PDF(Pubmed)
Abstract：
UNASSIGNED: Chronic total occlusions in the central venous system limit access and increase morbidity in chronically ill pediatric patients. We report the results of transcatheter recanalization of occluded central veins using angioplasty and stenting.
UNASSIGNED: Patients undergoing successful intervention for venous chronic total occlusions at our institution between April 2013 and December 2019 were retrospectively reviewed.
UNASSIGNED: Sixty-eight occluded central veins in 29 patients underwent recanalization with angioplasty (26 veins) or stenting (42 veins). The indications included limited access for catheterization or central line maintenance (19 patients), limb swelling (4 patients), superior vena cava syndrome (3 patients), and pleural effusion (3 patients). The primary risk factor for occlusion was a history of central venous lines after surgery or extracorporeal membrane oxygenation support in 76% of the patients. The median age and weight at the time of initial intervention were 5.8 years and 14.5 kg, respectively. There were no major complications. Of 10 patients with symptoms of venous congestion, 8 experienced symptomatic improvement. Twenty-two patients (59 veins) underwent 44 recatheterizations during a median follow-up duration of 288 days. Early reintervention was typically planned. The median time to recatheterization was 71 days. Twenty-one veins reoccluded and required repeat recanalization. Reocclusion was associated with persistent upstream collateral vein decompression, as determined using postintervention venography (odds ratio, 14.2; 95% CI, 3.3-62.6; P < .001), which was thought to indicate persistently poor venous inflow. Reinterventions were performed on 40 veins. Fifty-two veins that were followed up (88%) remained patent after the most recent intervention.
UNASSIGNED: Invasive transcatheter rehabilitation of occluded central veins has the potential to preserve critical access sites and improve the symptoms of venous congestion in pediatric patients. Reinterventions are common for reocclusion, restenosis, and somatic growth.
UNASSIGNED: Patients undergoing successful intervention for venous chronic total occlusions at our institution between April 2013 and December 2019 were retrospectively reviewed.
UNASSIGNED: Sixty-eight occluded central veins in 29 patients underwent recanalization with angioplasty (26 veins) or stenting (42 veins). The indications included limited access for catheterization or central line maintenance (19 patients), limb swelling (4 patients), superior vena cava syndrome (3 patients), and pleural effusion (3 patients). The primary risk factor for occlusion was a history of central venous lines after surgery or extracorporeal membrane oxygenation support in 76% of the patients. The median age and weight at the time of initial intervention were 5.8 years and 14.5 kg, respectively. There were no major complications. Of 10 patients with symptoms of venous congestion, 8 experienced symptomatic improvement. Twenty-two patients (59 veins) underwent 44 recatheterizations during a median follow-up duration of 288 days. Early reintervention was typically planned. The median time to recatheterization was 71 days. Twenty-one veins reoccluded and required repeat recanalization. Reocclusion was associated with persistent upstream collateral vein decompression, as determined using postintervention venography (odds ratio, 14.2; 95% CI, 3.3-62.6; P < .001), which was thought to indicate persistently poor venous inflow. Reinterventions were performed on 40 veins. Fifty-two veins that were followed up (88%) remained patent after the most recent intervention.
UNASSIGNED: Invasive transcatheter rehabilitation of occluded central veins has the potential to preserve critical access sites and improve the symptoms of venous congestion in pediatric patients. Reinterventions are common for reocclusion, restenosis, and somatic growth.
摘要：
■在慢性儿科患者中，中心静脉系统的慢性完全闭塞限制了通路并增加了发病率。我们报告了使用血管成形术和支架置入术对闭塞的中央静脉进行经导管再通的结果。
■对2013年4月至2019年12月在我们机构成功介入治疗静脉慢性完全闭塞的患者进行回顾性分析。
■29例患者的68例闭塞的中央静脉行血管成形术（26条静脉）或支架置入术（42条静脉）再通。适应症包括导管插入术或中央导管维护（19例患者），肢体肿胀（4例），上腔静脉综合征（3例），和胸腔积液（3例）。阻塞的主要危险因素是76％的患者在手术或体外膜氧合支持后有中心静脉线的病史。初始干预时的中位年龄和体重分别为5.8岁和14.5公斤，分别。无重大并发症。有静脉淤血症状的10例患者,8经历了症状改善。在288天的中位随访时间内，22例患者（59条静脉）接受了44次再治疗。通常计划进行早期再干预。再次治疗的中位时间为71天。21条静脉重新闭塞，需要重复再通。再闭塞与持续的上游侧支静脉减压有关，如使用干预后静脉造影确定的(比值比，14.2；95%CI，3.3-62.6；P<.001)，这被认为表明静脉流入量持续不佳。对40条静脉进行了再干预。在最近的干预之后，随访的52条静脉（88％）仍然是专利。
■对闭塞的中央静脉进行侵入性经导管康复治疗有可能保留关键的进入部位并改善儿科患者的静脉充血症状。再干预对于再闭塞很常见，再狭窄,和躯体生长。
■对2013年4月至2019年12月在我们机构成功介入治疗静脉慢性完全闭塞的患者进行回顾性分析。
■29例患者的68例闭塞的中央静脉行血管成形术（26条静脉）或支架置入术（42条静脉）再通。适应症包括导管插入术或中央导管维护（19例患者），肢体肿胀（4例），上腔静脉综合征（3例），和胸腔积液（3例）。阻塞的主要危险因素是76％的患者在手术或体外膜氧合支持后有中心静脉线的病史。初始干预时的中位年龄和体重分别为5.8岁和14.5公斤，分别。无重大并发症。有静脉淤血症状的10例患者,8经历了症状改善。在288天的中位随访时间内，22例患者（59条静脉）接受了44次再治疗。通常计划进行早期再干预。再次治疗的中位时间为71天。21条静脉重新闭塞，需要重复再通。再闭塞与持续的上游侧支静脉减压有关，如使用干预后静脉造影确定的(比值比，14.2；95%CI，3.3-62.6；P<.001)，这被认为表明静脉流入量持续不佳。对40条静脉进行了再干预。在最近的干预之后，随访的52条静脉（88％）仍然是专利。
■对闭塞的中央静脉进行侵入性经导管康复治疗有可能保留关键的进入部位并改善儿科患者的静脉充血症状。再干预对于再闭塞很常见，再狭窄,和躯体生长。
