Gerd Grözinger1, Ulrich Grosse2, Roland Syha1, Rüdiger Hoffmann1, Sasan Partovi3, Konstantin Nikolaou1, Stéphane Stahl4, Alfred Königsrainer5, Karolin Thiel5, Christian Thiel5. 1. Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany. 2. Department of Diagnostic and Interventional Radiology, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany. ulrich.grosse@med.uni-tuebingen.de. 3. Department of Radiology, Section of Interventional Radiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA. 4. Department for Plastic, Hand and Reconstructive Surgery, Klinikum Lüdenscheid, Paulmannshöher Straße 14, 58515, Lüdenscheid, Germany. 5. Department of General, Visceral and Transplant Surgery, Eberhard-Karls University Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Germany.
Abstract
PURPOSE: To evaluate indications, technical success rate and complications of CT-guided translumbar catheter placement in the inferior vena cava for long-term central venous access (Port and Hickman catheters) as a bail-out approach in patients with no alternative options for permanent central venous access. MATERIALS AND METHODS: This retrospective study included 12 patients with a total of 17 interventions. All patients suffered from bilaterally chronically occluded venous vessels of their upper extremities, without patent internal jugular and/or subclavian veins. Catheter implantation was performed as a hybrid procedure with CT-guided translumbar access into the inferior vena cava with subsequent angiography-guided catheter placement of a Hickman-type catheter (7×) or a Port catheter (10×). RESULTS: All interventions were technically successful. The total 30-day complication rate was 11.8% (n = 2). The two detected complications were bleeding at the subcutaneous port hub and subcutaneous kinking of the venous tube. Mean follow-up time was 68.4 ± 41.4 months (range 3.4-160 months). Six patients (50%) died during follow-up from non-procedure-related complications associated with the underlying disease. Late complications occurred in 8/17 (47.1%) cases and were infections of the catheter system in 35.3% (n = 6), mechanical defect of the catheter system in 5.8% (n = 1) and dislocation of the catheter system in 5.8% (n = 1). The overall infection rate was 0.77 per 1000 catheter days. CONCLUSIONS: CT-guided translumbar placement of permanent catheters is a technically feasible and safe method for permanent central venous access as last resort in chronically occluded veins of the upper extremities.
PURPOSE: To evaluate indications, technical success rate and complications of CT-guided translumbar catheter placement in the inferior vena cava for long-term central venous access (Port and Hickman catheters) as a bail-out approach in patients with no alternative options for permanent central venous access. MATERIALS AND METHODS: This retrospective study included 12 patients with a total of 17 interventions. All patients suffered from bilaterally chronically occluded venous vessels of their upper extremities, without patent internal jugular and/or subclavian veins. Catheter implantation was performed as a hybrid procedure with CT-guided translumbar access into the inferior vena cava with subsequent angiography-guided catheter placement of a Hickman-type catheter (7×) or a Port catheter (10×). RESULTS: All interventions were technically successful. The total 30-day complication rate was 11.8% (n = 2). The two detected complications were bleeding at the subcutaneous port hub and subcutaneous kinking of the venous tube. Mean follow-up time was 68.4 ± 41.4 months (range 3.4-160 months). Six patients (50%) died during follow-up from non-procedure-related complications associated with the underlying disease. Late complications occurred in 8/17 (47.1%) cases and were infections of the catheter system in 35.3% (n = 6), mechanical defect of the catheter system in 5.8% (n = 1) and dislocation of the catheter system in 5.8% (n = 1). The overall infection rate was 0.77 per 1000 catheter days. CONCLUSIONS: CT-guided translumbar placement of permanent catheters is a technically feasible and safe method for permanent central venous access as last resort in chronically occluded veins of the upper extremities.
Entities:
Keywords:
CT intervention; Hickman catheter; Port catheter; Translumbar approach