title: Percutaneous endovascular salvage techniques for implanted venous access device dysfunction.
abstract: OBJECTIVE
  Implanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques.
  
  
  METHODS
  Through a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new "mechanical adhesiolysis" maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication.
  
  
  RESULTS
  Eighty-eight salvage procedures were performed in 80 patients, mostly women (52.5 %), with a mean age of 54 years. Only a minority (17.5 %) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1 cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24 %). Overall technical success rate was 93.2 %. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted.
  
  
  CONCLUSIONS
  These IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement.
authors.affiliation: Diagnostic and Interventional Radiology Department, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland, stephane.breault@chuv.ch.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Breault
authors.forename: Frédéric
authors.initials: F
authors.lastname: Glauser
authors.forename: Malik
authors.initials: M
authors.lastname: Babaker
authors.forename: Francesco
authors.initials: F
authors.lastname: Doenz
authors.forename: Salah Dine
authors.initials: SD
authors.lastname: Qanadli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D005337:Fibrin; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005337:Fibrin