Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone” Clark et al (2017).
PURPOSE: To determine if concurrent placement of a central venous stent (CVS) and central venous access device (CVAD) compromises stent patency or catheter function in patients with malignant central venous obstruction.
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MATERIALS AND METHODS: CVS placement for symptomatic stenosis resulting from malignant compression was performed in 33 consecutive patients who were identified retrospectively over a 10-year period; 28 (85%) patients had superior vena cava syndrome, and 5 (15%) had arm swelling. Of patients, 11 (33%) underwent concurrent CVS and CVAD placement, exchange, or repositioning; 22 (67%) underwent CVS deployment alone and served as the control group. Types of CVADs ranged from 5-F to 9.5-F catheters. Endpoints were CVS patency as determined by clinical symptoms or CT and CVAD function, which was determined by clinical performance.
RESULTS: All procedures were technically successful. There was no difference between the 2 groups in clinically symptomatic CVS occlusion (P = .2) or asymptomatic in-stent stenosis detected on CT (P = .5). None of the patients in the CVS and CVAD group had recurrent clinical symptoms, but 3 (30%) of 10 patients with imaging follow-up had asymptomatic in-stent stenosis. In the control group, 3 (14%) patients had clinically symptomatic CVS occlusion and required stent revision, whereas 4 (21%) of 19 patients with imaging follow-up had asymptomatic in-stent stenosis. During the study, 2 (20%) functional but radiographically malpositioned catheters were identified (0.66 per 1,000 catheter days).
CONCLUSIONS: Presence of a CVAD through a CVS may not compromise stent patency or catheter function compared with CVS placement alone.
Clark, K., Chick, J.F., Reddy, S.N., Shin, B.J., Nadolski, G.J., Clark, T.W. and Trerotola, S.O. (2017) Concurrent Central Venous Stent and Central Venous Access Device Placement Does Not Compromise Stent Patency or Catheter Function in Patients with Malignant Central Venous Obstruction. Journal of Vascular and Interventional Radiology. February 23rd. [Epub ahead of print].
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