUSIONS
Central venous occlusion occurs particularly in patients under hemodialysis and with a history of multiple central venous catheterizations with large-diameter catheters and/or long total indwelling time periods. Patients with central venous occlusion verified by CT or MRT venography and need for central venous access should be referred for endovascular intervention.
Department of Anesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö, Sweden. andreas.pikwer@med.lu.se
Andreas
A
Pikwer
Stefan
S
Acosta
Tilo
T
Kölbel
Jonas
J
Åkeson
D000293:Adolescent; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D010690:Phlebography / Q000379:methods; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology; D055815:Young Adult