Withdrawal of implanted port-catheter for hepatic arterial infusion chemotherapy with fixed catheter tip technique

Complications arising from transfemoral, percutaneous implantation of an indwelling port-catheter system for hepatic infusion chemotherapy: Case series of the management and salvage of the system

INTRODUCTION

Regional hepatic arterial infusion of chemotherapy is performed for unresectable liver tumors via percutaneously implanted port-catheter systems; while these port-catheter systems are effective administration routes, they are associated with various complications. Withdrawal of the system is considered if the complications occur, but repeated hepatic arterial infusion of chemotherapy (HAIC) via an implanted port-catheter system is a last-resort treatment for unresectable advanced liver cancer, and the treatment must be continued. We discuss various cases with complications arising in the indwelling port area in hepatic arterial infusion of chemotherapy and report whether the system was salvaged.

METHODS

Between August 2013 and October 2017, eight patients (six males and two females) aged 61-80 years (mean age 76.6 years) with complications arising in a transfemoral indwelling port site for HAIC were referred to our department. All patients requested preservation of the system, especially the catheter. Each patient was assessed for the presence of "gross infection" based on a comprehensive evaluation of clinical findings and blood test results. In cases of "no gross infection," we performed catheter salvage procedures. If there was no clinical improvement following the catheter salvage procedure, the port-catheter system was withdrawn. This research work has been reported in line with the PROCESS criteria.

RESULTS

The port-catheter systems were withdrawn in two patients: one due to lasting infection and the other due to ulcer recurrence. Three cases were treated by removal of hematoma through an incision and ointment. The system was withdrawn in one of these cases due to exacerbation of ulcer; thus, the catheters were salvaged in five patients. None of these five patients experienced a relapse from 3 months to over 1 year after the procedure.

CONCLUSION

The success of subcutaneous HAIC significantly impacts a patient's prognosis, especially for unresectable tumors and residual tumor recurrences. Initially, we chose to preserve the devices without removal, particularly if there was no infection. However, this approach led to a delay in chemotherapy, prolongation of healing time, and additional complications. These cases demonstrate the importance of a thorough consultation with the patient's oncologist to discuss whether or not the device should be conserved.

Radiologic removal and replacement of port-catheter systems for hepatic arterial infusion chemotherapy

OBJECTIVE

The purpose of our study was to retrospectively evaluate the safety and efficacy of radiologic removal and replacement of port-catheter systems.

MATERIALS AND METHODS

Between January 1999 and December 2004, 532 patients with unresectable advanced liver cancer underwent radiologic placement of port-catheter systems at our institution. Of these, 18 patients (nine men and nine women; age range, 32-83 years; mean age, 53.8 years) underwent removal of an implanted port-catheter system via the right femoral artery and radiographically guided replacement with a new system to allow continuous hepatic arterial infusion chemotherapy; we retrospectively reviewed these 18 cases. The reasons for removal of the previously implanted systems were as follows: catheter dislodgement (n = 15), catheter obstruction (n = 1), infection related to the implanted port (n = 1), and hemodynamic change (n = 1). Digital subtraction angiography and CT were performed, usually during injection of contrast medium through the implanted port-catheter system, within a few days after the replacement procedure and every 3 months thereafter.

RESULTS

We successfully performed radiologic removal and replacement of the portcatheter system while the patient was under local anesthesia in all 18 patients without complications requiring treatment. The cumulative patency rates of the hepatic artery after removal of the old port-catheter system and replacement with a new port-catheter system were 87.8% and 64.1% at 6 months and 1 year, respectively. Hepatic arterial infusion chemotherapy after replacement was performed 0-68 times (median, 19 times).

CONCLUSION

When an implanted port-catheter system can no longer be used but the patency of the hepatic artery is confirmed and continuous hepatic arterial infusion chemotherapy is required, removal and replacement of the port-catheter system are recommended.

Complications of transfemoral removal of percutaneous transfemorally implanted port-catheter systems

Our purpose is to evaluate the feasibility and safety of the withdrawal procedure of percutaneous transfemorally implanted port-catheter systems. Thirty-seven patients (17.7%) underwent the withdrawal procedure of this port-catheter system among 209 patients. The reasons for withdrawal were as follows: termination of intra-arterial chemotherapy (n = 7), obstruction of hepatic artery (n = 5), port infection (n = 4), catheter infection (n = 4), catheter obstruction (n = 4), lower-limb palsy and pain (n = 2), exposure of the port due to skin defect (n = 2), patient's desire (n = 2), side effect of chemotherapy (n = 1), no effectiveness of chemotherapy (n = 1), hematoma at the puncture site (n = 1), duodenum perforation by the catheter (n = 1), intermittent claudication due to severe stenosis of right common iliac artery (n = 1), dissection of common hepatic artery (n = 1), and broken catheter (n = 1). In thirty-four of the 37 cases, the port-catheter system was successfully withdrawn without any complications. Clinical success rate was 91.9%. Complications occurred in three cases (8.1%), which were a pseudoaneurysm, thromboembolism of the right common iliac artery, and continuous bleeding from the subcutaneous pocket where the port system was placed for 1 month. In 15 cases, correction of the catheter tip or exchange for dislocation of the tip had to be done without withdrawal. It is not rare to withdraw port-catheter systems in cases of infection or hematoma around the system. Although withdrawal of a percutaneous transfemorally implanted port-catheter system is a relatively safe procedure, the port-catheter system should not be removed unless absolutely indicated.

Withdrawal of port-catheter system for hepatic arterial infusion chemotherapy implanted with fixed catheter tip method

PURPOSE

To evaluate the feasibility and safety of a method to withdraw port-catheter systems implanted by the fixed catheter tip method.

MATERIALS AND METHODS

Retrospective review was conducted of 14 cases of unresectable advanced liver cancer in which it was necessary to attempt 15 withdrawals of percutaneously placed implantable port-catheter systems. Reasons for withdrawal, withdrawal success, complications, and subsequent treatment of patient were evaluated.

RESULTS

In 14 of the 15 procedures (93.3%), the port-catheter system was successfully retrieved. Because continuation of hepatic arterial infusion chemotherapy was necessary in 10 procedures, a second implantation was performed after withdrawal of the initial catheter. Only one complication occurred, in which the indwelling catheter was broken in the aorta during withdrawal.

CONCLUSION

When retrieval of a port-catheter system implanted with the fixed catheter tip method is necessary, withdrawal can be accomplished safely with high frequency.

A new method using J-type long sheath for implantation of indwelling catheters for trans-femoral hepatic arterial infusion

PURPOSE

For implantation of a catheter-port system for hepatic arterial infusion chemotherapy, catheterization via the femoral artery is occasionally difficult. The purpose of this study was to determine the usefulness of a J-type long sheath, which facilitates difficult trans-femoral catheterization.

MATERIALS AND METHODS

We applied this technique to 15 patients for difficult trans-femoral catheterization for catheter-port system placement.

RESULTS

We successfully implanted a catheter-port system in all patients using this technique without significant complications.

CONCLUSION

We emphasize that our new technique using a J-type long sheath seems to be a reasonable option when trans-femoral catheterization is difficult.

Evaluation of a microcatheter-arterial port system for intraarterial therapy in an animal model

A new microcatheter-arterial port system for transarterial regional therapy was evaluated in a swine model. Subclavian or femoral access was followed by superselective catheterization of target arteries (hepatic, n = 6; splenic, n = 3). A hemostatic sleeve was placed at the arterial puncture site. Implantation into the target vessel succeeded in all nine placements (100%). After animal movement, no microcatheter tip moved by more than 10 mm. A small hematoma developed at one of the subclavian insertion sites. This system holds promise for transarterial therapies for regional cancer therapy.

Repetitive transarterial chemoembolization (rTACE) of hepatocellular carcinoma: comparisons between an arterial port system and conventional angiographic technique

PURPOSE

To compare the cost and radiation exposure of repetitive transarterial chemoembolization (rTACE) using percutaneously implantable port system with rTACE using conventional catheterization technique.

MATERIALS AND METHODS

In five patients with unresectable hepatocellular carcinoma, three cycles of TACE were performed using conventional technique and six cycles using port. The cumulative cost of material and contrast agent and dose area product (DAP) were compared with the cost and DAP that would be expected if the rTACE was performed conventionally.

RESULTS

The cost of material and contrast agent was 1002.6 Euro after three cycles of TACE using conventional technique and six cycles using port, but would be 1111.8 Euro if the nine cycles were performed using conventional technique alone. The rTACE with three cycles using conventional technique and six cycles using port led to approximately 63% of the cumulative DAP that would be expected in rTACE using conventional technique alone.

CONCLUSION

In rTACE, the use of percutaneously implantable port system might enable a reduction of cost and radiation exposure.