Thrombogenic properties of vascular catheter materials in vitro

A scanning electron microscopic study on thrombogenicity of intraarterial catheters for chemotherapeutic treatment in head and neck cancer

BACKGROUND

The purpose of this study was to assess the impact of standard anticoagulation and intermittent catheter irrigation on clot formation on intraarterial chemotherapeutical catheters.

METHODS

Sixteen nonheparinized catheters were placed in the carotid vessels of 10 patients. Ten catheters were perfused with chemotherapeutic drugs; six catheters were not perfused. Patients received LMWH anticoagulation; catheters were irrigated with boluses of heparinized saline daily. Catheters were retrieved for SEM evaluation after a mean intravessel placement interval of 21 days.

RESULTS

All samples demonstrated accumulation of thrombotic debris on luminal sides and outsides of catheters. Obliteration was seen in three samples. Detachment of thrombus fragments was present in several specimens. No significant dependence of clot formation on placement interval and chemotherapeutic perfusion was calculated.

CONCLUSIONS

Standard anticoagulation was ineffective in clot prevention. Heparinized catheters might potentially reduce the risk of clot formation. A delivery system should be engaged for continuous irrigation of catheters with heparinized saline.

Management of children with chronic femoral artery obstruction

Chronic obstruction of the femoral artery in children is a complication of diagnostic angiography, cardiac catheterization and umbilical artery catheterization. We have seen 22 cases and have operated on 7. The indications for operation are claudication, muscle wasting, and shortness of the lower limb. The diagnosis is confirmed by a Doppler profile and the abnormal vascular anatomy demonstrated by angiography via the contralateral femoral artery. We have done 4 ilio-femoral, two femo-femoral and one femoro-popliteal bypass grafts utilizing the long saphenous vein. Results have been good in five, the other two grafts having thrombosed.