Role of interventional radiology in provision of venous access / Hesham Omar Osman Ali ; Supervised Mohamed Mostafa , Fatina Fadel , Amr Abdelfattah Nassef

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Radio-diagnosis

METHODS: forty patients were included in our study with an age range 2 {u2013} 62 years, divided into 4 groups (oncology, dialysis, BMT & pre-surgery groups), they underwent full history taking, clinical examination and laboratory tests including complete blood count, serum creatinine & coagulation profiles.Ultrasound & color Doppler were performed for all cases & contrast venography to some cases to select access route. Image guided insertion of vascular access devices was performed through traditional (jugular, subclavian & basilic) & non-traditional (brachiocephalic, SVC collateral, hepatic & internal mammary) routes. 39 long term (ports, dialysis catheters & Hickman) & 1 intermediate term (PICC) devices were used. Patients were followed up clinically & radiologically (by ultrasound & X-ray) for 6 months, all complications were reported. RESULTS: technical success was achieved in all cases, 37 cases from single puncture. Among our cases 2 patients (5%) had intra-operative minor complications (arterial puncture & puncture related hematoma), 4 patients (10%) suffered catheter related infections; 2 were removed & the other 2 were exchanged, 2 devices (5%) became non-functioning due to catheter thrombosis & fibrin sheath formation and were resolved by balloon & catheter exchange, 1 device was accidentally dislodged. Among all, 3 patients were lost to follow up. CONCLUSION: Radiologists are ideally suited to provide vascular access services to children & adults because of inherent safety advantages and higher success from using image-guided techniques. The choice of the VAD primarily depends on the indication for its insertion & duration of need

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