title: Central venous thrombosis and perioperative vascular access in adult intestinal transplantation.
abstract: BACKGROUND
  Venous access is crucial in intestinal transplantation, but a thrombosed venous system may prevent the use of central veins of the upper body. The incidence of venous thrombosis and the necessity to perform alternative vascular access (AVA) in intestinal transplant recipients have not been fully investigated.
  
  
  METHODS
  Records of adult patients who underwent intestinal transplantation between January 1, 2001, and December 31, 2009, were reviewed. Contrast venography was performed as pre-transplantation screening. Vascular accesses at the transplantation were categorized as I (percutaneous line via the upper body veins), II (percutaneous line via the lower body veins), and III (vascular accesses secured surgically, with interventional radiology, or using non-venous sites). Categories II and III were defined as AVA. Risk factors for central venous thrombosis and those for requiring AVA were analysed, respectively.
  
  
  RESULTS
  Among 173 patients, central venous obstruction or stenosis (<50% of normal diameter) was found in 82% (141 patients). AVA was required in 4.6% (eight patients: four in each category II and III). Large-bore infusion lines were placed via the femoral arteries in all category III patients without complications. Existing inferior vena cava filter and hypercoagulable states were identified as the risk factors for the use of AVA, but not for central venous thrombosis. Outcomes of patients who underwent AVA were similar to those of patients without AVA.
  
  
  CONCLUSIONS
  The majority of adult patients undergoing intestinal transplantation had at least one central venous stenosis or obstruction. The recipient outcomes were comparable when either standard vascular access or AVA was used for transplantation.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh School of Medicine, UPMC Montefiore, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: T
authors.initials: T
authors.lastname: Matsusaki
authors.forename: T
authors.initials: T
authors.lastname: Sakai
authors.forename: C D
authors.initials: CD
authors.lastname: Boucek
authors.forename: K
authors.initials: K
authors.lastname: Abu-Elmagd
authors.forename: L M
authors.initials: LM
authors.lastname: Martin
authors.forename: N
authors.initials: N
authors.lastname: Amesur
authors.forename: F Leland
authors.initials: FL
authors.lastname: Thaete
authors.forename: I A
authors.initials: IA
authors.lastname: Hilmi
authors.forename: R M
authors.initials: RM
authors.lastname: Planinsic
authors.forename: S
authors.initials: S
authors.lastname: Aggarwal
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous; D000075202:Contraindications; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D010690:Phlebography / Q000379:methods; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D012778:Short Bowel Syndrome / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging