Chemoport Insertion-Less Is More

Vertebral Venous Congestion That May Mimic Vertebral Metastasis on Contrast-Enhanced Chest Computed Tomography in Chemoport Inserted Patients

OBJECTIVE

This study aimed to determine the prevalence of vertebral venous congestion (VVC) in patients with chemoport insertion, evaluate the imaging characteristics of nodular VVC, and identify the factors associated with VVC.

MATERIALS AND METHODS

This retrospective single-center study was based on follow-up contrast-enhanced chest computed tomography (CT) of 1412 adult patients who underwent chemoport insertion between January 2016 and December 2016. The prevalence of venous stenosis, reflux, and VVC were evaluated. The imaging features of nodular VVC, including specific locations within the vertebral body, were analyzed. To identify the factors associated with VVC, patients with VVC were compared with a subset of patients without VVC who had been followed up for > 3 years without developing VVC after chemoport insertion. Toward this, a multivariable logistic regression analysis was performed.

RESULTS

After excluding 333 patients, 1079 were analyzed (mean age ± standard deviation, 62.3 ± 11.6 years; 540 females). The prevalence of VVC was 5.8% (63/1079), with all patients (63/63) demonstrating vertebral venous reflux and 67% (42/63) with innominate vein stenosis. The median interval between chemoport insertion and VVC was 515 days (interquartile range, 204-881 days). The prevalence of nodular VVC was 1.5% (16/1079), with a mean size of 5.9 ± 3.1 mm and attenuation of 784 ± 162 HU. Nodular VVC tended to be located subcortically. Forty-four patients with VVC underwent CT examinations with contrast injections in both arms; the VVC disappeared in 70% (31/44) when the contrast was injected in the arm contralateral to the chemoport site. Bevacizumab use was independently associated with VVC (odds ratio, 3.45; P < 0.001).

CONCLUSION

The prevalence of VVC and nodular VVC was low in patients who underwent chemoport insertion. Nodular VVC was always accompanied by vertebral venous reflux and tended to be located subcortically. To avoid VVC, contrast injection in the arm contralateral to the chemoport site is preferred.

Layered Sheath-Assisted Dissection and Retrieval of Stuck Port Catheters: A Single-Center Experience

Chemoports are often required for oncological patients requiring repeated blood draws and long-term drug therapy. However, complications such as dislodgement, fracture, thrombosis, and venous occlusion may occur if the ports remain unremoved when not in use. Nonetheless, existing techniques require multiple accesses or release of the stuck catheter tip to retrieve the catheter, making the procedure inconvenient. We present our experience with a technique using the Bard Denali inferior vena cava filter retrieval kit to remove a stuck or fractured chemoport catheter through a single vascular access. The technique was performed in two female patients with satisfactory results (complete retrieval of broken chemoports) and an event-free follow-up period. The entire procedure was completed within 15-30 minutes with fluoroscopic time under two minutes. The technique allows for better case management by simplifying the procedure, reducing radiation, and improving workflow efficiency in the operating room.