Universität zu Köln

Chang, De-Hua, Mammadov, Kamal ORCID: 0000-0003-2178-4898, Hickethier, Tilman ORCID: 0000-0001-9303-9470, Borggrefe, Jan ORCID: 0000-0003-2908-7560, Hellmich, Martin, Maintz, David and Kabbasch, Christoph ORCID: 0000-0003-3712-2258 (2017). Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis. Therap. Clin. Risk Manag., 13. S. 111 - 116. ALBANY: DOVE MEDICAL PRESS LTD. ISSN 1178-203X

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Abstract

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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Chang, De-Hua UNSPECIFIED UNSPECIFIED UNSPECIFIED Mammadov, Kamal UNSPECIFIED orcid.org/0000-0003-2178-4898 UNSPECIFIED Hickethier, Tilman UNSPECIFIED orcid.org/0000-0001-9303-9470 UNSPECIFIED Borggrefe, Jan UNSPECIFIED orcid.org/0000-0003-2908-7560 UNSPECIFIED Hellmich, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Maintz, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Kabbasch, Christoph UNSPECIFIED orcid.org/0000-0003-3712-2258 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-247946
DOI:	10.2147/TCRM.S125130
Journal or Publication Title:	Therap. Clin. Risk Manag.
Volume:	13
Page Range:	S. 111 - 116
Date:	2017
Publisher:	DOVE MEDICAL PRESS LTD
Place of Publication:	ALBANY
ISSN:	1178-203X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TUNNELED HEMODIALYSIS CATHETERS; RECOMBINANT UROKINASE; PATENCY; RESTORATION; EXCHANGE; SALVAGE; VEIN Multiple languages Health Care Sciences & Services Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24794