Sotiriadis Charalampos, Hajdu Steven David, Doenz Francesco, Qanadli Salah D
Lausanne University Hospital, Lausanne, Switzerland.
Front Surg. 2017 Apr 10;4:20. doi: 10.3389/fsurg.2017.00020. eCollection 2017.
Implanted venous access device (IVAD) late dysfunction is commonly caused by fibrin sheath formation. The standard method of endovascular fibrin sheath removal is performed the femoral vein. However, it is not always technically feasible and sometimes contraindicated. Moreover, approximately 4-6 h of bed rest is necessary after the procedure. In this article, we describe an alternative method of fibrin sheath removal using the brachial vein approach in a young woman receiving chemotherapy for breast cancer. The right basilic vein was punctured, and a long 6°F introducer sheath was advanced into the right subclavian vein. Endovascular maneuvers consisted on advancing Atrieve™ Vascular Snare 15-9 mm after catheter insertion in the superior vena cava through a 5.2°F Judkins left catheter. IVAD patency was restored without any complication, and the patient was discharged immediately after the procedure. In conclusion, fibrin sheath removal from an obstructed IVAD could be performed the right brachial vein. Further research is necessary in order to prove efficacy of this technique.
植入式静脉通路装置（IVAD）晚期功能障碍通常由纤维蛋白鞘形成引起。血管内纤维蛋白鞘清除的标准方法是通过股静脉进行。然而，这在技术上并不总是可行的，有时甚至是禁忌的。此外，术后大约需要4至6小时的卧床休息。在本文中，我们描述了一种在一名接受乳腺癌化疗的年轻女性中使用肱静脉途径清除纤维蛋白鞘的替代方法。穿刺右侧贵要静脉，将一个长的6F引导鞘推进到右侧锁骨下静脉。血管内操作包括通过一个5.2F左Judkins导管将Atrieve™血管圈套器15 - 9mm在导管插入上腔静脉后推进。IVAD通畅得以恢复，且无任何并发症，患者在术后立即出院。总之，可通过右侧肱静脉清除阻塞性IVAD的纤维蛋白鞘。为了证明该技术的有效性，还需要进一步的研究。
