RESUMO
PURPOSE: The objective of this study was to evaluate and compare the relative durability and complications between the proximal valve polyurethane and distal valve silicone peripherally inserted central catheters (PICCs). METHODS: Institutional review board approval was obtained. A total of 326 patients (mean age, 50.4 years) was assigned randomly to receive either a proximal valve polyurethane PICC (n = 198) or a distal valve silicone Groshong PICC (n = 194). All PICCs were inserted under radiologic guidance by interventional radiologists. Follow-up data were collected until catheter removal because of complications or treatment completion. RESULTS: The mean catheter dwell time was 25.6 days (range, 1-245 days). Complications were encountered in 26.8% and 47.9% of the proximal valve polyurethane PICCs and distal valve silicone PICCs, respectively (P < .001). Significantly higher incidences of phlebitis (23.2% versus 11.6%, P = .003) and catheter-related infection (6.2% versus 2%, P = 0.043) were noted in the distal valve silicone PICCs. No significant differences in the incidence of catheter occlusion, fracture, or dislodgement were found. Multivariate logistic regression analysis showed a higher complication rate in the distal valve silicone PICCs corrected for patients' age, sex, underlying morbidity, indication, peripheral vein accessed, arm used, catheter tip placement, and the number of venepunctures attempted. CONCLUSIONS: Proximal valve polyurethane PICCs were more durable than distal valve silicone PICCs, which were associated with a higher incidence of phlebitis and infection, probably related to the materials of the catheters and the designs and placements of the catheter valves.
Assuntos
Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora , Poliuretanos , Silicones , Extremidade Superior/irrigação sanguínea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Distribuição de Qui-Quadrado , Remoção de Dispositivo , Desenho de Equipamento , Falha de Equipamento , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Flebite/etiologia , Estudos Prospectivos , Radiografia Intervencionista , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Pseudoaneurysm formation at the site of aortotomy is a rare complication following aortic valve replacement; it appears to be more common in those whose valve is replaced for endocarditis or in those who develop an early postoperative endocarditis or sepsis. We discuss the case of a 77-year-old male, who presented 12 years following mechanical aortic valve replacement, with rupture of an ascending aortic pseudoaneurysm arising from a transverse aortotomy line.