Clark Katherine, Chick Jeffrey Forris Beecham, Reddy Shilpa N, Shin Benjamin J, Nadolski Gregory J, Clark Timothy W, Trerotola Scott O
Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.
Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104; Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan.
J Vasc Interv Radiol. 2017 Apr;28(4):602-607. doi: 10.1016/j.jvir.2016.12.1222. Epub 2017 Feb 24.
To determine if concurrent placement of a central venous stent (CVS) and central venous access device (CVAD) compromises stent patency or catheter function in patients with malignant central venous obstruction.
CVS placement for symptomatic stenosis resulting from malignant compression was performed in 33 consecutive patients who were identified retrospectively over a 10-year period; 28 (85%) patients had superior vena cava syndrome, and 5 (15%) had arm swelling. Of patients, 11 (33%) underwent concurrent CVS and CVAD placement, exchange, or repositioning; 22 (67%) underwent CVS deployment alone and served as the control group. Types of CVADs ranged from 5-F to 9.5-F catheters. Endpoints were CVS patency as determined by clinical symptoms or CT and CVAD function, which was determined by clinical performance.
All procedures were technically successful. There was no difference between the 2 groups in clinically symptomatic CVS occlusion (P = .2) or asymptomatic in-stent stenosis detected on CT (P = .5). None of the patients in the CVS and CVAD group had recurrent clinical symptoms, but 3 (30%) of 10 patients with imaging follow-up had asymptomatic in-stent stenosis. In the control group, 3 (14%) patients had clinically symptomatic CVS occlusion and required stent revision, whereas 4 (21%) of 19 patients with imaging follow-up had asymptomatic in-stent stenosis. During the study, 2 (20%) functional but radiographically malpositioned catheters were identified (0.66 per 1,000 catheter days).
Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone.
确定在恶性中心静脉阻塞患者中同时放置中心静脉支架（CVS）和中心静脉通路装置（CVAD）是否会影响支架通畅性或导管功能。
对连续33例因恶性压迫导致症状性狭窄而进行CVS置入的患者进行回顾性研究，这些患者在10年期间被确诊；28例（85%）患者患有上腔静脉综合征，5例（15%）患者有手臂肿胀。其中，11例（33%）患者同时进行了CVS和CVAD的置入、更换或重新定位；22例（67%）患者仅进行了CVS置入，作为对照组。CVAD的类型从5F到9.5F导管不等。观察指标包括通过临床症状或CT确定的CVS通畅性以及通过临床表现确定的CVAD功能。
所有手术在技术上均获成功。两组在临床症状性CVS闭塞方面无差异（P = 0.2），在CT上检测到的无症状支架内狭窄方面也无差异（P = 0.5）。CVS和CVAD组的患者均无复发性临床症状，但在10例接受影像学随访的患者中，3例（30%）有无症状支架内狭窄。在对照组中，3例（14%）患者出现临床症状性CVS闭塞并需要进行支架修复，而在19例接受影像学随访的患者中，4例（21%）有无症状支架内狭窄。在研究期间，发现2例（20%）功能正常但影像学位置不当的导管（每1000导管日0.66例）。
与单独放置CVS相比，通过CVS放置CVAD可能不会影响支架通畅性或导管功能。
