Mechanical thrombolysis of thrombosed central venous port

To evaluate the effectiveness of a mechanical thrombolysis for thrombosed central venous port (CVP).

A total of 38 patients (22 women and 16 men, median age of 55 years) were referred to our interventional unit for thrombosed implanted CVPs. The period between CVP implantation and the initial suspicion of mechanical complication varied from 2 to 35 months (mean 11.5 months) and the interval since last use of the CVP averaged 47 days (range 28-324 days). Our mechanical thrombolysis technique was performed to fragment thrombus in the port chamber by whirling the floppy tip of 0.018-inch hair-wire. Only 19-gauge noncoring needle and 0.018-inch hire-wire were used without cut-down. After removing the hair-wire and placing a second needle, the fragmented thrombi was slowly aspirated with a negative pressure and the remnant thrombus was flushed out by pushing a saline fluid. The degree of fragmentation of thrombus was evaluated with posttreatment angiography; incomplete lysis was defined as more than 50 % of thrombus remaining, significant lysis was 10-50 % of initial thrombosis remaining, and near-complete lysis was less than 10 % thrombus remaining.

We observed near-complete lysis in 22 patients (58 %), significant lysis in 14 patients (37 %), and incomplete lysis in two patients (5 %). The technical success rate was 82 % (31 of 38 patients). There were no major or minor complications in the recovery room during a 30-min observation period or late complications at outpatient follow-up.

A mechanical thrombolysis technique can be used to dissolve thrombus effectively from thrombosed implanted CVP on an outpatient basis.