Alternative vascular access in superior vena cava syndrome
Background: Type III Intestinal Failure (IF) is a devastating condition characterized by the reduction of gut function requiring Parenteral Nutrition (PN) as chronic therapy. Life-threatening PN-related complications augment in the long-term; one of the most challenging is the loss of central venous access (LCVA) due to extended venous thrombosis. Our aim is to report the results of Non-conventional Vascular Accesses (NCVA) management as part of IF comprehensive multidisciplinary care and conduct a systematic review to understand the current available knowledge.
Methods. A retrospective analysis of a database from January 2006 to December 2019 was performed using SPSS v25.0 for statistical analysis. For systematic review, the PRISMA methodology was used.
Results. 173 NCVA were obtained under interventional radiology (IR) in 61 IF patients. Twenty-seven patients were female, 17±24 years. 166/173 (96%) were successfully done (see table), mean number of NCVA procedure/patient was 3.0±2.6, the average patency of NCVA was 738.6±997.0 days. Seventeen patients were listed and received an Intestinal transplant (ITx), they required a total of 24 NCVA from evaluation to ITx and 43 post-ITx.
Complications occurred in 10.4% procedures; 2 deaths occurred due to procedure-relate complications.
Systematic review. From a total of 337,542 articles selected, 15 were finally included.
In those articles, a total of 69 patients received NCVA in 75 procedures (1.1 procedure/patient); procedure-related complications were seen in 5.3% and one patient died (1.3%).
Conclusions. The data analyzed shows that NCVA can be successfully obtained and managed under IR within multidisciplinary teams, maximizing the possibilities of sustaining long-term PN, and increasing the ITx applicability for candidates in the extreme need for vascular access.
Perez Illidge L, Ramisch D, Valdivieso L, Guzman C, Antoni D, Rumbo C, Gentilini M, Trentadue J, Solar H, Gondolesi G O-12: Non Convectional Vascular Accesses for Treatment of Total Superior Vena Cava Syndrome Occlusion in Patients with Type Iii Intestinal Failure. Transplantation. 2021 Jul 1;105(7S):S6. doi: 10.1097/01.tp.0000757516.14566.35. PMID: 34792943.