Central Venous System Research Articles

Lymphaticovenous anastomosis of the caudal thoracic duct to the azygous vein: A feline cadaver study.

The aim of this study was to describe a technique for anastomosis of the thoracic duct (TD) to the azygos vein (AV) using a microvascular anastomotic coupler (MAC) device in feline cadavers. Our hypothesis was that a TD-AV lymphaticovenous anastomosis would be feasible in feline cadavers. Cadaveric study. Eight domestic shorthair feline cadavers. A left paracostal laparotomy and 9th or 10th intercostal thoracotomy was performed. Contrast media was injected into a mesenteric lymph node and lymphography was used to identify the TD and its branches. The TD and AV were isolated, ligated, and divided with the aid of a surgical microscope. The TD and AV were anastomosed end-to-end using a 1.5 or 2.0 mm MAC. Intraoperative patency was assessed by manipulation of chyle and venous blood across the anastomosis. Mesenteric lymphography was repeated to confirm postoperative anastomotic patency. The TD was identified via lymphography in seven of eight cats. The anastomosis was successful and patency was confirmed via intraoperative assessment and postoperative lymphography in all cats. The median (range) duration for the dissection and anastomosis portions of the procedure was 122 (80-150) min. End-to-end anastomosis of the TD to the AV using a MAC was feasible in the feline cadaver without major intraoperative technical challenges. Anastomosis of the TD and AV may have application as an alternative treatment for idiopathic chylothorax in cats. By directly connecting the abdominal lymphatics to the central venous system, the stimulus for collateral vessel development around the site of TD ligation may be minimized, which may prevent leakage of chyle through the more cranial lymphatics.

A modified double-incision technique to place tunneled central lines in children.

In children, there are two main techniques for placing a tunneled central venous catheter: single-incision (single puncture) and conventional (two punctures). Both have unique advantages and disadvantages. The modified single-stick technique combines the two aforementioned techniques to access the central venous system in an optimized way. This technique is feasible to perform particularly in young children and has a short learning curve for adult interventional radiologists.

Sonographic Appearance of Hemodialysis Reliable Outflow Graft (HeRO Graft)

HeRO Graft (Hemodialysis Reliable Outflow Graft) consists of 3 components; an arterial graft component, a titanium connector and a venous outflow component. It is implanted under the skin of end-stage renal failure patients as a subcutaneous permanent access. It is a vascular graft that traverses central venous stenosis and has no venous anastomosis, thus providing blood flow from an artery direct into the central venous system. Ultrasound imaging of the 3 components of the HeRO graft is performed and described in this article. Equipment used include Phillips ultrasound machines CX-50, iU22, and EPIQ 7 with linear transducers of frequency 3 to 15 MHz and curvilinear transducers of frequency 1 to 5 MHz. HeRO graft is often the last hemodialysis access available for patients on long-term dialysis who would have typically exhausted all other hemodialysis options like the native arterio-venous fistula (AVF) and arterio-venous graft (AVG). As long-term dialysis patients run out of typical AVF/AVG accesses coupled with the increasing longevity of persons in countries where advanced medical technology is available, subcutaneously implanted grafts such as the HeRO graft may become more commonplace. Description of the sonographic appearance of the various components of the HeRO graft may help sonographers who are not familiar with the graft to image the components.

Safety and feasibility of 3-month interval access and flushing for maintenance of totally implantable central venous port system in colorectal cancer patients after completion of curative intended treatments: Erratum.

Safety and feasibility of 3-month interval access and flushing for maintenance of totally implantable central venous port system in colorectal cancer patients after completion of curative intended treatments: Erratum.

Dependent contrast layering sign on CT in patients irrespective of cardiac dysfunction and its clinical implications: A preliminary retrospective study

Purpose: CT findings of contrast layering in dependent areas of the central venous system and solid organs have been reported in the literature to be associated with imminent cardiac arrest. However, no systematic research has explored the association of this distinctive CT finding with cardiac arrest and mortality. Therefore, we investigated the radiological manifestations of dependent layering of contrast in various vascular structures and organs and its clinical implications. Methods: A computerized search of radiological database was conducted using keywords “layering contrast” between January 2008 and January 2022. After reviewing CT scans of 226 patients that met the keyword criteria, 21 patients who exhibited the dependent contrast layering sign (DCLS) in vascular structures and organs were included in the final study population. Clinical data such as cardiac arrest within 2 hours, in-hospital mortality, and shock index ≥ 0.9 were collected. Number of involved structures in each patient is also investigated. Statistical significance and frequency regarding the association between radiologic findings and clinical data were analyzed. Results: The distribution of DCLS across anatomical structures reveals IVC is involved in 90.5% of patients and followed by hepatic vein (80.9%), liver parenchyma and right atrium. Cardiac arrest within 2 hours is significantly more common in patients with DCLS in right atrium (p=0.02, odds ratio = 21.6) and liver parenchyma (p=0.01, odds ratio = 24.8). DCLS in liver parenchyma is associated with the highest rate of in-hospital mortality (4 of 7, 57.1%). The total number of involved structures (p=0.01) and the number of common structures (p=0.001) are significantly higher in patients with cardiac arrest within 2 hours. Conclusions: The presence of DCLS in the right atrium and liver, as well as the larger number of involved structures, are significantly associated with impending cardiac arrest. Thus, it may offer additional insights for both radiologists and clinicians and aid in prompt initiation of resuscitative interventions before the onset of cardiac arrest. Nevertheless, larger prospective studies are warranted to validate the clinical relevance of DCLS across various vascular structures and organs.

Intravertebral collateral enhancement resembling sclerotic metastatic disease in a case of cervical epidural abscess.

Vertebral body enhancement is occasionally seen on postcontrast CT imaging in the absence of osseous pathology. This enhancement can mimic sclerotic osseous metastatic disease, leading to a diagnostic dilemma for radiologists and increasing the chance of misinterpretation. Existing literature has focused on the association between this enhancement and concomitant central venous system obstruction. We report a 61-year-old woman with a history of nasopharyngeal carcinoma presenting with an epidural abscess who exhibited vertebral body enhancement resembling sclerotic metastatic disease without imaging evidence of central venous obstruction or vertebral osseous metastatic disease. Awareness of this unique presentation may prevent the incorrect diagnostic errors and their associated negative effects on patients.

Proximalization of arterial inflow for treatment of hemodialysis access-induced distal ischemia

ObjectiveHemodialysis access-induced distal ischemia (HAIDI) is a known complication of hemodialysis (HD) access. Distal revascularization and interval ligation (DRIL) is the preferred treatment for HAIDI by many surgeons. Proximalization of arterial inflow (PAI) is a promising alternative technique that, unlike DRIL, preserves the native arterial inflow. The purpose of this study is to report our experience with PAI on a series of 64 patients. MethodsThis is a single-center, retrospective cohort study of patients with both arteriovenous (AV) fistulas and grafts who underwent PAI for HAIDI from 2017 to 2023. A 4 × 7 tapered polytetrafluoroethylene (PTFE) graft was used to connect HD access inflow to the axillary artery in the majority of cases. The primary outcome of the study is resolution of HAIDI (complete, partial, or no resolution). Secondary outcomes include functional patency (primary and secondary) and 30-day complications following PAI. ResultsOf the 71 patients identified to have had PAI between May 2017 to August 2023, seven were lost to follow-up. In total, 64 patients were included, with an average age of 65 years (standard deviation, 15 years), 59.4% (38/64) female, and 37.5% (24/64) African American. The study population was notable for numerous comorbid conditions including 95.3% (61/64) hypertension; 50% (32/64) coronary artery disease; 79.7% (51/64) diabetes; and 43.8% (28/64) smoking history. Following PAI intervention for HAIDI, 55 of 64 patients (85.9%) experienced complete resolution of ischemic symptoms; five of 64 patients (7.8%) had partial resolution; two of 64 patients (3.1%) had no resolution, and two of 64 patients (3.1%) had unknown resolution. Primary patency at 1, 12, and 24 months was 94%, 81%, and 71%, respectively. Secondary patency at 1, 12, and 24 months was 97%, 87%, and 84%, respectively. The 30-day complication rate was 10.9% (7/64), with five of 64 (7.8%) thromboses, one of 64 (1.6%) thrombosis and infection, and one of 64 (1.6%) upper extremity swelling secondary to central venous stenosis (resolved with angioplasty of central venous system). Failure rate due to thrombosis at 12 and 24 months was 14% (9/64) and 15.6% (10/64), respectively. ConclusionsOur study, the largest case series of PAI to date, demonstrates that PAI is a reliable option for HAIDI intervention and has comparable safety and efficacy results to DRIL, despite the use of a synthetic graft. Furthermore, PAI has the added benefit of maintaining the native arterial pathway. Further investigation of PAI is warranted as a promising alternative to DRIL for HAIDI management.

Differences in the Incidence of Sterile Inflammation After Trabectedin Infusion With Two Central Venous Port Systems: A Retrospective Study.

Purpose Sterile inflammation along the tunneled catheter is a characteristic complication associated with trabectedin infusion via a central venous port (CVP). To date, no studies have evaluated the differences in sterile inflammation incidence according to the CVP system used. This study evaluated the differences in sterile inflammation incidence between two different CVP systems. Methods This study was conducted at The University of Tokyo Hospital, Bunkyo-Ku, Tokyo, Japan. Patients with trabectedin infusion using CVP via the internal jugular vein between April 2016 and February 2024 were retrospectively evaluated. Sterile inflammation was characterized as skin erythema, swelling, pain, or induration along the tunneled catheter after infusion of trabectedin from the CVP and negative for various infection tests. The incidence of sterile inflammation was compared using two different CVP systems: Anthron® polyurethane catheter with Celsite port (P-U Celsite; Toray Medical, Tokyo, Japan) and DewX Eterna (Terumo, Tokyo, Japan). Results Of the 21 patients, 12 and nine patients used P-U Celsite and DewX Eterna for trabectedin infusion, respectively. Sterile inflammation occurred in five patients; of these, four underwent CVP removal because of worsened pain, making trabectedin infusion difficult. Sterile inflammation occurred in 0 (0/12) and 56% (5/9) of patients using P-U Celsite and DewX Eterna, respectively, with a significantly lower incidence in patients using P-U Celsite (P = 0.006). Conclusion Sterile inflammation incidence was significantly lower in patients using P-U Celsite compared to those using DewX Eterna.

Removal of the central venous port system in children. Is this an appropriate training procedure for resident physicians? A single-center retrospective study.

<b>Introduction:</b> A venous port system consists of a port chamber attached to a central catheter, which is implanted into the central venous system. The removal of the vascular port includes all items of this system. This procedure is usually simple and quick. Complications with port removal are rare but possible.<b>Aim:</b> The study aimed to summarize venous port removal procedures performed by pediatric surgeons.<b>Material and methods:</b> The single-center, retrospective study was conducted on 360 pediatric patients treated during the years 2010-2022 in the Department of Pediatric Surgery, Traumatology, and Urology in Poznan.<b>Results:</b> The port usage time before the removal ranged from 3 days to 8 years and 3 months, with an average of 22 months. The leading cause of vascular port removal was the end of treatment (78.06%). Other less frequent reasons were the infection (13.89%) and mechanical damage of the port (3.33%). There were almost no complications connected with the procedure of vascular port removal (92.2%). If the complications occurred, they included bleeding during surgery (3%), covering the vascular catheter with bone tissue of the clavicle, causing difficulties with the catheter removal from the vein (1.4%), and connected with the previous complications-prolonged clavicle pain after surgery (1.4%) and hematoma after surgery (2%).<b>Conclusions:</b> Removing the venous port is a safe procedure with a low risk of complications. This procedure can be considered as an appropriate training procedure for young trainees. A more extended period of use of the vascular port before its removal may be associated with more difficulties during surgery.

Radiation dose reduction during venous access port implantation: the importance of upgrading equipment and radiation-protection training.

Implantable central venous port systems are widely used in oncology. We upgraded our fluoroscopy machines, and all anesthetists completed two training courses focusing on the risks of ionizing radiation for patients and health workers. This study aimed to evaluate the impact of upgrading the machines and the radiation-protection training on ionizing radiation exposure during venous port system implantation. We retrospectively analyzed consecutive venous port implantations between 2019 and 2022. The older fluoroscopy machines were replaced by two new machines. A first training session about health worker radioprotection was organized. The medical staff completed a second training course focused on protecting patients from ionizing radiation. We defined four distinct time intervals (TI): venous port implantations performed with the old equipment, the new fluoroscopy machines, after the first training course, and after the second training course. The air kerma-area product (KAP) was compared between these four TI and fluoroscopy times and the number of exposures only with the new machines. We analyzed 2587 procedures. A 93% decrease in the median KAP between the first and last TI was noted (median KAP = 323.0mGy.cm2 vs. 24.0mGy.cm2, p < 0.0001). A decrease in the KAP was observed for each of the 11 anesthetists. We also noted a significant decrease in the time of fluoroscopy and the number of exposures. Upgrading the fluoroscopy equipment and completing two dedicated training courses allowed for a drastic decrease patient exposure to ionizing radiation during venous access port implantation by non-radiologist practitioners.

Peripherally Inserted Central Catheter (PICC) Guidelines - Nursing Perspective

A Peripherally Inserted Central Catheter PICC is a form of intravenous line that grants access to the central venous system. It is inserted through a vein in the arm and then carefully advanced until it reaches a large vein close to the heart. The PICC has one two or three separate channels called lumens that can be used for different purposes such as blood sampling medication administration fluid infusion and other interventions. Each lumen has a cap and a connector that prevents contamination and allows needle-free access. Venous access is crucial for many patients who need frequent or complex treatments such as critically ill patients who require blood tests drugs that affect blood pressure fluid replacement long-term antibiotics and other indications.

Research progress on nursing of infusion extravasation of implantable central venous port system

Research progress on nursing of infusion extravasation of implantable central venous port system

Should a forgotten guidewire be removed after years? An undesirable complication of hemodialysis catheter wire left in the body

Today, one of the most common methods used in the emergency room or intensive care unit (ICU) in patients is the Seldinger technique to access the central venous system, shunting for hemodialysis, intra-aortic balloon pump, or arterial insertion. Accidental leaving of the guide wire is an uncommon but important complication that can occur as a result of an incorrect technique, and it is sometimes found accidentally or due to complications years after the procedure. The case is a 53-year-old patient who underwent aortic valve replacement with a mechanical valve and mitral valve repair with a ring 12 years ago and was treated with warfarin. Two years after the heart surgery, due to chronic renal failure, the patient underwent dialysis, and after the preparation of an arteriovenous fistula, he underwent stenting. After approximately ten years, the patient developed fever, chills, and shortness of breath. During the examination, endocarditis was diagnosed, and a part of the aortic valve was released. There was a severe paravalvular leak in the aortic valve, and an abscess was formed in the aorta root. We also noticed a forgotten guide wire in the superior vena cava, right atrium, inferior vena cava, and hepatic vein, and echogenic masses were located on the guidewire. The diagnosis was confirmed by echocardiography, chest x-ray, and phenocopy. After antibiotic therapy, the patients underwent heart surgery, aortic valve replacement, and aortic root repair, and the guidewire was removed (70 cm long). Unfortunately, despite all measures, the patient died a few days after the surgery. Due to complications, a forgotten guidewire should be removed immediately after diagnosis. The preferred intervention is the removal of the guidewire by endovascular interventions, but surgical treatment should also be considered in some cases.

The Impact of Transfer-Related Ischemia on Free Flap Metabolism and Electrolyte Homeostasis-A New In Vivo Experimental Approach in Pigs.

Free flap tissue transfer represents the gold standard for extensive defect reconstruction, although malperfusion due to thrombosis remains the leading risk factor for flap failure. Recent studies indicate an increased immune response and platelet activation in connection with pathologic coagulation. The underlying cellular and molecular mechanisms remain poorly understood, however. The presented study, therefore, aims to investigate if transfer-related ischemia alters intra-flap metabolism and electrolyte concentrations compared to central venous blood after free flap transfer in pigs to establish a novel experimental model. Free transfer of a myocutaneous gracilis flap to the axillary region was conducted in five juvenile male pigs. The flap artery was anastomosed to the axillary artery, and intra-flap venous blood was drained and transfused using a rubber-elastic fixed intravenous catheter. Blood gas analysis was performed to assess the effect of transfer time-induced ischemia on intra-flap electrolyte levels, acid-base balance, and hemoglobin concentrations compared to central venous blood. Time to flap reperfusion was 52 ± 10 min on average, resulting in a continuous pH drop (acidosis) in the flaps' venous blood compared to the central venous system (p = 0.037). Potassium (p = 0.016), sodium (p = 0.003), and chloride (p = 0.007) concentrations were significantly increased, whereas bicarbonate (p = 0.016) and calcium (p = 0.008) significantly decreased within the flap. These observations demonstrate the induction of anaerobic glycolysis and electrolyte displacement resulting in acidosis and hence significant tissue damage already after a short ischemic period, thereby validating the novel animal model for investigating intra-flap metabolism and offering opportunities for exploring various (immuno-) thrombo-hemostatic issues in transplantation surgery.

The Implementation and Evaluation of Pharmaceutical Care Plan in Stroke Patients at Tertiary Care Hospital

Objective: To assess the pattern and prevalence of adverse drug reactions (ADRs) reported by the neurology department and review the benefits of the pharmaceutical care plan. Materials and Methods: A total of 148 stroke cases with previous medication history correlated with current complaints leading to hospitalization were included in the prospective study for one year in the neurology department. Results: This study identified non-adherence (50%) and ADRs (38%). Ignorance of the disease, its complications, and the possible adverse effects of self-medication have been identified as risk factors. The medication-related problems were mainly observed with antimicrobials, central nervous system (CNS), central venous system (CVS), and inflammatory and immune modulators. Conclusion: The risk factors involved are illiteracy regarding prescribed therapy benefits. In the patient’s medication therapy, warfarin has more adverse events, and an observation of the patient’s plasma concentration levels increased.

Normal variations of the superior vena cava and azygos venous system depiction by CT scan in the adult Thai population.

Identification of normal variations to the thoracic central venous system anatomy is essential in radiological intervention and cardiothoracic surgery to prevent complications. To estimate the prevalence and pattern of normal variations of superior vena cava (SVC) and azygos venous system as well as factors associated with normal variations of SVC. Venous-phase chest CT of 1336 patients were retrospectively reviewed. Age, sex, and underlying disease were recorded. SVC diameter and cross-sectional area were measured to evaluate for associations with normal variations. The prevalence of normal anatomical variations of SVC and azygos venous system were 0.3% and 1.5%, respectively. Duplicated SVC was the most common variations. The most common variation for the azygos venous system was the connection between the hemiazygos and accessory hemiazygos veins draining into the left brachiocephalic vein (12/1336 cases, 0.9%). The median (interquartile range [IQR]) cross-sectional area compared between normal SVC (297.2 mm2) and duplicated SVC (223.5 mm2) showed a statistically significant difference (P = 0.033). This study determined the prevalence of rare normal variations of the azygos venous system, a connection between the hemiazygos and accessory hemiazygos veins draining into the left brachiocephalic vein. The prevalence of normal variations of the SVC and azygos venous system in the adult Thai population was similar with that of previous publications. Cross-sectional area was the only factor with a significant association with SVC variations.

Clinician satisfaction and preference for central venous catheter systems promoting patient safety, ease-of-use and reduced clinician error

ABSTRACT Objectives Central venous catheters (CVC) are frequently utilized with limited data on user preferences. A simulation/survey-based study was conducted among anesthesia providers to evaluate attitudes toward general CVC system attributes, and satisfaction with elements of the most-commonly used and a novel CVC system. Methods Forty providers completed a simulation using both CVC systems and a 29-item questionnaire, including multiple-choice, free-text, ranking, and Likert-like questions. Ranking scores were reported using a scale of 0 (least important/satisfactory) to 100 (most important/satisfactory). Statistical significances were evaluated via Wilcoxon signed-rank sum test. Results Participants chose (mean±SD) patient safety (83.9 ± 25.3), ease-of-use (64.6 ± 26.1), and reduced risk for error (61.1 ± 26.7) as the most important attributes when considering a CVC system. Satisfaction levels were significantly higher for the novel system: overall (p < 0.001), its ease-of-use (p < 0.001), tray layout/design (p < 0.001), and safety (p = 0.012). Mean satisfaction scores were significantly higher for the novel system’s potential to reduce 5 of 7 common issues, including clinician error (p < 0.001), and contamination/infection (p < 0.001). Conclusion Anesthesia providers preferred CVC systems promoting patient safety, ease-of-use and reduce clinician error. Significantly higher (p < 0.05) satisfaction scores were awarded to a novel system featuring a sequentially organized tray, enhanced labeling, and a guidewire funnel.

Respiratory impairment in multiple sclerosis: A Single-Center Study in 371 People with MS (P14-3.006)

<h3>Objective:</h3> Study the association between respiratory impairment (RI) and multiple sclerosis (MS) and its relationship with <h3>Background:</h3> It is unclear whether RI in people with multiple sclerosis (PwMS) should be viewed as the result of muscle weakness or MS-specific structural central venous system (CNS) abnormalities as a precipitant factor for the worsening of motor impairment or cognitive symptoms. Here we present a study aimed to define the reach of RI associated with CNS damage. <h3>Design/Methods:</h3> Cross-sectional observational study evaluating the association between forced spirometry results with clinical and imaging features in PwM. Normative metrics of forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), and the relation FEV1/FVC were calculated. Qualitative and quantitative brain magnetic resonance imaging (MRI) examinations were conducted. <h3>Results:</h3> A total of 371 PwMS were included in the study. Of those 196 (53%) had RRMS, 92 (25%), and 83 (22%) PPMS. RI was present in 16 (8%), 16 (19%), and 23 (25%) of the patients in the RRMS, PPMS, and SPMS, respectively. PwMS with T2-FLAIR lesions involving the corpus callosum had a significantly higher frequency of RI (<i>OR</i> 3.62; <i>95%CI</i> 1.33–9.83; p 0.012) than patients without lesions in that region. This relationship remained significant in the RRMS group (<i>OR</i> 10.1; <i>95%CI</i> 1.3–67.8; p 0.031) when the model excluded PPMS and SPMS. According to our study, for every increase of 1 z-score of FVC, we observed an increase of 0.25 cm³ of hippocampal volume (β 0.25; <i>95%CI</i> 0.03–0.47; p 0.023) and 0.43 cm³ of left hippocampus volume (<i>b</i> 0.43; <i>95%CI</i> 0.16–0.71; p 0.002). <h3>Conclusions:</h3> We observed an incremental prevalence of RI according to the phenotype: from more early relapsing courses to long-standing progressive courses (RRMS to PPMS or SPMS). In addition, our observations shed light on the potential role of early neurodegeneration in the development of RI and vice versa. <b>Disclosure:</b> Dr. Murrieta-Alvarez has nothing to disclose. Dr. Perez has nothing to disclose. Dr. Leon Pena has nothing to disclose. Mr. Benítez Salazar has nothing to disclose. Dr. Gallardo Pérez has nothing to disclose. Dr. Olivares-Gazca has nothing to disclose. Dr. Ruiz-Delgado has nothing to disclose. Guillermo Ruiz-Arguelles has nothing to disclose.

Survey-Based Evaluation of Cancer Patients’ Satisfaction and Discomfort Experienced During Central Venous Port Use

Introduction: The use of central venous port provides a safer and better quality of life for cancer patients undergoing chemotherapy. Refusal of central venous port implantation in patients with inadequate venous access may lead to discontinuation of chemotherapy or even extravasation of peripheral vasculitis and anti-cancer drugs. By doing this survey-based study, it was aimed to determine the reasons before the implantation of central venous port systems, the patient’s satisfaction afterwards, the complications associated with the port system, the discomfort they cause and the expectations of the patients. Patients and Methods: The study was carried out based on a questionnaire and through one-to-one interview by a cardiovascular surgeon with 100 patients who were treated with central venous port in the chemotherapy unit of Eskişehir City Hospital between August 1 and October 31, 2022. Results: Sixty-one percent of the patients cited long-term intravenous therapy and 44% cited inadequate venous access as the cause of port implantation. Ninety-six percent of the participants stated that they were satisfied with their ports. Only six patients stated that they had various problems, but were satisfied overall. When asked about the advantages of using the port, 76% of the patients stated that they no longer had more than one vascular puncture problem and 75% stated that they felt less pain. Fifty-one percent of the patients stated that they felt anxiety before the procedure; the most felt concern was possible complications (13 patients) and the thought that it would cause discomfort in life. Nine patients experienced complications after port implantation. Five patients described port system obstruction and four patients described the development of skin infection. Conclusion: Especially in our country, most patients still do not use central venous ports. The fact that existing fears and anxiety of the patients before the procedure cannot be eliminated with adequate and correct information plays an important role in this. At this point, the operator who performs the surgical procedure in the center where the procedure is performed should inform the patient and the oncology and chemotherapy nurse who give first information to the patient.

Central Vein Recanalization and Rehabilitation in Pediatric Patients: Changing the Paradigm for Chronic Occlusions.

Chronic total occlusions in the central venous system limit access and increase morbidity in chronically ill pediatric patients. We report the results of transcatheter recanalization of occluded central veins using angioplasty and stenting. Patients undergoing successful intervention for venous chronic total occlusions at our institution between April 2013 and December 2019 were retrospectively reviewed. Sixty-eight occluded central veins in 29 patients underwent recanalization with angioplasty (26 veins) or stenting (42 veins). The indications included limited access for catheterization or central line maintenance (19 patients), limb swelling (4 patients), superior vena cava syndrome (3 patients), and pleural effusion (3 patients). The primary risk factor for occlusion was a history of central venous lines after surgery or extracorporeal membrane oxygenation support in 76% of the patients. The median age and weight at the time of initial intervention were 5.8 years and 14.5 kg, respectively. There were no major complications. Of 10 patients with symptoms of venous congestion, 8 experienced symptomatic improvement. Twenty-two patients (59 veins) underwent 44 recatheterizations during a median follow-up duration of 288 days. Early reintervention was typically planned. The median time to recatheterization was 71 days. Twenty-one veins reoccluded and required repeat recanalization. Reocclusion was associated with persistent upstream collateral vein decompression, as determined using postintervention venography (odds ratio, 14.2; 95% CI, 3.3-62.6; P < .001), which was thought to indicate persistently poor venous inflow. Reinterventions were performed on 40 veins. Fifty-two veins that were followed up (88%) remained patent after the most recent intervention. Invasive transcatheter rehabilitation of occluded central veins has the potential to preserve critical access sites and improve the symptoms of venous congestion in pediatric patients. Reinterventions are common for reocclusion, restenosis, and somatic growth.