Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis

Abstract

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

Keywords

• Central venous port catheter Thrombolysis Urokinase Angiography