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[Clinical experience with the use of implantable vascular systems in advanced heart failure]
M Galli1, A Politi, F Tettamanti
1Divisione di Cardiologia, Ospedale S. Anna, Como.
Insights
Implantable vascular access systems are effective for managing end-stage cardiomyopathy patients, reducing hospitalizations. Careful training can minimize complications associated with these essential devices.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Devices
Background:
- End-stage cardiomyopathy necessitates frequent, prolonged infusional treatments and hospitalizations.
- Safe and reliable vascular access is critical for outpatient therapies like inotropes and diuretics.
- This study assesses implantable vascular access devices for end-stage cardiomyopathy management.
Purpose of the Study:
- To evaluate the utility and applicability of implantable vascular access systems in end-stage cardiomyopathy.
- To analyze technical challenges and complications associated with these devices.
Main Methods:
- Nineteen implantable vascular systems (16 Port-A-Cath, 3 Celsite) were implanted in 15 end-stage cardiomyopathy patients.
- Patients previously required prolonged hospitalization and infusional therapy.
- Implantation utilized local anesthesia and a pacemaker-derived technique.
Main Results:
- All procedures were well-tolerated with an average duration of 30 minutes; no immediate complications occurred.
- Complications included catheter thrombosis (2 patients), rupture (1 patient), and inflammatory reaction (1 patient).
- Catheter thrombosis was treated with urokinase in 2 cases; one catheter was repositioned. Average device permanence was 8 months.
Conclusions:
- Implantable vascular systems are beneficial and practical for end-stage cardiomyopathy patients.
- Proper training can mitigate avoidable complications.
- Device use contributes to reduced hospitalization duration and frequency.
Background:
Patients with end-stage cardiomyopathy frequently require acute or chronic infusional treatments and long hospitalization. Availability of a simple and safe vascular access is a true necessity for these patients, especially in case of inotropic or diuretic outpatient treatment. In this study we have evaluated the usefulness and the applicability of implantable vascular access in the management of end-stage cardiomyopathy. Technical problems and both short and long term complications have been analysed.
Methods:
Nineteen implantable vascular system (16 Port-A-Cath, Pharmacia; 3 Celsite, Bruneau) have been implanted in a group of 15 patients with end-stage cardiomyopathy. All patients had been previously hospitalized and needed prolonged infusional therapy. Implantation was performed in local anaesthesia with technique derived from pace-maker implantation.
Results:
All the interventions were well tolerated, average procedural time was 30 min (range 20-60 min). No procedural complications occurred. Re-implantation of the system was required in 2 patients due to catheter thrombosis, In 1 patient due to catheter rupture caused by wrong positioning of infusion needle, and in 1 patient due to inflammatory reaction. In 2 further cases catheter thrombosis was treated with local infusion of urokinase. In 1 patient the catheter was repositioned after dislocation. The average in situ permanence of the systems was 8 months (range 15 day-18 months).
Conclusions:
Vascular implantable systems have proved useful and easily applf1p4e in the management of patients with end stage cardiomyopathy. After training some of the implied complications are easily avoidable. The use of this device has concurred to reduce duration and frequency of hospitalizations.