Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case series

Abstract

Background

Pediatric patients with intestinal failure are critically dependent on central venous access for nutrition and fluids. Long-term central venous access can be complicated by recurrent infections, catheter malfunction, and venous stricture and thrombosis. Prior studies have discussed hybrid procedures to salvage suboptimal central venous access sites; however, data is very limited.

Methods

This is a retrospective review of six pediatric patients with intestinal failure (IF) and long-term total parenteral nutrition (TPN) dependence who underwent one or more hybrid procedures for achieving complex vascular access, vascular mapping, and/or salvage of vascular access sites.

Results

Median age at the time of intervention was 1.4 years (range 2.5 weeks – 2.6 years) with a median weight of 10 kg (range 3.3–13.8 kg). The median number of lifetime central lines was 4 (range 2–6). Indications for hybrid intervention included line fractures, occlusions, dislodgement, recurrent infections, and refractory central line infection. The most common procedures included vascular access, vein mapping, and balloon angioplasty of occluded central veins. The median procedure time was 4.6 h (range 1.3–5.9 h) with a median procedural radiation dose of 2.2 Gycm² (range 0.1–6.7 Gycm²). All patients who underwent hybrid procedures had successful exchange and/or rehabilitation of the at-risk access site.

Conclusions

These cases highlight the importance of vascular mapping for identifying potential access sites, as well as techniques for successful vascular rehabilitation for maintenance or salvage of existing central venous access. A multidisciplinary hybrid approach is a feasible and effective means of maintaining central venous access.