Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case series

• Maintenance of central venous access for patients with critical access is very challenging • Data on hybrid interventions for central line rehabilitation is very limited • We describe successful hybrid interventions for central line rehabilitation • We discuss vascular mapping for diagnosis and identification of central venous access sites Pediatric patients with intestinal failure are critically dependent on central venous access for nutrition and fluids. Long-term central venous access can be complicated by recurrent infections, catheter malfunction, and venous stricture and thrombosis. Prior studies have discussed hybrid procedures to salvage suboptimal central venous access sites; however, data is very limited. This is a retrospective review of 6 pediatric patients with intestinal failure (IF) and long-term total parenteral nutrition (TPN) dependence who underwent one or more hybrid procedures for achieving complex vascular access, vascular mapping, and/or salvage of vascular access sites. Median age at the time of intervention was 1.4 years (range 2.5 weeks – 2.6 years) with a median weight of 10 kg (range 3.3-13.8 kg). The median number of lifetime central lines was 4 (range 2-6). Indications for hybrid intervention included line fractures, occlusions, dislodgement, recurrent infections, and refractory central line infection. The most common procedures included vascular access, vein mapping, and balloon angioplasty of occluded central veins. The median procedure time was 4.6 hours (range 1.3-5.9 hours) with a median procedural radiation dose of 2.2 Gycm 2 (range 0.1-6.7 Gycm 2 ). All patients who underwent hybrid procedures had successful exchange and/or recanalization of the at-risk access site. These cases highlight the importance of vascular mapping for identifying potential access sites, as well as techniques for successful vascular rehabilitation for maintenance or salvage of existing central venous access. A multidisciplinary hybrid approach is a feasible and effective means of maintaining central venous access.