[Coil embolization of arteriovenous fistulae on in situ saphenous vein bypasses: success rate and complications]. / Erfolgs- und Komplikationsrate der Coil-Embolisation arteriovenöser Fisteln nach Vena-saphena-magna-in-situ-Bypassanlage.

PURPOSE: To determine the success and complication rate of coil embolization of arteriovenous fistulae on in situ saphenous vein bypasses. MATERIALS AND METHOD: 82 AV-fistulae on 30 bypasses (28 patients, 20 men, age 62.5 +/- 8.3 years) were treated using coils. The success rate, complications, duration, amount of contrast material and radiation exposure were measured. Color-coded duplex sonography was performed 1 - 2 days and up to 6 - 18 months after embolization. RESULTS: The success rate was 68.3 %. The reasons for persistent fistula perfusion were: 96 % fistula not accessible, 4 % reperfusion during thrombolysis. 7 complications were observed in 6 bypasses: failure of placement and retrieving of coil (n = 4), thrombembolic complications with thrombolysis (n = 3). The duration of intervention was 118.3 +/- 46.6 min, the contrast material need was 277.03 +/- 94.0 ml, and the radiation exposure was 10 966 +/- 11 295 cGy/cm (2). Additional balloon dilatation was performed in 30 % of the bypasses. All bypasses were open 1-2 days after intervention. During follow-up, 11 persistent fistulae were detected. CONCLUSIONS: Coil-embolization of arteriovenous fistulae on saphena magna bypasses proved to be a method with moderate success and complication rates.

[Ultrasound guided implantation of chest port systems via the lateral subclavian vein]. / Die sonographisch gezielte Implantation von Portkathetersystemen über die laterale Vena subclavia.

PURPOSE: Retrospective analysis of the success and complication rates of chest port implantation via the lateral subclavian vein. MATERIALS AND METHODS: Between January 2003 and June 2004, the lateral subclavian vein in 271 patients (186 women, 85 men, mean age 53.2 years) was punctured guided by ultrasound. This access was used to insert a port system, and the catheter tip was placed at the cavoatrial junction. The port reservoir was implanted in a subcutaneous infraclavicular pocket and fixed to the fascia of the pectoralis muscle. Indications for port implantation were chemotherapy (n = 239), total parenteral nutrition (n = 2) and intravenous medication (n = 30). The patient follow-up was mainly performed either by the oncology division of the department of gynecology or by the department of internal medicine. RESULTS: A chest port catheter system was successfully implanted in all patients. The catheter remained in place for a mean duration of 269.4 days (SD 192.3 days). No complications occurred during implantation. In the post-interventional period, 6 catheter dysfunctions were found (thrombotic 0.09 per 1000 catheter days; mechanic 0.05 per 1000 catheter days). While one local infection occurred in the early post-interventional period, 3 local and 15 systemic infections were independent of the port catheter placement (0.39 per 1000 catheter days). The rate of port catheter ex-plantation due to dysfunction or infection was 0.07 per 1000 catheter days. CONCLUSION: Ultrasound-guided puncture of the lateral subclavian vein is a safe procedure for the insertion of central venous port catheter systems and had a very low complication rate in our study. For further evaluation of our port placement technique, prospective studies compared to placement through the internal jugular vein are necessary.