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Recanalization of Occluded Central Veins in a Parenteral Nutrition-Dependent Child With No Access

Patrick M Sullivan1, Russell Merritt2, Juan Carlos Pelayo3

  • 1Divisions of Pediatric Cardiology, patrick.morris.sullivan@gmail.com.

Pediatrics
|April 4, 2018
PubMed

Insights

Central venous thromboses complicate care for children with intestinal failure. Angioplasty and stenting successfully reconstructed occluded veins, preserving vital central venous access for a young patient.

Area of Science:

  • Pediatric Interventional Radiology
  • Vascular Surgery
  • Gastroenterology

Background:

  • Central venous thromboses are a significant challenge in pediatric patients with chronic illnesses, particularly those with intestinal failure requiring parenteral nutrition.
  • Progressive loss of central venous access sites is a life-threatening complication in these vulnerable patients.
  • Standard anticoagulation therapy may be insufficient to maintain venous access in some cases.

Observation:

  • A 5-year-old girl with parenteral nutrition-dependent short bowel syndrome experienced progressive central venous occlusions, losing all standard access sites despite anticoagulation.
  • A bloodstream infection necessitated the removal of her tunneled central venous line.
  • Initial attempts to recanalize and dilate occluded veins were performed, followed by stenting for long-term patency.

Findings:

  • Angioplasty and stent implantation successfully reconstructed chronically occluded central veins, including the right iliofemoral vein and infrarenal inferior vena cava.
  • A new tunneled central venous line was placed in the reconstructed right iliofemoral vein for antimicrobial therapy.
  • Following successful treatment, the left innominate vein was also recanalized, allowing for a new tunneled line, with both stents remaining patent at 10 months.

Implications:

  • This case demonstrates the potential of angioplasty and stenting to prevent central venous access site exhaustion in pediatric patients unresponsive to anticoagulation.
  • These interventional techniques may offer a new paradigm to reduce morbidity and mortality associated with chronic venous access needs.
  • Successful venous reconstruction could potentially decrease the need for intestinal transplantation in patients with intestinal failure.

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