Venous Port Salvage Utilizing Low Dose tPA

Abstract

This study was performed to evaluate the efficacy of low dose tPA for catheter salvage in cases of fibrin sheath formation in patients with venous access ports. Prospective evaluation was accomplished in patients who had venous ports with catheter malfunction. There were a total of 50 patients and 56 occlusive events. Each patient had a catheter injection documenting a fibrin sheath. Patient population included 45 for chemotherapy and 5 for antibiotics. A low dose tPA regimen was instilled into the port and upon successful return of function, a completion venogram was accomplished. Fifty patients were enrolled in the study with the average time between placement and dysfunction of 99 days. Five patients had a second occlusive event (38.5 days) and one had a third event (27 days). All patients had a venogram confirming a fibrin sheath as the cause of catheter malfunction. The average dose of tPA was 2.29 mg (range 1 mg-4 mg). Success was achieved in 52 of the 56 occlusive events (92.9%). There were no bleeding complications. Catheter occlusion is a common complication of long-term venous access ports. Aggressive therapy with low-dose tPA can salvage function. It provides safe and effective therapy for venous port malfunction secondary to fibrin sheath.

Local Low-Dose Thrombolysis for Safe and Effective Treatment of Venous Port-Catheter Thrombosis

“…7,13,14,[32][33][34] A trial comparing mechanical manipulation versus catheter exchange showed that tunneled hemodialysis catheters with over-the-wire exchange is superior to percutaneous fibrin sheath stripping in short-and long-term (4 months) patency rates. 18 Gray et al compared mechanical manipulation versus thrombolysis and demonstrated that urokinase in central dialysis catheters is equal to fibrin sheath stripping in the short term (45 days).…”

“…Depending on the type of injection, a limited local or systemic effect results. [7][8][9][10][11][12][13][14] Apart from pharmacologic treatment, invasive angiographic stripping of the fibrin sheath surrounding the port-catheter or surgical exchange of the malfunctioning port-catheter are described. 10,[15][16][17][18][19] The aim of the study was to evaluate a minimally invasive and simple approach for adequate management of port-catheter thrombosis.…”

Current Management of Difficult Central Venous Access in Pediatric Patients

“…Surgical intervention should be considered only after fibrinolytic agents have failed. 30,31 Thrombosis can be further divided into 2 types; 1. Acute right-sided venous thrombosis, especially right atrial thrombosis, which is a rare but life-threatening complication possibly leading to pulmonary embolism and cardiac arrest.…”

Tunnelled central venous catheter–induced thrombosis: a rare case of superior vena cava syndrome

“…These agents are most successful when delivered directly to the centre of the thrombus using the tunnelled CVC itself rather than infused peripherally. [31][32][33][34][35][36][37][38][39] In addition, anticoagulation with LMWH may be instituted to slow thrombus propagation. Once initiated, this should be maintained until follow-up with a hematologist and resolution of symptoms.…”