Vascular Access Center, Oncology Center of Agel Nový Jičín Hospital, Nový Jičín, Czech Republic.
Sci Prog. 2024 Jul-Sep;107(3):368504241260374. doi: 10.1177/00368504241260374.
Persistent withdrawal occlusion (PWO) is a specific catheter malfunction characterized by the inability to withdraw blood through the device. The most common cause of PWO in ports is the presence of a fibroblastic sleeve (FS). If malfunction occurs, medication can be applied incorrectly with the increased risk of complications.
One hundred seventy-seven cases of PWO in venous ports were managed. We focused on evaluating the cause of PWO, the frequency of occurrence of FS, and the options to address the malfunction. The patients underwent fluoroscopy with a contrast agent administration. Mechanical disruption (MD) with a syringe of saline using the flush method was used; in case of its failure, subsequent administration of a lock solution with taurolidine and urokinase, or low-dose thrombolysis with alteplase was indicated. Demographic data were compared with a control group.
A significantly higher proportion of female patients was found in the cohort of patients with PWO (80.3% vs 66.3%, = 0.004), dominantly patients with ovarian cancer (12.8% vs 4.8%, = 0.022). No effect of the cannulated vein or the type of treatment on the incidence of PWO was demonstrated. The presence of FS was verified in 70% of cases. MD with a syringe was successful in 53.5% of cases. A significantly shorter time to referral (3 weeks) was demonstrated with successful management. The overall success rate of achieving desobliteration by MD alone or in combination with a thrombolytic (urokinase or alteplase) administration was 97.4%.
We created a method for resolving PWO using MD +/- application of thrombolytics with 97.4% success rate. Current evidence showed that FS is not likely to be affected by thrombolytic drugs; however, we have ascertained an effect of these drugs, proposing a hypothesis of microthrombotic events at the tip of the catheter if fibroblastic sleeve is present.
持续性拔栓阻塞（PWO）是一种特定的导管故障，其特征是无法通过装置抽出血液。在端口中，PWO 最常见的原因是存在纤维母细胞套（FS）。如果发生故障，药物的应用可能不正确，从而增加并发症的风险。
我们对 177 例静脉端口的 PWO 进行了处理。我们专注于评估 PWO 的原因、FS 的发生频率以及解决故障的选择。患者接受了带有造影剂的透视检查。使用冲洗法用盐水注射器进行机械破坏（MD）；如果失败，随后给予含有牛磺熊去氧胆酸和尿激酶的锁定溶液，或给予低剂量的阿替普酶溶栓。比较了人口统计学数据与对照组。
在 PWO 患者队列中，女性患者的比例明显更高（80.3%比 66.3%，=0.004），主要是卵巢癌患者（12.8%比 4.8%，=0.022）。未发现套管静脉或治疗类型对 PWO 发生率有影响。70%的病例证实存在 FS。注射器 MD 成功 53.5%。成功管理的转诊时间明显更短（3 周）。仅通过 MD 或与溶栓药物（尿激酶或阿替普酶）联合应用单独或联合实现再通的总体成功率为 97.4%。
我们创建了一种使用 MD 解决 PWO 的方法，成功率为 97.4%，单独使用或联合使用溶栓药物。现有证据表明，FS 不太可能受到溶栓药物的影响；然而，我们已经确定了这些药物的效果，如果存在纤维母细胞套，我们提出了导管尖端发生微血栓事件的假说。
