Search

To study various anatomical factors determining procedure success versus failure for plug-assisted retrograde transvenous obliteration (PARTO) of gastro-lieno-renal shunt. A retrospective review of 50 patients (M:F-37:13; mean age 58.4yrs) who were planned for PARTO of gastro-lieno-renal shunt from July 2017 to July 2019 was done. Anatomical factors [shunt diameter, shunt angle, shunt orientation, left renal vein (LRV) size/calibre and distance of shunt from renal vein-IVC confluence] were analysed on a pre-procedure CT. Statistical analysis of the data was done to assess the relationship between these factors and technical success/failure. PARTO was successfully performed in 82% (n = 41). Analysis of anatomical factors showed that aneurysmal dilatation of the LRV, extreme acute/obtuse angulation and extreme antero-posterior orientation of the shunt in relation to the LRV was associated with higher probability of technical failure of PARTO. Minimum/maximum and entry point shunt diameter was not associated with procedure outcome. It was also noted that an increased distance of the shunt from the renal vein-IVC confluence favoured trans-jugular over trans-femoral venous access for PARTO. Knowledge of various anatomical factors of gastro-lieno-renal shunt may help in deciding the access route for PARTO and may determine technical success/failure. Alternate methods like BRTO or coil-assisted obliteration (CARTO) or anterograde obliteration of the shunt via trans-hepatic/splenic route might be needed in such circumstances.

Life-threatening bleeding may occur following percutaneous portal venous access procedures. Various embolic agents have been utilised to minimise this risk, each with their own disadvantages, including inadvertent embolization of the portal vein and inadequate tract embolization. We aim to assess the feasibility of a novel approach to percutaneous portal venous access closure by utilising the MYNXGRIP® vascular closure device (Cardinal Health, USA). This retrospective study analysed 20 patients who underwent interventional radiological procedures with closure of the percutaneous transhepatic portal venous access tract using the MYNXGRIP® closure device with either N-butyl cyanoacrylate or thick gelatin paste. None of these patients demonstrated clinical evidence of post-procedural haemorrhage, which was further confirmed on abdominal imaging in 15 of these patients. MYNXGRIP®-assisted percutaneous transhepatic portal venous access closure is feasible and able to achieve haemostasis with minimal embolization risk.

To compare incidence of port inversion among different types of implantable venous access devices.Records of patients who underwent imaging-guided subcutaneous port placement without port fixation between July 2001 and April 2015 were reviewed with use of a quality assurance database. 1930 patients with complete follow-up (death or explant) were included in the study. Collected data included date and indication for port placement, port type, venous access site, immediate and long-term complications, indication for removal, and total number of catheter days. BMI of patients with inverted ports was also calculated.Port inversion within the pocket was observed in 18 patients (0.9%) including 7/82 (9%) of Dignity ports, 4/126 (3%) of Vaxcel plastic arm ports, 3/142 (2%) of Smartports, 2/100 (2%) of Powerports, 1/14 (7%) of Vaccess ports, and 1/1421 (0.07%) of Vortex LP ports. Among these designs, the inversion rate was significantly lower in Vortex LP ports (0.1%) (P 0.05). There was a trend toward higher inversion rate of Dignity ports, which have a rectangular design with a relatively narrow base. Mean dwell in inverted ports was 114 days (7-580).The incidence of port inversion without suture fixation of the port base to the pocket is extremely low. The present study shows differences in inversion incidence based on port design.Case Series, Level IV.

Purpose: Implanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques. Methods and Materials: Through a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new "mechanical adhesiolysis” maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication. Results: Eighty-eight salvage procedures were performed in 80 patients, mostly women (52.5%), with a mean age of 54years. Only a minority (17.5%) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24%). Overall technical success rate was 93.2%. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted. Conclusion: These IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement.

With the increased use of implanted venous access devices (IVADs) for continuous long-term venous access, several techniques such as percutaneous endovascular fibrin sheath removal, have been described, to maintain catheter function. Most standard techniques do not capture the stripped fibrin sheath, which is subsequently released in the pulmonary circulation and may lead to symptomatic pulmonary embolism. The presented case describes an endovascular technique which includes stripping, capture, and removal of fibrin sheath using a novel filter device. A 64-year-old woman presented with IVAD dysfunction. Stripping was performed using a co-axial snare to the filter to capture the fibrin sheath. The captured fragment was subsequently removed for visual and pathological verification. No immediate complication was observed and the patient was discharged the day of the procedure.

To evaluate the safety and feasibility of percutaneous stripping of totally implantable venous access devices (TIVAD) in case of catheter-related sleeve and to report a technique to free the catheter tip from vessel wall adherence.A total of 37 stripping procedures in 35 patients (14 men, 40%, and 21 women, 60%, mean age 53±14 years) were reviewed. Totally implantable venous access devices were implanted because of malignancy in most cases (85.7%). Catheter-related sleeve was confirmed as cause of persistent catheter dysfunction despite instillation of thrombolytics. A technique to mobilize the catheter tip from the vessel wall was used when stripping with the snare catheter was impossible. Technical success, complication rate, and outcome were noted.A total of 55.9% (n=19) of the 34 technically successful procedures (91.9%) could be done with the snare catheter. In 15 cases (44.1%), additional maneuvers to free the TIVAD's tip from the vessel wall were needed. Success rate was not significantly lower before (72.4%) than after (96.7%) implementation of the new technique (P=0.09). No complications were observed. Follow-up was available in 67.6% of cases. Recurrent catheter dysfunction was found in 17 TIVADs (78.3%) at a mean of 137.7 days and a median of 105 days.Stripping of TIVADs is technically feasible and safe, with an overall success rate of 91.9%. Additional endovascular techniques to mobilize the distal catheter tip from the wall of the superior vena cava or right atrium to allow encircling the TIVAD tip with the snare catheter may be needed in 44.1% of cases.

Purpose This study was designed to compare central venous ports (CVP) from two different routes of venous access―the subclavian vein and arm vein―in terms of safety for patients with head and neck cancer (HNC).

We report a method that we have devised in which a secure subcutaneous tunnel is prepared during the placement of an indwelling central venous reservoir in the forearm. Subjects included 69 cases in which a procedure for implanting an indwelling reservoir in the forearm was performed between June 2006 and May 2007. For the subcutaneous tunnel, a 22-G Cathelin needle was advanced from the puncture site, turning toward the subcutaneous pocket side to the deep subcutaneous area. A 14-G Surflo IV catheter was then advanced along the 22-G Cathelin needle from the subcutaneous pocket. With the tip of the 14-G Surflo IV catheter emerging above the skin at the puncture site, the inner needle of the 14-G Surflo IV catheter and the 22-G Cathelin needle were removed. The catheter was passed through the outer 14-G Surflo IV catheter to emerge on the subcutaneous pocket site, then the outer needle of the Surflo catheter was also removed, and a connection to the port was made to create the subcutaneous tunnel. In all 69 cases, the subcutaneous tunnel in the forearm of the nondominant arm was successfully created within a short period of time (100% success rate). No problems were observed due to slack in the catheter until removal of the sutures 1 week later and for 3 months after treatment. With this method, we believe that a subcutaneous tunnel can be prepared in which the contained catheter has minimal freedom of movement, and which minimizes any damage induced by slack in the catheter within the subcutaneous tunnel.

We describe a useful technique for the removal of an irretrievable/stuck long-term intravenous catheter. The alternative would have meant removing it surgically or snaring it in a case of extremely difficult venous access. The process we used was effective in this particular case.

Selected issues regarding radiological placement of CVA devices have been reviewed with emphasis on those aspects that place an interventional radiologist in the unique position of being able to offer an all-inclusive VAS, the quality of which equals or exceeds that of other specialists providing venous access, and may offer it at a lower cost.

The program of the annual meeting of CIRSE consisted of 276 oral presentations and 69 posters. The main highlights of the meeting were Arterial Interventions; Aortic Stent Grafts; TIPS and Portal Vein Interventions; Thrombolysis and Thrombectomy; Liver Tumors; Venous Interventions; Central Venous Access; and Gastrointestinal Interventions. The presentations related to the most prominent topics of the meeting are summarized here. The abstracts listed below refer to the Main Programme of the Meeting published in CardioVascular and Interventional Radiology 20 [Suppl 1], 1997.

Central venous catheter placement is indicated in many situations, and an increasing number of patients require temporary and long-term central catheters. Frequently, patients who have undergone multiple central veins catheterizations develop complete and diffuse venous occlusion, and this constitutes a difficult-to-manage clinical problem. We report a case of a 20-year-old patient who was referred to our department for central venous line placement who manifested bilateral femoral, jugular, and subclavian veins occlusion. A central venous catheter was implanted through a cervical collateral vein, targeting on and puncturing an angioplasty balloon, and advanced into the collateral vein through a transhepatic venous access.

Conventional surgical technique of subcutaneous venous port placement describes dissection of the port pocket to the pectoralis fascia and suture fixation of the port to the fascia to prevent inversion of the device within the pocket. This investigation addresses the necessity of that step. Between October 8, 2004 and October 19, 2007, 558 subcutaneous chest ports were placed at our institution; 24 cases were excluded from this study. We performed a retrospective review of the remaining 534 ports, which were placed using standard surgical technique with the exception that none were sutured into the pocket. Mean duration of port use, total number of port days, indications for removal, and complications were recorded and compared with the literature. Mean duration of port use was 341 days (182,235 total port days, range 1–1279). One port inversion/flip occurred, which resulted in malfunction and necessitated port revision (0.2%). Other complications necessitating port removal included infection 26 (5%), thrombosis n = 2 (

This report describes a technique of inserting an implantable venous access port (portacath) through a thrombosed and occluded vein employing a pre-existing peripherally inserted central catheter (PICC) as the route of access. The PICC was used as a conduit for venous access in a way that has not been described previously in the literature. This procedure was performed in a young patient with cystic fibrosis in an effort to prevent the use of his virgin contralateral veins, which might be used in the future.

When patients with end-stage renal disease have exhausted both conventional and unconventional venous access options, creative solutions must be sought for hemodialysis catheter placement in order to ensure survival. This case describes a patient in urgent need of a dialysis catheter despite total occlusion of the jugular, subclavian, and femoral veins. Occlusion of the inferior vena cava (IVC) and right renal vein resulted in failed attempts at translumbar catheter placement. A gooseneck snare was temporarily advanced through the liver to the IVC for use as a fluoroscopic target to facilitate successful single-puncture, translumbar catheterization.

Central venous access plays an important role in the management of an ever-increasing population of patients ranging from those that are critically ill to patients with difficult clinical access. Interventional radiologists are key in delivering this service and should be familiar with the wide range of techniques and catheters now available to them. A comprehensive description of these catheters with regard to indications, technical aspects of catheterization, success rates, and associated early and late complications, as well as a review of various published guidelines on central venous catheter insertion are given in this article.

The purpose of the note is to describe a new technique for type II endoleak treatment, using an alternative approach through femoral venous access. Three patients who developed type II endoleak after endovascular repair of abdominal aortic aneurysm were treated with direct transcaval puncture and embolization inside the aneurysm sac. The detailed technique is described. All patients were treated without any complications and discharged 48 hours after the treatment. At 1 month follow-up the computed tomograph scan did not show a recurrence of a type II endoleak. The management of patients with type II endoleak is a controversial issue and different techniques have been proposed. We suggest an alternative technique for type II endoleak treatment. The feasibility and the advantages of this approach can offer new possibilities for the diagnosis as well as for the treatment of this complication.

We retrospectively evaluated the usefulness of both arterial and venous access with the pull-through technique in endovascular treatment of totally occluded Brescia–Cimino fistulas. We treated 26 patients (17 men, 9 women; age range 43–82 years, mean age 66 years) with occluded Brescia–Cimino fistulas. First, the occluded segment was traversed from the antegrade brachial arterial access using a microcatheter–guidewire system. Second, the vein was retrogradely punctured after confirmation of all diseased segments, and a 0.014- or 0.016-inch guidewire was pulled through the venous access when the occluded segment was long. All interventions including thrombolysis, thromboaspiration, angioplasty, and stent placement were performed via the venous access. The occlusion was successfully crossed via the brachial arterial access in 23 patients (88%). In 2 patients it was done from the venous approach. In the remaining patient it was not possible to traverse the occluded segment. The pull-through technique was successful in all 19 attempts. Clinical success was achieved in 96%, the primary patency rates at 6, 12, and 18 months were 83%, 78%, and 69%, the primary assisted patency rates were 92%, 92%, and 72%, and the secondary patency rates were 92%, 92%, and 92%, respectively. Minor complications in 5 patients included venous perforation in 2 (8%), venous rupture in 1 (4%), and regional hematoma in 2 (8%). Our study suggests that endovascular treatments with both arterial and venous access using the pull-through technique are highly effective in restoring function in totally occluded Brescia–Cimino fistulas.

Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.

A great variety of central venous access devices such as tunneled and non-tunneled central venous catheters (CVC) as well as port systems are implanted by interventional radiologists at an increasing rate. There are some possible immediate, early, and late complications related to the implantation technique, care, and maintenance of CVCs. This review will illustrate possible complications of CVCs and will discuss risk factors. Different strategies will be shown regarding the prevention and treatment of complications.

To describe the implementation of a technique to trim the excess length of a central venous catheter via a process of endovascular snaring without exposing or changing the device. We report on the outcome of this technique in 3 patients. The technique was successful in two cases and successful with a modification in the remaining case. The technique is useful to salvage an implanted venous access device. It appears to be less invasive with reduced procedure time and less patient discomfort than other techniques.

To assess safety and function of central venous port systems implanted percutaneously in the interventional radiology suite.One hundred and twenty-five consecutive ports in 123 patients were evaluated retrospectively. One hundred and twenty ports were implanted via the subclavian vein.Technical success was 100%. Fourteen patients (11.2%) experienced immediate procedural complications, all minor (pneumothorax 1.6%). During follow-up (4-343 days, mean service period 97.8 days), nine complications occurred, six of which were major. These were three port infections which led to hospitalization and port removal, one chamber penetration through the skin, and two port occlusions. Port removal as a result of complications was performed in six patients. Altogether, 20 complications occurred within a total of 11,056 days of service, which means 1.8 events per 1000 days of service.Percutaneous implantation of central venous port systems is safe and easy to perform. Complication rates of this study compare favorably with those of other radiological and surgical series.

We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm.Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route.All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheter-related phlebitis occurred.Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis.