Subject(s)
Arteriovenous Malformations , Embolization, Therapeutic , Pulmonary Artery , Pulmonary Veins , Recurrence , Female , Humans , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/therapy , Arteriovenous Malformations/surgery , Embolization, Therapeutic/instrumentation , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/abnormalities , Pulmonary Artery/surgery , Pulmonary Veins/abnormalities , Pulmonary Veins/diagnostic imaging , Pulmonary Veins/surgery , Treatment Outcome , Middle AgedABSTRACT
PURPOSE: To report the safety and effectiveness of fibrin sheath stripping of pediatric chest ports. MATERIALS AND METHODS: Fibrin sheath stripping procedures for pediatric chest ports between 2018 and 2023 were retrospectively reviewed. The treatment indication was the inability to aspirate blood from the port. The technical success, adverse events, days of primary and secondary service intervals, fluoroscopy time, and fluoroscopy dose were recorded. RESULTS: Fibrin sheath stripping procedures were performed in 15 patients for a total of 18 procedures. All patients treated with fibrin sheath stripping had failed fibrinolytic treatment and a preprocedural fluoroscopy examination suggestive of fibrin sheath before attempting stripping. All fibrin sheath stripping procedures were technically successful. The median and mean total days of primary service interval from the date of port placement to the date of suspected fibrin sheath were 666 and 617 days, respectively. The median and mean total number of days of secondary service interval were 385 and 561 days, respectively. The mean fluoroscopy time was 16.9 minutes. The mean fluoroscopy air kerma was 29.8 mGy. No adverse events were observed. CONCLUSIONS: Fibrin sheath stripping is a safe and effective minimally invasive option to maintain the function of pediatric chest ports.
Subject(s)
Fibrin , Humans , Retrospective Studies , Female , Male , Child, Preschool , Treatment Outcome , Child , Time Factors , Infant , Radiography, Interventional , Adolescent , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/adverse effects , Fluoroscopy , Catheters, Indwelling , Risk Factors , Radiation Dosage , PuncturesABSTRACT
PURPOSE: To describe the use of the internal mammary vein as an alternative access for central venous catheters. METHODS: We performed a retrospective review of patients who underwent placement of central venous catheters via the internal mammary vein. Patient demographics, indication for venous access, technical success, catheter type, dwell time and indication for exchange or removal were recorded. RESULTS: Placement of central venous catheters via the internal mammary vein was attempted in 11 patients including 8 children (4 males, mean age 5.7 years) and 3 adults. The most common indication was parenteral nutrition in patients with intestinal failure (7/11). Initial needle access of the vein was successful in all patients. Catheter placement was successful in 9 and unsuccessful in 2 patients due to occlusion of the superior vena cava. There were no immediate complications. A total of 20 catheters of various sizes (3-14.5 French) and lengths (8-23 cm) were either placed (n = 12) or exchanged (n = 8). The most common indications for catheter exchange were poor function and malposition (7/8). Four catheters were removed for infection and 4 were accidentally removed. The mean dwell time was 141 days (range 0-963 days) per catheter for a total of 2829 catheter days. The total mean dwell time per patient, including primarily placed and exchanged catheters, was 314 days (range 5-963 days). CONCLUSIONS: The internal mammary vein may provide a safe alternative route for patients who have lost their traditional access veins.
