Percutaneous retrieval of an embolized central venous chemoport in a patient with colon cancer

Case report: Extravascular catheter migration in a child: A rare complication of the totally implantable venous access device

BACKGROUND

Totally implantable venous access devices (TIVADs) are widely used to gain intermittent central venous access, such as in patients who need long-term chemotherapy, total parenteral nutrition, and long-term antibiotic treatment. At present, there are many complications associated with the use of these devices. Complete extravascular migration of TIVADs via the internal jugular vein is a very rare and potentially serious condition, especially in children.

CASE PRESENTATION

A 1-year-old girl needed palliative chemotherapy because of hepatoblastoma complicated by inferior vena cava thrombosis. A TIVAD was implanted through the right internal jugular vein with a routine heparin flushing tube. On the second day after the operation, a pale bloody liquid was drawn out from the device and the chest X-ray was checked to confirm that the position of the catheter was normal. On the third day after the operation, however, the patient's right respiratory sound was weakened on physical examination and auscultation. Fluoroscopy showed that the tip of the catheter was located in the right thoracic cavity, and there was a large amount of effusion in the right thoracic cavity. The pleural effusion was removed, the TIVAD was replaced again, and the child was discharged 2 days later.

CONCLUSIONS

Following TIVAD implantation, if abnormalities are found, in addition to chest X-ray, saline flush and echocardiography should be performed to determine the position of the catheter and rule out extravascular migration of the catheter to avoid irreparable consequences.

Successful recovery of central venous catheter fragment from coronary venous sinus and right ventricle: A case report

Catheter fracture with subsequent embolization is a well known but a potentially serious late complication of central venous catheter placement. Central venous catheters are frequently implanted for the purpose of chemotherapy and parenteral nutrition. Most common vein used for the placement of central venous catheter is subclavian vein. According to case reports, catheter placed in subclavian vein is vulnerable for fracture and is often preceded by the "pinch-off sign", first described by Aikten and Minton. It is due to shearing forces between the clavicle and first rib. Broken catheter frequently embolises to Right atrium, Right Ventricle, Inferior vena cava, Pulmonary arteries and rarely into Coronary sinus. Migration to Coronary sinus is very uncommon and only 5 cases are reported in the literature as of now. We are presenting an unusual case where chemoport catheter severed and lodged partly in coronary venous sinus and partly in right ventricle taking a "U "shape. Fragment was successfully retrieved percutaneously using a snare after straightening it with a pigtail catheter. Though majority of patients deny symptoms however, some do have symptoms or complications. Catheter fragment can lead to arrhythmias, thrombosis, infection and perforation. Thrombosis of coronary sinus is a life threatening complication. Regular follow up with Chest x ray may recognize the fracture and embolization much earlier. In almost all cases the migrated portion can be retrieved safely percutaneously without recourse to surgery.

Fracture of the Port Catheter and Migration Into the Coronary Sinus: Case Report and Brief Review of the Literature

Introduction:

Totally implantable venous device has a good safety profile, although certain complications may occur. Late mechanical complications include catheter fracture and cardiac migration which are rarely occurring in approximately 0.1% to 1% of patients.

Case presentation:

A 33-year-old woman referred by the surgical oncologist for port catheter fragment extraction through endovascular approach. She was asymptomatic on presentation and has a history of hypertension and smoking. Chest X-ray showed a port catheter fragment previously thought to be in the right atrium at the level of 8-9 thoracic vertebrae (right heart catheterization showed that the port catheter fragment was in the coronary sinus). Angiography of the right outflow tract indicates that the fragment was not in the outflow tract or pulmonary arteries but posterior to it. It was concluded that the port catheter fragment had migrated deep into the coronary sinus and the snare was unable to pull the fragment. It was deemed unfeasible to remove the fragment through the endovascular approach.

Discussion:

The port catheter fracture had migrated entirely into the coronary sinus and to the deep of our knowledge; this was the fourth case reported in the current literature. We tried to do a review of previous similar case reports; interestingly, this was the only case where the fragmented catheter was situated deep within the coronary sinus without any part of the fragment projected to the right atrium. This made the retrieval of the fragment much more difficult with a high chance of failure.

Conclusions:

Migration of totally implantable venous device into coronary sinus is a rare but possible complication and might be difficult to remove if the position is unfavorable.

Percutaneous transvenous retrieval of fractured catheter in cancer patients receiving chemotherapy

OBJECTIVE

To explore the clinical efficacy and safety of percutaneous transvenous retrieval of intravascular fractured catheter and to evaluate the possible reasons and final results in cancer patients.

METHODS

A dataset of 19 patients was used. Percutaneous transvenous retrieval of intravascular fractured catheter was performed in each patients. Clinical data was retrospectively analyzed with respect to the efficacy, safety and outcome, and chest radiography was performed to verify that no catheter fragments were left.

RESULTS

Two cases had peripherally inserted central catheter and 17 had subcutaneous implanted port catheter. The catheter fragments were located in the brachiocephalic vein-superior vena cava (n = 1), superior vena cava (n = 1), superior and inferior vena cava (n = 1), superior vena cava-right atrium (n = 2), brachiocephalic vein-superior vena cava-right atrium (n = 1), superior vena cava-right atrium-right ventricle (n = 6), brachiocephalic vein-superior vena cava-right atrium and right ventricle (n = 1) and pulmonary artery (n = 6), respectively. All of these catheter fragments were retrieved successfully. No complications such as bleeding and thrombosis were found.

CONCLUSION

Percutaneous transvenous retrieval is a safe, minimally invasive and relatively simple procedure for the patients with fractured catheter and should be recommended as the first choice.

Spontaneous fracture and migration of catheter of a totally implantable venous access port via internal jugular vein--a case report

Background

The totally implantable venous access ports (TIVAPs) are indicated for patients undergoing chemotherapy, total parenteral nutrition and long-term antibiotic treatment. But, among their complications, the fracture and migration of the catheter of a TIVAP via internal jugular vein represents a very rare but potentially severe condition.

Case presentation

A 50-year-old woman indentified with a spontaneous fracture and migration of catheter of a TIVAP via right internal jugular vein after adjuvant chemotherapy for ovary cancer. She had been not evaluated and not managed with the heparin lock flush solution during three months after adjuvant chemotherapy. And then, she complained right neck bulging during saline infusion via a TIVAP and a chest radiography showed the fractured and migrated catheter of a TIVAP in right atrium. So, we emergently removed the catheter fragment by a goose neck snare via right femoral vein. After then, there was no problem.

Conclusions

If the fractured catheter of a TIVAP is detected, it is desirable to remove a fragment by an endovascular approach if it is possible.