Sullivan Patrick M, Takao Cheryl, Patel Neil D, Ing Frank F
Children's Hospital Los Angeles Heart Institute, Los Angeles, California.
Division of Cardiology, University of California, Davis Children's Hospital, Sacramento, California.
J Soc Cardiovasc Angiogr Interv. 2022 Nov 28;2(2):100547. doi: 10.1016/j.jscai.2022.100547. eCollection 2023 Mar-Apr.
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.
Patients undergoing successful intervention for venous chronic total occlusions at our institution between April 2013 and December 2019 were retrospectively reviewed.
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; < .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.
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.
中心静脉系统的慢性完全闭塞限制了通路，并增加了慢性病患儿的发病率。我们报告了使用血管成形术和支架置入术对闭塞的中心静脉进行经导管再通的结果。
对2013年4月至2019年12月在我们机构成功接受静脉慢性完全闭塞干预的患者进行回顾性研究。
29例患者的68条闭塞中心静脉接受了血管成形术（26条静脉）或支架置入术（42条静脉）再通。适应证包括导管插入术或中心静脉置管维护通路受限（19例患者）、肢体肿胀（4例患者）、上腔静脉综合征（3例患者）和胸腔积液（3例患者）。76%的患者闭塞的主要危险因素是手术后或体外膜肺氧合支持后有中心静脉置管史。初次干预时的中位年龄和体重分别为5.8岁和14.5千克。无重大并发症。10例有静脉充血症状的患者中，8例症状改善。22例患者（59条静脉）在中位随访期288天内进行了44次再次置管。通常计划进行早期再次干预。再次置管的中位时间为71天。21条静脉再次闭塞，需要重复再通。再次闭塞与干预后静脉造影确定的持续性上游侧支静脉减压有关（比值比，14.2；95%可信区间，3.3-62.6；P<0.001），这被认为表明静脉流入持续不佳。对40条静脉进行了再次干预。52条接受随访的静脉（88%）在最近一次干预后保持通畅。
侵入性经导管修复闭塞的中心静脉有可能保留关键通路部位，并改善患儿静脉充血症状。再次干预常见于再次闭塞、再狭窄和身体生长。
