title: Feasibility and safety of endovascular stripping of totally implantable venous access devices.
abstract: OBJECTIVE
  To evaluate the safety and feasibility of percutaneous stripping of totally implantable venous access devices (TIVAD) in case of catheter-related sleeve and to report a technique to free the catheter tip from vessel wall adherence.
  
  
  METHODS
  A total of 37 stripping procedures in 35 patients (14 men, 40%, and 21 women, 60%, mean age 53±14 years) were reviewed. Totally implantable venous access devices were implanted because of malignancy in most cases (85.7%). Catheter-related sleeve was confirmed as cause of persistent catheter dysfunction despite instillation of thrombolytics. A technique to mobilize the catheter tip from the vessel wall was used when stripping with the snare catheter was impossible. Technical success, complication rate, and outcome were noted.
  
  
  RESULTS
  A total of 55.9% (n=19) of the 34 technically successful procedures (91.9%) could be done with the snare catheter. In 15 cases (44.1%), additional maneuvers to free the TIVAD's tip from the vessel wall were needed. Success rate was not significantly lower before (72.4%) than after (96.7%) implementation of the new technique (P=0.09). No complications were observed. Follow-up was available in 67.6% of cases. Recurrent catheter dysfunction was found in 17 TIVADs (78.3%) at a mean of 137.7 days and a median of 105 days.
  
  
  CONCLUSIONS
  Stripping of TIVADs is technically feasible and safe, with an overall success rate of 91.9%. Additional endovascular techniques to mobilize the distal catheter tip from the wall of the superior vena cava or right atrium to allow encircling the TIVAD tip with the snare catheter may be needed in 44.1% of cases.
authors.affiliation: Department of Radiology, University Hospitals Leuven, and Center for Health Services and Nursing Research, Katholieke Universteit Leuven, Herestraat 49, B-3000, Leuven, Belgium. sam.heye@uzleuven.be
authors.forename: Sam
authors.initials: S
authors.lastname: Heye
authors.forename: Geert
authors.initials: G
authors.lastname: Maleux
authors.forename: G A
authors.initials: GA
authors.lastname: Goossens
authors.forename: Johan
authors.initials: J
authors.lastname: Vaninbroukx
authors.forename: M
authors.initials: M
authors.lastname: Jerôme
authors.forename: M
authors.initials: M
authors.lastname: Stas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010690:Phlebography; D015641:Radiography, Interventional; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents