Outcomes of Venoplasty-Assisted, Peripherally Inserted Central Catheter Placement in Patients with Upper-Arm Venous Stenosis: Comparison with Midlines and Contralateral Placement.PURPOSE
 To compare the effectiveness and safety of percutaneous transluminal angioplasty and peripherally inserted central catheter (PTA + PICC), contralateral PICC, and midline catheterization (MC) in patients with venous stenosis.


 A total of 7,327 PICC procedures were performed in 5,421 patients at a single institution between 2013 and 2019.  Among them, 87 patients had upper-arm venous stenoses and were managed with PTA + PICC, contralateral PICC, or MC.  Data on catheter-dwell time, clinical success rate, and adverse events were recorded.  The procedure was considered to have clinically succeeded when a PICC was removed from the patient just before discharge or after the completion of therapy.  Catheter survival time and the chance of adverse events were compared among the groups using the Kaplan-Meier method and log-rank test.


 PTA + PICC, contralateral PICC, and MC procedures were performed for 57 (65.5%, 57/87), 10 (11.5%, 10/87), and 20 (23.0%, 23/87) patients, respectively.  The mean catheter-dwell time in the PTA + PICC, contralateral PICC, and MC groups was 49.7, 28.7, and 15.1 days, respectively, and the clinical success rate of each group was 86.0% (49/57), 80.0% (8/10), and 50.0% (10/20).  The PTA + PICC group had a significantly longer catheter survival time than the MC group (P < .001).  The chance of a catheter-related infection (P = .008) was significantly lower in the PTA + PICC group than in the MC group.


 CONCLUSIONS
 PTA + PICC or contralateral PICC should be considered prior to ipsilateral MC when venous stenosis is encountered during PICC procedures.
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