Mechanism and management of persistent withdrawal occlusion.

TL;DRAbstract

An unresolved complication of the use of totally implantable central venous access ports (e.g., Mediport, Infusa-port) is persistent withdrawal occlusion (PWO), i.e. the unimpeded capacity for infusion of fluids accompanied by the inability to withdraw blood. This study demonstrates the mechanism of persistent withdrawal occlusion and describes a method for resolving this complication. Of 42 cancer patients with totally implantable central venous access ports, 8 (19%) patients developed 11 episodes of PWO. Venograms demonstrated a sheath around the catheter beginning at the catheter entrance to the central vein and extending 1-5 cm beyond the catheter tip. Each episode of PWO was treated with 250,000 units of urokinase dissolved in 150cc D5/W infused through the port over 90 minutes. Venograms were obtained immediately after each urokinase infusion. Follow-up ranged from 13-130 days. After urokinase infusion the venogram showed no change in the sheath in 1 episode of PWO and complete d

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