Читать книгу Veterinary Surgical Oncology - Группа авторов - Страница 81

Interventional radiologists are often called on to relieve malignant effusions within the thoracic and abdominal cavities. In cases of malignant effusions, the goal of placing a catheter is palliation of the associated adverse clinical signs. The catheter may be placed temporarily or attached to an external or subcutaneous port for long‐term drainage. Placement of the drainage catheter does not treat the primary disease, and recurrence of the pleural or abdominal fluid may be rapid. Long‐term placement of a catheter with a port may be indicated in many cases of malignant effusion. A case series of 10 cases (6 dogs, 4 cats) undergoing placement of a port and intrathoracic drainage catheter to treat pleural effusion have been reported (Brooks and Hardie 2011). Only one case in that cohort was confirmed to have a pleural effusion secondary to neoplasia, and the follow‐up time was short as the patient was euthanized after six days due to progression of disease.

Many interventional radiologists consider pigtail catheters placed with ultrasound guidance, the gold standard when treating malignant effusions (Klein et al. 1995; Parulekar et al. 2001; Liang et al. 2009). In human patients with malignant thoracic effusions, small‐bore catheters (such as pigtail catheters) have demonstrated similar outcomes when compared to large‐bore chest tubes (Clementsen et al. 1998; Parulekar et al. 2001). Patients undergoing removal of thoracic effusions with small‐bore tubes were also found to be more comfortable (Clementsen et al. 1998).

A modified Seldinger technique has been used to place small‐bore chest drains in the thorax to relieve effusions in dogs and cats (Valtolina and Adamantos 2009). While only 1 of 20 animals had a malignant effusion, the study revealed that these chest drains were placed easily and effectively by people with varying levels of experience (Valtolina and Adamantos 2009). Anesthesia was not necessary for drain placement in any of the cases, and 24 of 29 chest drains were placed in less than 10 minutes (Valtolina and Adamantos 2009). In the author’s practice, a minimally invasive technique (using a modified Seldinger technique) is utilized to place permanent thoracic drainage tubes connected to a subcutaneous port. For this procedure, the thoracic drain (multi‐fenestrated catheter) is placed through a sheath (placed intercostally) and is tunneled subcutaneously to a port that is introduced under the skin through a small incision.