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Minimally Invasive Monitoring of Chronic Central Venous Catheter Patency in Mice Using Digital Subtraction Angiography (DSA).

Figueiredo G, Fiebig T, Kirschner S, Nikoubashman O, Kabelitz L, Othman A, Nonn A, Kramer M, Brockmann MA - PLoS ONE (2015)

Bottom Line: The introduction of vascular access mini-ports (VAMP) for mice allows long-term vascular catheterization, hereby eliminating the need for repeated vessel puncture.At this time point, nevertheless, all VAMPs verified intravascular contrast administration.From our observations we conclude DSA to be a fast and valuable minimally invasive tool for investigation of catheter and parent vessel patency and for anatomical studies of collateral blood flow in animals as small as mice.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic and Interventional Neuroradiology, University Hospital of the RWTH Aachen, Aachen, Germany; Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

ABSTRACT

Background: Repetitive administration of medication or contrast agents is frequently performed in mice. The introduction of vascular access mini-ports (VAMP) for mice allows long-term vascular catheterization, hereby eliminating the need for repeated vessel puncture. With catheter occlusion being the most commonly reported complication of chronic jugular vein catheterization, we tested whether digital subtraction angiography (DSA) can be utilized to evaluate VAMP patency in mice.

Methods: Twenty-three mice underwent catheterization of the jugular vein and subcutaneous implantation of a VAMP. The VAMP was flushed every second day with 50 μL of heparinized saline solution (25 IU/ml). DSA was performed during injection of 100 μL of an iodine based contrast agent using an industrial X-ray inspection system intraoperatively, as well as 7±2 and 14±2 days post implantation.

Results: DSA allowed localization of catheter tip position, to rule out dislocation, kinking or occlusion of a microcatheter, and to evaluate parent vessel patency. In addition, we observed different ante- and retrograde collateral flow patterns in case of jugular vein occlusion. More exactly, 30% of animals showed parent vessel occlusion after 7±2 days in our setting. At this time point, nevertheless, all VAMPs verified intravascular contrast administration. After 14±2 days, intravascular contrast injection was verified in 70% of the implanted VAMPs, whereas at this point of time 5 animals had died or were sacrificed and in 2 mice parent vessel occlusion hampered intravascular contrast injection. Notably, no occlusion of the catheter itself was observed.

Conclusion: From our observations we conclude DSA to be a fast and valuable minimally invasive tool for investigation of catheter and parent vessel patency and for anatomical studies of collateral blood flow in animals as small as mice.

No MeSH data available.


Related in: MedlinePlus

Collateral ante- and retrograde flow pattern.DSA directly after implantation of a catheter port shows timely filling of the superior cava vein (SCV) (A), the right atrium, ventricle, pulmonary arteries (PA), (B) as well as the aortic arch (AA) and supraaortic arterial vessels (C). One week later, the SCV was occluded at the site of the catheter tip (arrow head) (D) and retrograde flow (dotted arrows) of contrast agent leads to filling of perivertebral “ladder-like” and cervicothoracic collateral veins (E). Finally, the intercostal veins (ICV) are contrasted and a faint filling of the right ventricle and the lungs is observed. Another week later (G-I) complete occlusion of the parent vessel is evident. This results in retrograde flow of contrast agent along the outside of the catheter (H and I), which continues outside the jugular vein.
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pone.0130661.g004: Collateral ante- and retrograde flow pattern.DSA directly after implantation of a catheter port shows timely filling of the superior cava vein (SCV) (A), the right atrium, ventricle, pulmonary arteries (PA), (B) as well as the aortic arch (AA) and supraaortic arterial vessels (C). One week later, the SCV was occluded at the site of the catheter tip (arrow head) (D) and retrograde flow (dotted arrows) of contrast agent leads to filling of perivertebral “ladder-like” and cervicothoracic collateral veins (E). Finally, the intercostal veins (ICV) are contrasted and a faint filling of the right ventricle and the lungs is observed. Another week later (G-I) complete occlusion of the parent vessel is evident. This results in retrograde flow of contrast agent along the outside of the catheter (H and I), which continues outside the jugular vein.

Mentions: The number of catheters showing a “regular” antegrade blood flow declined over the following two weeks. More exactly, after 7±2 days only 70% (n = 16) of the catheters provided a regular antegrade flow with sufficient arterial contrast. The other 30% (n = 7) presented with different collateral blood flow patterns, which resulted in a reduced arterial contrast in DSA. In all animals showing a collateral flow pattern, however, catheter patency with regard to intravascular administration of contrast agent was confirmed after one week. The following collateral flow patterns were observed: 1.) Occlusion of the jugular vein resulted in contrast enhancement via a “ladder-like” network of perivertebral veins, from which the contralateral jugular vein and the vena cava were contrasted (example shown in Fig 2D–2F). We termed this flow pattern antegrade collateral flow, as the flow filled the collaterals in an antegrade direction. 2.) Occlusion of the jugular vein resulted in blood flow via ipsilateral cervicothoracic collaterals into the vena cava (Fig 3D–3F). This flow pattern we termed “retrograde collateral flow”, as the blood flow filled collaterals in a retrograde direction. 3.) In some cases we visualized a combination of both flow patterns, which we thus termed antegrade and retrograde collateral flow (exemplarily shown in Fig 4D–4F). The incidence of catheter patency and the observed respective flow patterns over the course of two weeks is summarized in Fig 5.


Minimally Invasive Monitoring of Chronic Central Venous Catheter Patency in Mice Using Digital Subtraction Angiography (DSA).

Figueiredo G, Fiebig T, Kirschner S, Nikoubashman O, Kabelitz L, Othman A, Nonn A, Kramer M, Brockmann MA - PLoS ONE (2015)

Collateral ante- and retrograde flow pattern.DSA directly after implantation of a catheter port shows timely filling of the superior cava vein (SCV) (A), the right atrium, ventricle, pulmonary arteries (PA), (B) as well as the aortic arch (AA) and supraaortic arterial vessels (C). One week later, the SCV was occluded at the site of the catheter tip (arrow head) (D) and retrograde flow (dotted arrows) of contrast agent leads to filling of perivertebral “ladder-like” and cervicothoracic collateral veins (E). Finally, the intercostal veins (ICV) are contrasted and a faint filling of the right ventricle and the lungs is observed. Another week later (G-I) complete occlusion of the parent vessel is evident. This results in retrograde flow of contrast agent along the outside of the catheter (H and I), which continues outside the jugular vein.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4476576&req=5

pone.0130661.g004: Collateral ante- and retrograde flow pattern.DSA directly after implantation of a catheter port shows timely filling of the superior cava vein (SCV) (A), the right atrium, ventricle, pulmonary arteries (PA), (B) as well as the aortic arch (AA) and supraaortic arterial vessels (C). One week later, the SCV was occluded at the site of the catheter tip (arrow head) (D) and retrograde flow (dotted arrows) of contrast agent leads to filling of perivertebral “ladder-like” and cervicothoracic collateral veins (E). Finally, the intercostal veins (ICV) are contrasted and a faint filling of the right ventricle and the lungs is observed. Another week later (G-I) complete occlusion of the parent vessel is evident. This results in retrograde flow of contrast agent along the outside of the catheter (H and I), which continues outside the jugular vein.
Mentions: The number of catheters showing a “regular” antegrade blood flow declined over the following two weeks. More exactly, after 7±2 days only 70% (n = 16) of the catheters provided a regular antegrade flow with sufficient arterial contrast. The other 30% (n = 7) presented with different collateral blood flow patterns, which resulted in a reduced arterial contrast in DSA. In all animals showing a collateral flow pattern, however, catheter patency with regard to intravascular administration of contrast agent was confirmed after one week. The following collateral flow patterns were observed: 1.) Occlusion of the jugular vein resulted in contrast enhancement via a “ladder-like” network of perivertebral veins, from which the contralateral jugular vein and the vena cava were contrasted (example shown in Fig 2D–2F). We termed this flow pattern antegrade collateral flow, as the flow filled the collaterals in an antegrade direction. 2.) Occlusion of the jugular vein resulted in blood flow via ipsilateral cervicothoracic collaterals into the vena cava (Fig 3D–3F). This flow pattern we termed “retrograde collateral flow”, as the blood flow filled collaterals in a retrograde direction. 3.) In some cases we visualized a combination of both flow patterns, which we thus termed antegrade and retrograde collateral flow (exemplarily shown in Fig 4D–4F). The incidence of catheter patency and the observed respective flow patterns over the course of two weeks is summarized in Fig 5.

Bottom Line: The introduction of vascular access mini-ports (VAMP) for mice allows long-term vascular catheterization, hereby eliminating the need for repeated vessel puncture.At this time point, nevertheless, all VAMPs verified intravascular contrast administration.From our observations we conclude DSA to be a fast and valuable minimally invasive tool for investigation of catheter and parent vessel patency and for anatomical studies of collateral blood flow in animals as small as mice.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic and Interventional Neuroradiology, University Hospital of the RWTH Aachen, Aachen, Germany; Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

ABSTRACT

Background: Repetitive administration of medication or contrast agents is frequently performed in mice. The introduction of vascular access mini-ports (VAMP) for mice allows long-term vascular catheterization, hereby eliminating the need for repeated vessel puncture. With catheter occlusion being the most commonly reported complication of chronic jugular vein catheterization, we tested whether digital subtraction angiography (DSA) can be utilized to evaluate VAMP patency in mice.

Methods: Twenty-three mice underwent catheterization of the jugular vein and subcutaneous implantation of a VAMP. The VAMP was flushed every second day with 50 μL of heparinized saline solution (25 IU/ml). DSA was performed during injection of 100 μL of an iodine based contrast agent using an industrial X-ray inspection system intraoperatively, as well as 7±2 and 14±2 days post implantation.

Results: DSA allowed localization of catheter tip position, to rule out dislocation, kinking or occlusion of a microcatheter, and to evaluate parent vessel patency. In addition, we observed different ante- and retrograde collateral flow patterns in case of jugular vein occlusion. More exactly, 30% of animals showed parent vessel occlusion after 7±2 days in our setting. At this time point, nevertheless, all VAMPs verified intravascular contrast administration. After 14±2 days, intravascular contrast injection was verified in 70% of the implanted VAMPs, whereas at this point of time 5 animals had died or were sacrificed and in 2 mice parent vessel occlusion hampered intravascular contrast injection. Notably, no occlusion of the catheter itself was observed.

Conclusion: From our observations we conclude DSA to be a fast and valuable minimally invasive tool for investigation of catheter and parent vessel patency and for anatomical studies of collateral blood flow in animals as small as mice.

No MeSH data available.


Related in: MedlinePlus