Experience at a single institution with endovascular treatment of mechanical complications caused by implanted central venous access devices in pediatric and adult patients.

ABSTRACT

OBJECTIVE: Our objective was to describe the technical aspects and evaluate the feasibility, safety, and efficacy of endovascular management of mechanical complications related to implanted central venous devices. MATERIALS AND METHODS: One hundred fifty-six patients with cancer, who ranged in age from 3 months to 75 years (mean +/- SD, 47 +/- 18 years), were referred 290 +/- 200 days (mean +/- SD; range, 0-1202 days) after central venous device placement for retrieval of a fractured and embolized central venous device catheter (n = 100), retrieval of a guidewire embolized during placement of a central venous device (n = 2), repositioning of the migrated tip of a central venous device catheter (n = 38), and fibrin-sheath stripping (n = 16). All procedures were performed with the patient under local anesthesia on an outpatient basis, except for the eight pediatric patients. RESULTS: Ninety-five of the 100 embolized catheters and both of the guidewires were successfully retrieved. Retrieval was preceded by repositioning the embolized catheter with a pigtail catheter in 48 of these cases. Most of the procedures were performed with standard vascular tools (loop snares and pigtail catheters); the use of more sophisticated devices (grasping forceps, baskets, or balloons) rarely overcame the failure of a loop snare. Repositioning a migrated catheter tip was achieved with a pigtail catheter in 32 of 38 attempts. Of the repositioned catheters, only 24 could be used. Most of the 11 repositioning and retrieval failures were encountered because the catheter lacked a free end. Fibrin-sheath stripping was always technically successful all these catheters were patent at 3-month follow-up. No procedure-related complications occurred. CONCLUSION: The endovascular approach is highly feasible, safe, and effective for the management of mechanical complications of central venous devices. It is probably advisable to reserve endovascular repositioning for port catheters that are cumbersome to exchange and to replace simple catheters.