PICC in patients with venous stenosis
Abstract:
Purpose: To compare the effectiveness and safety of percutaneous transluminal angioplasty and the peripherally inserted central catheter (PTA+PICC), contralateral PICC, and midline catheterization (MC) in patients with venous stenosis.
Materials and methods: A total of 7327 PICC procedures were performed in 5421 patients at our institution between 2013 and 2019. Among them, 87 patients had upper arm venous stenosis and were managed with PTA+PICC, contralateral PICC, or MC. The catheter dwelling time, clinical success rate, and adverse events were addressed. A PICC was considered to have clinically succeed when a PICC was removed from the patient just before discharge or after completion of therapy. The catheter survival time and chance of adverse event were compared between the groups using Kaplan-Meier method and log-rank test.
Results: PTA+PICC, contralateral PICC, and MC procedures were performed for 57 (65.5%, 57/87), 10 (11.5%, 10/87), and 20 (23.0%, 23/87) patients, respectively. The mean dwelling times of the PTA+PICC, contralateral PICC, and MC groups were 49.7, 28.7, and 15.1 days respectively. The clinical success rate of each group was 86.0% (49/57), 80.0% (8/10), and 50.0% (10/20), respectively. The PTA+PICC group had a significantly long catheter survival time than the MC group (p < .001). The chance of catheter-related infection (p = .008) was significantly lower in the PTA+PICC group than in the MC group.
Conclusion: PTA+PICC or contralateral PICC should be considered prior to ipsilateral MC when venous stenosis is encountered during PICC procedures.
Reference:
Kim SH, Hur S, Lee M, Kim HC, Jae HJ, Chung JW, Choi JW. Outcomes in Venoplasty-assisted Peripherally Inserted Central Catheter Placement in Patients with Upper Arm Venous Stenosis: Comparison with other Methods. J Vasc Interv Radiol. 2021 Oct 26:S1051-0443(21)01439-1. doi: 10.1016/j.jvir.2021.10.014. Epub ahead of print. PMID: 34715320.