Safe and simple reinsertion technique for occluded central venous catheter in premature infants

Endovascular extraction of entrapped long-term central feeding catheter: Case series

Long-term tunneled central venous catheters are widely used in several clinical indications, that is, hemodialysis, chemotherapy, and total parenteral nutrition. However, central venous catheters are associated with a number of complications, including catheter occlusion and sepsis, which may necessitate earlier catheter removal. In most cases manual traction is sufficient to remove the catheter. Nevertheless, in some cases severe adhesions, formed between the catheter and the vessel wall, complicate simple catheter removal. We present four cases of entrapped long-term central venous catheters and describe methods (e.g. endoluminal balloon dilatation and wire snare) performed by experienced cardiologists at high-volume center to remove them. We claim that permanent central venous catheters removal procedures may be unpredictable and hazardous. Therefore, entrapped central venous catheters should be extracted by experienced operators in specialized high-volume centers.

Histological changes of the unligated vein wall adjacent to the central venous catheter after open cutdown in rats

BACKGROUND

The sequelae of a central venous cutdown usually include venous deformity causing venous stenosis or stricture. However, the cellular mechanisms causing these deformities have not been elucidated.

METHODS

Silicone 2.7-Fr catheters were placed via the right external jugular vein of 16 rats with the cutdown method. After fixation with formalin at scheduled intervals (1week, 2weeks, 4weeks, and 8weeks; 4 rats in each group), the vein segment with the catheter in situ was harvested. Histological changes in the vein wall were studied and serially compared with light microscopy; standard hematoxylin-eosin staining, Masson's trichrome staining, van Gieson's elastin stain, and immunohistochemical stain against α-actin.

RESULTS

Pericatheter sleeve formation, circumferential smooth muscle cell proliferation and infiltration into the pericatheter sleeve by direct contact were noted in all 4 rats of 1-week model; this indicated the initiation of neointimal hyperplasia. The neointimal hyperplasia was located inside the elastin layer. At 2weeks, the SMCs stained faintly but the components of the vein wall were largely replaced by collagen. The proliferation and infiltration of SMCs stabilized at 4weeks and no SMCs were stained around the catheter. At 8weeks, luminal narrowing was noted and the venous wall was composed mainly of collagen.

CONCLUSIONS

Circumferential neointimal hyperplasia occurred after surgical cutdown of the external jugular vein in a rat model and was caused by SMC activation, proliferation, and infiltration into the pericatheter sleeve.