Endovascular techniques for placement of long-term chemotherapy catheters

Abstract

PURPOSE:To analyze the results from using endovascular techniques to place long-term chemotherapy catheters when advancing the catheter using the external jugular vein is difficult due to obstructions or kinking.METHODS: Between July 1997 and August 2000, 320 long-term chemotherapy catheters were placed, and in 220 cases the external jugular vein was used as the primary venous approach. In 18 of these patients, correct positioning was not achieved and several endovascular techniques were then utilized to overcome these obstacles, including manipulation of a J-wire with a moveable core, venography, and the exchange wire technique.RESULTS: In 94.5% of the patients with difficulties in obtaining the correct positioning, we were able to advance the long-term catheter to the desired position with the assistance of endovascular techniques.CONCLUSIONS: Venography and endovascular guidance techniques are useful for the placement of long-term catheters in the external jugular vein.

Vena Cava Filters in Cancer Patients: Experience With 50 Patients

“…This is a lower rate than reported from other centers, where the rate has ranged from 2.5% to 33%. 16,17,19,27,30,33 We also recorded 1 patient (0.5%) with thrombus retained in the filter and 2 patients (1%) with thrombosis of the inferior vena cava. These rates are much lower than found in some series: 10% to 22% and 7% to 24%, respectively.…”

“…Some authors have advocated puncture of the internal jugular vein, 17,29,30 while others have preferred puncture of the femoral vein. 28 In the majority of our cases (86%), we performed the procedure by puncture of the femoral vein contralateral to the limb affected by the DVT, with the aim of avoiding the risks associated with puncture of the subclavian or jugular vein (hemopneumothorax and cervical hematoma).…”

“…These rates are much lower than found in some series: 10% to 22% and 7% to 24%, respectively. 19,27,30,33 It should be borne in mind that occlusion of the inferior vena cava could be considered to be a complication, possibly due to the presence of the foreign body in the lumen of the vessel, but it may also signify therapeutic success (retention of the thrombus), independent of whether the thrombus has a central or marginal position. No filter migrated in our patients, while such an occurrence may be found at a rate of more than 20%, in other reports.…”

“…No filter migrated in our patients, while such an occurrence may be found at a rate of more than 20%, in other reports. 27,30 The large number of patients who died can be explained by considering the fact that our sample consisted of patients with cancer that were mostly at an advanced stage, and thus these were individuals with a low life expectancy. It is emphasized that none of the 20 deaths could be attributed to the procedure of implanting the filter or to being a consequence of pulmonary thromboembolism, therefore showing the efficacy of the method.…”

Comparative Study of Valved and Nonvalved Fully Implantable Catheters Inserted Via Ultrasound-Guided Puncture for Chemotherapy

“…1e4 These devices are completely covered by skin during their use, allowing long-term usage, minimal aesthetic changes, no limitations on physical and social activities, and a low complication rate compared with catheters that are not completely implantable. 5,6,7 These devices can be classified as either valved (V) and nonvalved (NV). Theoretically, the valve prevents spontaneous blood reflux into the catheter, reducing the incidence of complications.…”