Angiografische Diagnostik und Interventionelle Therapie von Portdysfunktionen

Zusammenfassung

Ziel: Evaluation der interventionsradiologischen Darstellung und Behebung von Portdysfunktionen. Material und Methoden: Es erfolgte die retrospektive Auswertung von 429 Portdarstellungen an 393 Portkathetersystemen bei insgesamt 389 Patienten über einen Zeitraum von 10 Jahren. Einbezogen wurden sowohl die intern radiologisch implantierten Portsysteme, 193 (49,1 %), als auch die zur Portdarstellung überwiesenen Patienten mit chirurgisch implantierten Portsystemen, 200 (50,9 %). Portkatheterdysfunktionen wurden in Früh- und Spätkomplikationen sowie in thrombotische und nicht thrombotische Ereignisse unterteilt. Die Portdarstellung erfolgte nach Gabe von Kontrastmittel in digitaler Subtraktionsangiografie (DSA). Ergebnisse: Es zeigten sich 359 (83,7 %) Spätkomplikationen sowie 70 (16,3 %) Frühkomplikationen. In 299 (69,7 %) Fällen traten thrombotische Ereignisse auf, nicht thrombotische Ereignisse wurden 130 (30,3 %) mal verzeichnet. Häufigster Grund für die Portkatheterdarstellung war die katheterassoziierte Thrombose mit insgesamt 269 (62,7 %) Fällen. 70 (16,3 %) Kathetermigrationen und 30 (7,0 %) Fibrinummantelungen wurden dargestellt. 18 (4,2 %) Portnadeldefekte konnten durch Austausch der Nadel behoben werden. Alle 15 (3,5 %) Katheterdiskonnektionen erforderten die Revision des Portsystems. Die ebenfalls vollständige Explantation erfolgte bei 6 (1,4 %) Katheterfrakturen. Schlussfolgerung: Die Möglichkeiten der angiografischen Darstellung und die interventionsradiologische Behebung von Portkatheterdysfunktionen müssen im vollen Umfang ausgenutzt werden, um eine vorzeitige Portexplantation zu vermeiden.

Abstract

Purpose: To evaluate the impact of interventional radiological imaging and treatment of central venous port catheter complications. Materials and Methods: In this retrospective analysis 429 port catheter dysfunctions were evaluated in 393 port catheter systems for a total of 389 patients over a period of 10 years. The study included 193 (49.1 %) patients with radiologically implanted port catheter systems and 200 (50.9 %) referred patients with surgically implanted port systems. Port catheter dysfunctions were subdivided into early and late complications as well as into non-thrombotic and thrombotic events. After administration of contrast medium, the port system was visualized using digital subtraction angiography. Data were retrospectively collected from the in-house databases and then analyzed descriptively. Results: 429 contrast media injections via port catheters were performed in 393 port catheter systems. There were 359 (83.7 %) late complications and 70 (16.3 %) early complications. In 299 (69.7 %) cases thrombotic events occurred and 130 (30.3 %) non-thrombotic events were recorded. The most common reason for contrast media injection via port catheter system was port catheter-related thrombosis in 269 (62.7 %) cases. 70 (16.3 %) catheter migrations and 30 (7.0 %) fibrin sheath formations were detected. 18 (4.2 %) port needle malfunctions could be resolved through needle exchange. All 15 (3.5 %) catheter disconnections had to be revised in all cases. Also six port explantations were performed in 6 (1.4 %) catheter fractures. Conclusion: The possibilities of angiographic imaging and interventional radiological correction of port catheter dysfunctions must be exploited fully in order to avoid premature port explantation.

Key words

vascular - veins - venography - fluoroscopy - catheters - outcome analysis

Literatur

• 1 Gebauer B, El-Sheik M, Vogt M et al. Combined ultrasound and fluoroscopy guided port catheter implantation – high success and low complication rate.  Eur J Radiol. 2009;  69 517-522
• 2 Vardy J, Engelhardt K, Cox K et al. Long-term outcome of radiological-guided insertion of implanted central venous access port devices (CVAPD) for the delivery of chemotherapy in cancer patients: institutional experience and review of the literature.  British journal of cancer. 2004;  91 1045-1049
• 3 Moureau N, Poole S, Murdock M A et al. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients.  J Vasc Interv Radiol. 2002;  13 1009-1016
• 4 Yip D, Funaki B. Subcutaneous chest ports via the internal jugular vein. A retrospective study of 117 oncology patients.  Acta Radiol. 2002;  43 371-375
• 5 Wieners G, Redlich U, Dudeck O et al. Erste Erfahrungen mit intravenösen Portsystemen mit der Zulassung zur Hochdruckinjektion von Kontrastmittel in der Computertomografie.  Fortschr Röntgenstr. 2009;  181 664-668
• 6 Lenhart M, Schatzler S, Manke C et al. Radiologische Implantation zentralvenöser Portsysteme am Unterarm Implantationsergebnisse und Langzeit-Follow-up bei 391 Patienten.  Fortschr Röntgenstr. 2010;  182 20-28
• 7 Teichgraber U K, Gebauer B, Benter T et al. Central venous access catheters: radiological management of complications.  Cardiovasc Intervent Radiol. 2003;  26 321-333
• 8 Silberzweig J E, Sacks D, Khorsandi A S et al. Reporting standards for central venous access. Technology Assessment Committee.  J Vasc Interv Radiol. 2000;  11 391-400
• 9 O’Grady N P, Alexander M, Dellinger E P et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention.  MMWR Recomm Rep. 2002;  51 1-29
• 10 Biffi R, Orsi F, Pozzi S et al. Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trial.  Annals of oncology: official journal of the European Society for Medical Oncology/ESMO. 2009;  20 935-940
• 11 Caers J, Fontaine C, Vinh-Hung V et al. Catheter tip position as a risk factor for thrombosis associated with the use of subcutaneous infusion ports.  Support Care Cancer. 2005;  13 325-331
• 12 Biffi R, De Braud F, Orsi F et al. A randomized, prospective trial of central venous ports connected to standard open-ended or Groshong catheters in adult oncology patients.  Cancer. 2001;  92 1204-1212
• 13 Kock H J, Pietsch M, Krause U et al. Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems.  World J Surg. 1998;  22 12-16
• 14 Gregorio M A, Miguelena J M, Fernandez J A et al. Subcutaneous ports in the radiology suite: an effective and safe procedure for care in cancer patients.  Eur Radiol. 1996;  6 748-752
• 15 Stein de M, Wagner R H. [Complications of central venous access devices: outcome analysis of 2359 implantations].  Dtsch Med Wochenschr. 2005;  130 1129-1132
• 16 Wun T, White R H. Venous thromboembolism (VTE) in patients with cancer: epidemiology and risk factors.  Cancer Invest. 2009;  27 63-74
• 17 Kakkar A K, Levine M, Pinedo H M et al. Venous thrombosis in cancer patients: insights from the FRONTLINE survey.  Oncologist. 2003;  8 381-388
• 18 Levitan N, Dowlati A, Remick S C et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data.  Medicine. 1999;  78 285-291
• 19 Falanga A, Zacharski L. Deep vein thrombosis in cancer: the scale of the problem and approaches to management.  Ann Oncol. 2005;  16 696-701
• 20 Blom J W, Doggen C J, Osanto S et al. Malignancies, prothrombotic mutations, and the risk of venous thrombosis.  JAMA. 2005;  293 715-722
• 21 Haddad T C, Greeno E W. Chemotherapy-induced thrombosis.  Thromb Res. 2006;  118 555-568
• 22 Gomes M P, Deitcher S R. Diagnosis of venous thromboembolic disease in cancer patients.  Oncology. 2003;  17 126-135, 139 ; discussion 139 – 144
• 23 Kerner Jr J A, Garcia-Careaga M G, Fisher A A et al. Treatment of catheter occlusion in pediatric patients.  JPEN Journal of parenteral and enteral nutrition. 2006;  30 S73-S81
• 24 Ryder M. Evidence-based practice in the management of vascular access devices for home parenteral nutrition therapy.  JPEN Journal of parenteral and enteral nutrition. 2006;  30 S82-S93, S 98–S89
• 25 Nakazawa N. Infectious and thrombotic complications of central venous catheters.  Semin Oncol Nurs. 2010;  26 121-131
• 26 Mermel L A, Allon M, Bouza E et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.  Clin Infect Dis. 2009;  49 1-45
• 27 Gastmeier P, Geffers C. Prevention of catheter-related bloodstream infections: analysis of studies published between 2002 and 2005.  J Hosp Infect. 2006;  64 326-335
• 28 Lapalu J, Losser M R, Albert O et al. Totally implantable port management: impact of positive pressure during needle withdrawal on catheter tip occlusion (an experimental study).  J Vasc Access. 2010;  11 46-51
• 29 Gebauer B, Teichgraber U K, Podrabsky P et al. Radiological interventions for correction of central venous port catheter migrations.  Cardiovasc Intervent Radiol. 2007;  30 668-674
• 30 Schummer C, Sakr Y, Steenbeck J et al. Risk of extravasation after power injection of contrast media via the proximal port of multilumen central venous catheters: case report and review of the literature.  Fortschr Röntgenstr. 2010;  182 14-19
• 31 Collin G R, Ahmadinejad A S, Misse E. Spontaneous migration of subcutaneous central venous catheters.  Am Surg. 1997;  63 322-326
• 32 Aitken D R, Minton J P. The „pinch-off sign”: a warning of impending problems with permanent subclavian catheters.  Am J Surg. 1984;  148 633-636
• 33 Hinke D H, Zandt-Stastny D A, Goodman L R et al. Pinch-off syndrome: a complication of implantable subclavian venous access devices.  Radiology. 1990;  177 353-356
• 34 Vandoni R E, Guerra A, Sanna P et al. Randomised comparison of complications from three different permanent central venous access systems.  Swiss Med Wkly. 2009;  139 313-316
• 35 Araujo C, Silva J P, Antunes P et al. A comparative study between two central veins for the introduction of totally implantable venous access devices in 1201 cancer patients.  Ejso. 2008;  34 222-226
• 36 Rouzrokh M, Shamsian B S, KhaleghNejad Tabari A et al. Totally implantable subpectoral vs. subcutaneous port systems in children with malignant diseases.  Arch Iran Med. 2009;  12 389-394
• 37 Wagner H J, Teichgraber U, Gebauer B et al. Transjugular implantation of venous port catheter systems.  Fortschr Röntgenstr. 2003;  175 1539-1544
• 38 Funaki B. Central venous access: a primer for the diagnostic radiologist.  Am J Roentgenol. 2002;  179 309-318