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Hybrid interventions for catheter placement in pediatric intestinal rehabilitation patients with end-stage venous
Ludger Sieverding1, Andreas Busch2, Jens Gesche3
1Department of Pediatric Cardiology, University Children's Hospital Tuebingen.
Insights
Hybrid endovascular and open surgical procedures successfully restore central venous catheters in children with intestinal failure. This approach is vital for intestinal rehabilitation programs, potentially reducing the need for intestinal transplantation.
Area of Science:
- Pediatric Surgery
- Interventional Radiology
- Vascular Access
Background:
- Children with intestinal failure often have end-stage venous access, complicating treatment.
- Central venous catheters are crucial for managing intestinal failure but are challenging to place in these patients.
Purpose of the Study:
- To evaluate the efficacy of a combined endovascular and open surgical approach for inserting permanent central venous catheters.
- To assess the safety and success rate of hybrid procedures in pediatric patients with complex venous access needs.
Main Methods:
- Retrospective review of 14 children (16 interventions) undergoing hybrid procedures for central venous catheter insertion.
- Utilized a combination of endovascular techniques for access and surgical measures for catheter placement.
- Data collected on patient demographics, procedure time, and outcomes.
Main Results:
- Successful catheter placement was achieved in all patients.
- Median intervention time was 66 minutes with low radiation exposure.
- No intra-procedural or post-procedural complications were reported.
Conclusions:
- Hybrid endovascular/open surgical procedures are effective for restoring central venous access in children with intestinal failure.
- This approach is a valuable component of pediatric intestinal rehabilitation programs.
- Successful catheter management may decrease the requirement for intestinal transplantation.
Purpose:
The purpose of this study is to analyze the combined approach of endovascular and open surgical procedures for insertion of permanent central venous catheters in children with intestinal failure and end-stage venous access.
Methods:
Data of 14 children (16 interventions) with intestinal failure and end-stage venous access, treated within the pediatric intestinal rehabilitation program at our institution between September 2011 and November 2016, were retrospectively reviewed. The patients underwent hybrid endovascular/open surgical approaches for insertion of central venous catheters. Access to central veins was established through endovascular intervention; catheter placement was achieved with combined interventional and surgical measures depending on the individual vascular conditions.
Results:
Median age at intervention was 47months (interquartile range (IQR),29-74), median time for interventions was 66min (IQR,42-111). Catheter placement was successfully achieved in all patients. The median dose of irradiation during angiography was 0.2Gy*cm2 (IQR, 0.2-0.6), no complications occurred during or after interventions.
Conclusions:
Hybrid endovascular/open surgical procedures can be successfully applied for restoring or maintaining permanent central venous catheters in children with intestinal failure and end-stage venous access. These approaches are a valuable contribution in intestinal rehabilitation programs contributing to a further decrease of the need for intestinal transplantation in affected patients.
Type Of Study:
Treatment Study.
Level Of Evidence:
Level IV.