title: Hybrid interventions for catheter placement in pediatric intestinal rehabilitation patients with end-stage venous access.
abstract: OBJECTIVE
  The purpose of this study is to analyze the combined approach of endovascular and open surgical procedures for insertion of permanent central venous catheters in children with intestinal failure and end-stage venous access.
  
  
  METHODS
  Data of 14 children (16 interventions) with intestinal failure and end-stage venous access, treated within the pediatric intestinal rehabilitation program at our institution between September 2011 and November 2016, were retrospectively reviewed. The patients underwent hybrid endovascular/open surgical approaches for insertion of central venous catheters. Access to central veins was established through endovascular intervention; catheter placement was achieved with combined interventional and surgical measures depending on the individual vascular conditions.
  
  
  RESULTS
  Median age at intervention was 47months (interquartile range (IQR),29-74), median time for interventions was 66min (IQR,42-111). Catheter placement was successfully achieved in all patients. The median dose of irradiation during angiography was 0.2Gy*cm2(IQR, 0.2-0.6), no complications occurred during or after interventions.
  
  
  CONCLUSIONS
  Hybrid endovascular/open surgical procedures can be successfully applied for restoring or maintaining permanent central venous catheters in children with intestinal failure and end-stage venous access. These approaches are a valuable contribution in intestinal rehabilitation programs contributing to a further decrease of the need for intestinal transplantation in affected patients.
  
  
  METHODS
  Treatment Study.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Pediatric Cardiology, University Children's Hospital Tuebingen.
authors.forename: Ludger
authors.initials: L
authors.lastname: Sieverding
authors.affiliation: Pediatric Gastroenterology and Hepatology, University Children's Hospital Tuebingen.
authors.forename: Andreas
authors.initials: A
authors.lastname: Busch
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen.
authors.forename: Jens
authors.initials: J
authors.lastname: Gesche
authors.affiliation: Department of Clinical Epidemiology and Applied Biometry, University of Tuebingen.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Pediatric Gastroenterology and Hepatology, University Children's Hospital Tuebingen.
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Sturm
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen.
authors.forename: Ilias
authors.initials: I
authors.lastname: Tsiflikas
authors.affiliation: Pediatric Gastroenterology and Hepatology, University Children's Hospital Tuebingen.
authors.forename: Femke
authors.initials: F
authors.lastname: Piersma
authors.affiliation: Department of Pediatric Cardiology, University Children's Hospital Tuebingen.
authors.forename: Anja
authors.initials: A
authors.lastname: Hauser
authors.affiliation: Department of Pediatric Cardiology, University Children's Hospital Tuebingen.
authors.forename: Gesa
authors.initials: G
authors.lastname: Wiegand
authors.affiliation: Pediatric Gastroenterology and Hepatology, University Children's Hospital Tuebingen.
authors.forename: Steffen
authors.initials: S
authors.lastname: Hartleif
authors.affiliation: Department of Pediatric Cardiology, University Children's Hospital Tuebingen.
authors.forename: Michael
authors.initials: M
authors.lastname: Hofbeck
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen.
authors.forename: Jörg
authors.initials: J
authors.lastname: Fuchs
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen. Electronic address: steven.warmann@med.uni-tuebingen.de.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Warmann
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D062905:Central Venous Catheters / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000601:surgery
keywords: Central; Hybrid interventions; Pediatric intestinal rehabilitation; Short bowel syndrome; Venous catheter