Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis
De-Hua Chang,1 Kamal Mammadov,1 Tilman Hickethier,1 Jan Borggrefe,1 Martin Hellmich,2 David Maintz,1 Christoph Kabbasch1 1Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, NRW, Germany; 2Institute of Medical Statistics, Informatics and Epidemiology, University H...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2017-01-01
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| Series: | Therapeutics and Clinical Risk Management |
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| Online Access: | https://www.dovepress.com/fibrin-sheaths-in-central-venous-port-catheters-treatment-with-low-dos-peer-reviewed-article-TCRM |
| _version_ | 1818575982977613824 |
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| author | Chang DH Mammadov K Hickethier T Borggrefe J Hellmich M Maintz D Kabbasch C |
| author_facet | Chang DH Mammadov K Hickethier T Borggrefe J Hellmich M Maintz D Kabbasch C |
| author_sort | Chang DH |
| collection | DOAJ |
| description | De-Hua Chang,1 Kamal Mammadov,1 Tilman Hickethier,1 Jan Borggrefe,1 Martin Hellmich,2 David Maintz,1 Christoph Kabbasch1 1Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, NRW, Germany; 2Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, NRW, Germany Purpose: Evaluation of the efficacy of single-shot, low-dose urokinase administration for the treatment of port catheter-associated fibrin sheaths. Methods: Forty-six patients were retrospectively evaluated for 54 episodes of port catheter dysfunction. The presence of a fibrin sheath was detected by angiographic contrast examinations. On an outpatient basis, patients subsequently received thrombolysis consisting of a single injection of urokinase (15.000 IU in 1.5 mL normal saline) through the port system. A second attempt was made in cases of treatment failure. Patients were followed up for technical success, complications and long-term outcome. Results: Port dysfunction occurred at a median of 117 days after implantation (range: 7–825 days). The technical success after first port dysfunction by thrombolysis was 87% (40/46); thereof, initial thrombolysis was effective in 78% (36/46). Nine patients (20%) received a second dose of urokinase after previous treatment failure. Follow-up was available for 26 of 40 patients after successful thrombolysis. In 8 of these, rethrombosis occurred after a median of 98 days (range: 21–354 days), whereby rethrombolysis was effective in 5 of 7 (63%) patients. The overall success of all thrombolyses performed was 70% (45/64). No procedure-related technical or clinical complications occurred. After first favorable thrombolysis, a Kaplan–Meier analysis yielded a 30-, 90- and 180-day probability of patency of 96%, 87% and 81%. Conclusion: Thrombolytic therapy on an outpatient basis appears to be a safe and efficient. Three-month patency rates are comparable to more invasive treatment options, including catheter exchange over a guide wire and percutaneous fibrin sheath stripping. Keywords: central venous port catheter, thrombolysis, urokinase, angiography, port dysfunction, catheter occlusion |
| first_indexed | 2024-12-15T00:48:14Z |
| format | Article |
| id | doaj.art-b6c63364c42146519007e3f3366b33de |
| institution | Directory Open Access Journal |
| issn | 1178-203X |
| language | English |
| last_indexed | 2024-12-15T00:48:14Z |
| publishDate | 2017-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Therapeutics and Clinical Risk Management |
| spelling | doaj.art-b6c63364c42146519007e3f3366b33de2022-12-21T22:41:29ZengDove Medical PressTherapeutics and Clinical Risk Management1178-203X2017-01-01Volume 1311111531002Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basisChang DHMammadov KHickethier TBorggrefe JHellmich MMaintz DKabbasch CDe-Hua Chang,1 Kamal Mammadov,1 Tilman Hickethier,1 Jan Borggrefe,1 Martin Hellmich,2 David Maintz,1 Christoph Kabbasch1 1Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, NRW, Germany; 2Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, NRW, Germany Purpose: Evaluation of the efficacy of single-shot, low-dose urokinase administration for the treatment of port catheter-associated fibrin sheaths. Methods: Forty-six patients were retrospectively evaluated for 54 episodes of port catheter dysfunction. The presence of a fibrin sheath was detected by angiographic contrast examinations. On an outpatient basis, patients subsequently received thrombolysis consisting of a single injection of urokinase (15.000 IU in 1.5 mL normal saline) through the port system. A second attempt was made in cases of treatment failure. Patients were followed up for technical success, complications and long-term outcome. Results: Port dysfunction occurred at a median of 117 days after implantation (range: 7–825 days). The technical success after first port dysfunction by thrombolysis was 87% (40/46); thereof, initial thrombolysis was effective in 78% (36/46). Nine patients (20%) received a second dose of urokinase after previous treatment failure. Follow-up was available for 26 of 40 patients after successful thrombolysis. In 8 of these, rethrombosis occurred after a median of 98 days (range: 21–354 days), whereby rethrombolysis was effective in 5 of 7 (63%) patients. The overall success of all thrombolyses performed was 70% (45/64). No procedure-related technical or clinical complications occurred. After first favorable thrombolysis, a Kaplan–Meier analysis yielded a 30-, 90- and 180-day probability of patency of 96%, 87% and 81%. Conclusion: Thrombolytic therapy on an outpatient basis appears to be a safe and efficient. Three-month patency rates are comparable to more invasive treatment options, including catheter exchange over a guide wire and percutaneous fibrin sheath stripping. Keywords: central venous port catheter, thrombolysis, urokinase, angiography, port dysfunction, catheter occlusionhttps://www.dovepress.com/fibrin-sheaths-in-central-venous-port-catheters-treatment-with-low-dos-peer-reviewed-article-TCRMCentral venous port catheter Thrombolysis Urokinase Angiography |
| spellingShingle | Chang DH Mammadov K Hickethier T Borggrefe J Hellmich M Maintz D Kabbasch C Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis Therapeutics and Clinical Risk Management Central venous port catheter Thrombolysis Urokinase Angiography |
| title | Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis |
| title_full | Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis |
| title_fullStr | Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis |
| title_full_unstemmed | Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis |
| title_short | Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis |
| title_sort | fibrin sheaths in central venous port catheters treatment with low dose single injection of urokinase on an outpatient basis |
| topic | Central venous port catheter Thrombolysis Urokinase Angiography |
| url | https://www.dovepress.com/fibrin-sheaths-in-central-venous-port-catheters-treatment-with-low-dos-peer-reviewed-article-TCRM |
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