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Feasibility and Safety of Endovascular Stripping of Totally Implantable Venous Access Devices

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Abstract

Purpose

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.

Materials and Methods

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.

Results

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.

Conclusions

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.

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Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium

    Sam Heye, Geert Maleux & Johan Vaninbroukx

  2. Department of Surgical Oncology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium

    G. A. Goossens, M. Jerôme & M. Stas

  3. Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium

    G. A. Goossens

Authors
  1. Sam Heye
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  2. Geert Maleux
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  3. G. A. Goossens
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  4. Johan Vaninbroukx
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  5. M. Jerôme
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  6. M. Stas
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Correspondence to Sam Heye.

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Heye, S., Maleux, G., Goossens, G.A. et al. Feasibility and Safety of Endovascular Stripping of Totally Implantable Venous Access Devices. Cardiovasc Intervent Radiol 35, 607–612 (2012). https://doi.org/10.1007/s00270-011-0158-2

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  • DOI: https://doi.org/10.1007/s00270-011-0158-2

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