静脉造影在完全植入式静脉输液港植入术中导引和并发症诊断、预测中的作用

The role of venography in making intraoperative guidance and in diagnosing and predicting the postoperative complications in patients receiving implantation of totally implantable venous access port

目的 探讨静脉造影在经腋静脉完全植入式静脉输液港(TIVAP)植入术中导引和术后并发症诊断、预测中的作用。方法 收集2018年1月至2020年12月在上海市公共卫生临床中心就诊并经腋静脉近侧段植入TIVAP的342例患者临床资料。分析静脉造影导引穿刺成功率、置港成功率、术后并发症、静脉造影在并发症诊断和预测中的作用。结果 静脉造影导引下腋静脉穿刺成功率97.4%(76/78),所有患者TIVAP植入均获成功。误穿动脉3例,气胸1例。术前应用静脉造影预测夹闭综合征2例。术后应用静脉造影诊断导管阻塞3例,纤维蛋白鞘2例。随访确诊5例症状性静脉血栓,36例无症状性静脉血栓,发生率12%(41/342)。单因素分析显示,年龄、左心室射血分数(LVEF)、血栓弹力图(TEG)、腋静脉显影延迟、同侧经外周穿刺中心静脉导管(PICC)植入史与静脉血栓发生相关;多因素回归分析显示,年龄、LVEF、腋静脉显影延迟、同侧PICC植入史是静脉血栓独立预测因素。结论 静脉造影导引下经腋静脉近侧段植入TIVAP安全可行,静脉造影在并发症诊断和预测中起重要作用。

Objective To discuss the role of venography in making intraoperative guidance and in diagnosing and predicting the postoperative complications in patients receiving totally implantable venous access port(TIVAP) implantation via axillary venous approach.Methods The clinical data of a total of 342patients,who received TIVAP implantation via the proximal segment of the axillary vein approach at the Shanghai Public Health Clinical Center of China between January 2018 and December 2020,were collected.The puncture success rate,technical success rate of TIVAP implantation,and postoperative complications were analyzed,and the role of venography in diagnosing and predicting the postoperative complications was evaluated.Results The success rate of venography-guided axillary vein puncture was 97.4%(76/78),and successful TIVAP implantation was accomplished in all patients.Mispuncturing into artery occurred in 3patients and pneumothorax occurred in one patient.Preoperative venography made prediction of possible occurrence of pinch-off syndrome in 2 patients.Postoperative venography demonstrated catheter obstruction in3 patients and fibroprotein sheath formation in 2 patients.During follow-up period,venography detected symptomatic venous thrombosis in 5 patients and asymptomatic venous thrombosis in 36 patients,the incidence of venous thrombosis was 12%(41/342).Univariate analysis indicated that age,left ventricular ejection fraction(LVEF),thrombelastogram(TEG),delayed visualization of axillary vein,and history of PICC implantation through ipsilateral peripheral venous puncture were closely related to the occurrence of venous thrombosis.Multivariate logistic regression analysis revealed that age,LVEF,delayed visualization of axillary vein,and history of ipsilateral PICC implantation were the independent predictors for venous thrombus.Conclusion Venography-guided TIVAP implantation via the proximal segment of the axillary vein approach is clinically safe and feasible,besides,venography plays an important role in diagnosing and predicting the postoperative complications.(J Intervent Radiol,2022,31:374-379)