Hybrid interventions for catheter placement in pediatric intestinal rehabilitation patients with end-stage venous access

Abstract Purpose To analyze the combined approach of endovascular and open surgical procedures for insertion of permanent central venous catheters in children with intestinal failure and end-stage venous access. Methods Data of 14 children (16 interventions) with intestinal failure and end-stage venous access, treated within the pediatric intestinal rehabilitation program at our institution between September 2011 and November 2016, were retrospectively reviewed. The patients underwent hybrid endovascular/open surgical approaches for insertion of central venous catheters. Access to central veins was established through endovascular intervention, catheter placement was achieved with combined interventional and surgical measures depending on the individual vascular conditions. Results Median age at intervention was 47 months (interquartile range (IQR),29–74), median time for interventions was 66 min (IQR,42–111). Catheter placement was successfully achieved in all patients. The median dose of irradiation during angiography was 0.2 Gy*cm2 (IQR,0.2–0.6), no complications occurred during or after interventions. Conclusions Hybrid endovascular/open surgical procedures can be successfully applied for restoring or maintaining permanent central venous catheters in children with intestinal failure and end-stage venous access. These approaches are a valuable contribution in intestinal rehabilitation programs contributing to a further decrease of the need for intestinal transplantation in affected patients. Type of study Treatment Study. Level of evidence Level IV.