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Benvenuti S, Finetti F, Porteri E, Ceresoli R, Pintossi C, Zanatta F, Bartolini G, Facchini F, Annovazzi C, Alberti D. Guidewire replacement of valved tunneled-cuffed silicone catheters with power injectable polyurethane tunneled-cuffed catheters or with ports. J Vasc Access 2024:11297298231218593. [PMID: 38166575 DOI: 10.1177/11297298231218593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Silicone Cuffed Centrally Inserted Central venous catheters (CICCs) were a type of catheters that have been used for a long time especially in cancer patients. Recently, thanks to biomedic research progresses, polyurethane catheters have resulted in higher surgical performances compared to classical silicone ones. Indeed, the inferior calibers of these new catheters lead to an extremely faster infusion rate. The presence of a valve at the tip of the catheter could suggest an impossible replacement procedure over a Seldinger guidewire. METHOD The aim of this article is to explain our replacement technique over guidewire of silicone cuffed and valved tunneled CICCs with a power injectable polyurethane cuffed tunneled CICC. The casistic presented was evaluated at the Vascular Access Unit of ASST Spedali Civili in Brescia, Italy. The study involved 35 successful catheter replacement over guidewire, meanwhile cases where patients presented sepsis, exit site infection, or catheter damage were premeditatedly excluded. RESULTS The maneuver was always conducted following the same procedure without noticing particular complications associated with CICC insertion. Indeed, the operation was quick, feasible, and safe. Septic, thromboembolic, or hemorrhagic complications also related to patients presenting dysfunctional coagulation cascade were not encountered. CONCLUSIONS Our experience regarding the replacement technique of silicone cuffed and valved catheters over guidewire was considered feasible, accurate, and efficient for all patients treated, even in those presenting thrombocytopenia or a dysfunctional coagulation cascade.
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Affiliation(s)
- Stefano Benvenuti
- Vascular Access Unit, ASST Spedali Civili, Brescia, Lombardia, Italy
| | | | - Elena Porteri
- Vascular Access Unit, ASST Spedali Civili, Brescia, Lombardia, Italy
| | - Rosanna Ceresoli
- Vascular Access Unit, ASST Spedali Civili, Brescia, Lombardia, Italy
| | - Cristian Pintossi
- Vascular Access Unit, ASST Spedali Civili, Brescia, Lombardia, Italy
| | - Francesca Zanatta
- Vascular Access Unit, ASST Spedali Civili, Brescia, Lombardia, Italy
| | | | - Federica Facchini
- Vascular Access Unit, ASST Spedali Civili, Brescia, Lombardia, Italy
| | | | - Daniele Alberti
- Department of Pediatric Surgery, ASST-Spedali Civili "Children Hospital", University of Brescia, Brescia, Lombardia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Lombardia, Italy
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Chatani S, Tsukii R, Nagasawa K, Hasegawa T, Murata S, Kato M, Yamaura H, Onaya H, Matsuo K, Watanabe Y, Inaba Y. Difficult removal of totally implantable venous access devices in adult patients: Incidence, risk factors, and management. J Vasc Access 2023; 24:1150-1157. [PMID: 35081814 DOI: 10.1177/11297298211069256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Totally implantable venous access devices (TIVADs) have played an important role of medical oncology practice. However, operators sometimes encounter considerable difficulty when removing TIVADs. This study aimed to investigate the incidence of difficult TIVAD removal, determine associated risk factors, and investigate interventional radiology (IR) approaches to difficult removal. METHODS A total of 514 TIVAD removal procedures performed in a single-center between January 2014 and May 2021 were retrospectively analyzed to determine incidence of difficult removal and associated risk factors. IR approaches applied in difficult removal cases were also reviewed. RESULTS The incidence of difficult removal was 7.4% (38/514). In univariable analysis, indwelling duration, silicone catheter, and subcutaneous leakage of fluid were identified as significant risk factors for difficult removal. Multivariable analysis showed that indwelling duration per year (odds ratio (OR), 1.46; 95% confidence interval (CI), 1.28-1.67; p < 0.01) and subcutaneous leakage of fluid (OR, 6.04; 95% CI, 2.45-14.91; p < 0.01) were significantly associated with difficult removal. In the 38 difficult removal cases, 32 TIVADs could be removed using more dissection and traction than the standard removal method. In the other 6, TIVADs were successfully removed by using several IR techniques, including insertion of a guide wire (n = 1), dissection using an introducer sheath (n = 2), pushing with a dilator (n = 1), and pulling with a snare (n = 2). CONCLUSION Difficult TIVAD removal is uncommon. However, operators should expect it when removing long indwelling TIVADs and those with subcutaneous leakage. IR approaches to difficult removal are minimally invasive and can be useful.
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Affiliation(s)
- Shohei Chatani
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Ryota Tsukii
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kyohei Nagasawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takaaki Hasegawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shinichi Murata
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Mina Kato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hidekazu Yamaura
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Onaya
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
- Division Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
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Gennequin M, Elmawieh J, Gomas F. Complications after removal of totally implanted central venous access devices: A single-center retrospective study. J Vasc Access 2023:11297298221145740. [PMID: 36847159 DOI: 10.1177/11297298221145740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Complications after removal of totally implanted vascular access devices. (TIVADs) have not been studied widely. The aim of this study was to assess the prevalence and risk factors of these complications. METHODS This was a single-center retrospective study conducted in Gustave Roussy hospital in Villejuif, Ile-de-France, France. All adult patients scheduled for TIVAD removal between January 2015 and November 2019 were eligible for the study. The record of complications was compiled by noting the reason for a surgical or emergency department consultation during the month following removal, and also by calling the patients during the week of TIVAD removal to assess whether surgical advice was needed. RESULTS There were 2533 included patients, representing 2583 TIVAD removals. The prevalence of complications was 1.47% (n = 38), of which 0.31% were infectious complications (n = 8). These complications required surgical or interventional radiology management in 50% of cases. In multivariate analysis, two independent risk factors were associated with these complications: the duration of the surgical procedure (p = 0.04) and the active status of the underlying malignant disease (p = 0.07). CONCLUSIONS Complications after TIVAD removal are uncommon (prevalence = 1.47%), but their morbidity appears to be high, with interventional procedures frequently needed. The duration of the removal procedure and the active status of cancer appear to be associated with the occurrence of complications.
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Affiliation(s)
- Mael Gennequin
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, DMU Parabol, AP-HP Nord, Université de Paris, Clichy, France
| | - Jamie Elmawieh
- Department of Anesthesiology, Institut Gustave Roussy, Villejuif, France
| | - Frederic Gomas
- Department of Anesthesiology, Institut Gustave Roussy, Villejuif, France
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Kondo T, Matsumoto S, Doi K, Nomura M, Muto M. Femoral placement of a totally implantable venous access port with spontaneous catheter fracture: case report. CVIR Endovasc 2020; 3:2. [PMID: 32027011 PMCID: PMC6966363 DOI: 10.1186/s42155-019-0094-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background The incidence of catheter fracture after standard positioning of a totally implantable venous access port (TIVAP) is reported to be 1.1%–5.0%; however, the incidence of catheter fracture after TIVAP implantation at a femoral site remains unclear. Case presentation In a 30-year-old man with angiosarcoma of the right atrium, tumor embolism was observed from the left brachiocephalic vein to the superior vena cava. A TIVAP was implanted in the right femur. A catheter fracture was spontaneously observed after 7 months. Conclusions To the best of our knowledge, this is the first case of catheter fracture in a TIVAP implantation at a femoral site.
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Arm mobilization provokes deformity of long-term indwelling ports implanted via the jugular vein. J Vasc Surg Venous Lymphat Disord 2020; 9:998-1006. [PMID: 33130283 DOI: 10.1016/j.jvsv.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The incidence of totally implantable catheter fracture ranges from 0.48% to 5.00%, and these fractures represent a potentially fatal complication. The fracture mechanism of catheters implanted via the jugular vein is unclear, and whether extreme arm movements represent an additional risk factor for repetitive stress of the material remains unknown. The aim of this study was to demonstrate and classify catheter deformations caused by extreme arm mobilization and associations with changes in catheter function and displacement. METHODS We analyzed the fluoroscopy images of 60 consecutive patients undergoing long-term indwelling port implantation via the jugular vein. Three images were taken: arm in maximal abduction, maximal frontal elevation, and maximal adduction. The images were compared with an image of the remainder of the arm. We analyzed three catheter regions to classify the deformity: A, connection between catheter and reservoir; B, the catheter's subcutaneous tunnel; and C, the catheter's entrance in the jugular vein. The deformations were classified in comparative manner as follows: 0 (no changes), 1 (minor changes, new slightly curvatures with an angle of >90°), and 2 (major changes, new severe curvatures with angles of ≤90°). In each position, catheter function (injection and aspiration) and displacement of the reservoir and tip were analyzed. RESULTS Only 15% of patients did not show a deformity; 33.3% had a deformity in only one position, 47.7% in two positions, and 10% in three positions. Minor deformities were observed in 70% of patients and major deformities in 40%. Moreover, 25% of patients presented both major and minor deformities. Major deformities were observed in 25.0% of patients on maximal frontal elevation, in 23.3% on maximal adduction and in none on maximal abduction. Region B was the most affected, with 57.8% of all minor deformities and 78.1% of all major deformities. No change in function was noted in 91.7% of the catheters. Maximal arm adduction resulted in greater vertical and horizontal displacement of the catheter tip and horizontal displacement of the reservoir. Higher body mass index values were associated with major deformities. CONCLUSIONS Maximal frontal elevation and maximal adduction were associated with major catheter deformities, and the subcutaneous tunnel region was the most deformed catheter region. An association between major catheter deformity and high body mass index was noted; in contrast, no association between the severity of catheter deformity, tip or reservoir displacement, or worsened functioning was observed.
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Sun X, Bai X, Shen J, Yu Z, Zhuang Z, Jin Y. Comparison between ultrasound-guided TIVAD via the right innominate vein and the right internal jugular vein approach. BMC Surg 2019; 19:189. [PMID: 31829196 PMCID: PMC6907195 DOI: 10.1186/s12893-019-0651-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To compare the efficacy and safety of right internal jugular vein (IJV) approach and right innominate vein (INV) approach for US-guided totally implantable venous access devices (TIVADs), and to explore the advantages and disadvantages of the two approaches. METHODS Six hundred and nineteen adult patients had long-term infusion and chemotherapy needs and inconvenience of peripheral venous infusion. Right INV approach was used to implant 339 cases of TIVADs, and right IJV approach was used to implant 280 cases of TIVADs. The success rate of one-time catheterization and the incidence of complications in the two groups were retrospectively analyzed. RESULTS All patients were successfully implanted in TIVAD. The success rates of one-time puncture in INV group and IJV approach group were 98.53% (334/339) and 95.36% (267/280), respectively. There was significant difference between the two groups (P = 0.020). The incidence of perioperative complications and long-term complications in the right INV group were 1.18% (4/339) and 3.54% (12/339), respectively, while those in the right IJV group were 1.43% (4280) and 3.93% (11280). There was no significant difference in the incidence of perioperative or long-term complications between the two groups (P = 0.785, P = 0.799, respectively). CONCLUSIONS US-guided TIVADs via the right INV approach and the right IJV approach are both safe and reliable. The right INV approach improves the one-time puncture success rate, as long as the technique is properly operated, serious complications rarely occur.
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Affiliation(s)
- Xingwei Sun
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Xuming Bai
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Jiaofeng Shen
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Ziyang Yu
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Zhixiang Zhuang
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China.
| | - Yong Jin
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China.
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Matsunari K, Watanabe K, Hishizume N, Fujisawa H. Influence of venipuncture point and port chamber site on the risk of catheter fracture in right internal jugular port placements. J Vasc Access 2019; 20:666-671. [PMID: 30973300 DOI: 10.1177/1129729819839614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For subcutaneously implanted central venous ports, some complications due to prolonged placement have been reported. We investigated the appropriate puncture points and port placement sites to prevent catheter fracture in right internal jugular port placement. METHODS This retrospective study included 709 patients who underwent right internal jugular vein puncture and port implantation in the right precordium between 1 May 2012 and 31 March 2018. The cases were divided into undamaged catheter group and damaged catheter group comprising normal and fracture cases, respectively. The catheter angle, distance from the clavicle, tip position, and curvature radius were measured from fluoroscopic images obtained at the time of implantation. The t-test was used in statistical analysis. RESULTS Median angles were 91.6° in the undamaged catheter group and 58.0° in the damaged catheter group. Median distances were 26.0 mm in the undamaged catheter group and 36.6 mm in the damaged catheter group. Median tip positions were 51.6 mm in the undamaged catheter group and 37.5 mm in the damaged catheter group. Median curvature radii were 9.2 R in the undamaged catheter group and 7.1 R in the damaged catheter group. Significant differences were found in the angle, height, and curvature radius between the two groups. CONCLUSION Our results indicate that a venipuncture as close to the clavicle as possible (less than 3 cm) and a gentle catheter curve (close to 90° angle) are associated with a lower risk of catheter fracture.
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Affiliation(s)
- Kazuya Matsunari
- Department of Radiology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kota Watanabe
- Department of Radiology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Norihiro Hishizume
- Department of Radiology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hidefumi Fujisawa
- Department of Radiology, Showa University Northern Yokohama Hospital, Yokohama, Japan
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Saijo F, Mutoh M, Tokumine J, Yoshinobu O, Hama H, Namima T, Shibahara M, Tokumura H. Late fracture of Groshong ports: A report of the three cases. J Vasc Access 2019; 20:563-566. [PMID: 30854915 DOI: 10.1177/1129729819834512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Totally implantable venous access devices are valuable tools for total parenteral nutrition, chemotherapy, and long-term intravenous therapy. However, late catheter fracture is a well-known complication of totally implantable venous access device, particularly in Groshong silicone catheter. Recently, a specific type of totally implantable venous access device made with Groshong silicone has been introduced to facilitate power injection of contrast medium for enhanced computed tomography. CASES DESCRIPTION We reported three cases of catheter fracture in power-injectable Groshong silicone totally implantable venous access device. From May 2012 to August 2014, 66 patients underwent power-injectable Groshong silicone totally implantable venous access device implantation at our institution, with a median follow-up of 20.1 (range 0.2-58.1) months. The catheters in all patients were inserted into the internal jugular vein under ultrasound guidance and were connected to the port implanted in the upper chest through the subcutaneous tunnel. Chemotherapy was administered using these routes. Fractures of all three cases specifically showed a torn catheter section: smooth surface on one side, and a rough edge on the other side of the catheter, suggesting that long-term repeated stretch force may be related with the mechanism of fracture. CONCLUSION Totally implantable venous access devices with Groshong silicone catheters, if inserted via the internal jugular vein, have a potential risk for late catheter fracture.
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Affiliation(s)
- Fumito Saijo
- 1 Department of Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Mitsuhisa Mutoh
- 1 Department of Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Joho Tokumine
- 2 Department of Anesthesiology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Odaka Yoshinobu
- 3 Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Department of Biology, University of Cincinnati Blue Ash College, Cincinnati, OH, USA
| | - Hikaru Hama
- 5 Department of Radiology, Tohoku Rosai Hospital, Sendai, Japan
| | | | - Mii Shibahara
- 1 Department of Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Hiromi Tokumura
- 1 Department of Surgery, Tohoku Rosai Hospital, Sendai, Japan
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Busch JD, Vens M, Mahler C, Herrmann J, Adam G, Ittrich H. Complication Rates Observed in Silicone and Polyurethane Catheters of Totally Implanted Central Venous Access Devices Implanted in the Upper Arm. J Vasc Interv Radiol 2017; 28:1177-1183. [PMID: 28549710 DOI: 10.1016/j.jvir.2017.04.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/16/2017] [Accepted: 04/24/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To present frequency and types of complications related to silicone (SI) versus polyurethane (PUR) catheters of totally implanted venous access devices (TIVADs) placed in the upper arm. MATERIAL AND METHODS A cohort of 2,491 consecutive patients with TIVADs implanted between 2006 and 2015 was retrospectively analyzed. Complications were classified according to SIR guidelines. Pearson χ2 test was used for categorical variables, and Student t test was used for continuous variables. Nominal P values were reported, and 2-sided P values < .05 were considered significant. RESULTS Of 2,270 patients meeting the inclusion criteria, 538 had an SI catheter, and 1,732 had a PUR catheter. Total dwell time was 584,853 catheter days. Mean total complication rate was 12.25% (SI, 14.87%; PUR, 11.43%; P = .040). Subanalysis revealed significant differences for material failures (eg, catheter fracture [SI, 3.35%; PUR, 0.06%; P < .001] and thrombotic catheter occlusion/venous thromboses [SI, 2.79%/0.74%; PUR, 1.33%/3.17%; P < .001]) but nonsignificant differences for infections (eg, local infection and catheter-related sepsis [SI, 4.64%; PUR, 4.68%; P = 1]) or other nonthrombotic dysfunctions (eg, catheter detachment, line migration, wound dehiscence [SI, 3.35%; PUR, 2.19%; P = .179]). CONCLUSIONS The reported data suggest different risk profiles in SI catheters compared with PUR catheters, with more material failures and thrombotic catheter occlusions in SI catheters and more venous thromboses in PUR catheters.
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Affiliation(s)
- Jasmin D Busch
- Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.
| | - Maren Vens
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Catherine Mahler
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Jochen Herrmann
- Section of Pediatric Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Harald Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
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Abstract
Resumo A utilização de cateteres totalmente implantáveis no tratamento quimioterápico constitui uma necessidade que acarreta o risco de múltiplas complicações, algumas inerentes à inserção do dispositivo e outras relacionadas ao próprio cateter. Relatamos três casos nos quais o cateter apresentou-se desacoplado de seu respectivo reservatório. No primeiro caso, ocorreu a desconexão do cateter de seu respectivo reservatório, e nos outros dois casos, verificou-se a fragmentação do cateter. Em todos os casos, foi necessária a retirada endovascular do cateter. Tal desfecho é apontado como raro, mas costuma estar presente na maioria das revisões e traz consigo o risco de complicações graves, ainda que frequentemente seja assintomático. É desejável o acompanhamento de pacientes que possuem tais cateteres a fim de que se possa detectar precocemente tais complicações e compreender os fatores que determinam o aparecimento dessas situações.
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Fracture of Totally Implanted Central Venous Access Devices: A Propensity-Score-Matched Comparison of Risks for Groshong Silicone versus Polyurethane Catheters. J Vasc Access 2016; 17:535-541. [DOI: 10.5301/jva.5000606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose To evaluate retrospectively the fracture risk of totally implanted venous access devices connected to Groshong silicone (SC) versus polyurethane (PU) catheters, inserted via the internal jugular vein. Materials and methods The study population comprised 384 SC and 221 PU central venous catheters implanted via the internal jugular vein. The presence of catheter fracture was evaluated. Variables possibly related to catheter fracture were evaluated. First, in order to determine the factors associated with fracture, fracture rates were compared with the log-rank test between the two groups divided by each of the variables. Then, in order to adjust for potential confounders, propensity-score matching of the variables was employed in the two catheter groups. Finally, the rates of fracture were compared between the two propensity-score-matched catheter groups. Results There were 16 cases of catheter fracture, for an overall fracture percentage of 2.6% (16/605). All 16 cases of fracture occurred in the SC catheter group. Smaller patient body mass index (p = 0.039), deeper catheter tip position (p = 0.022), and SC catheters (p = 0.019) were significantly associated with fracture. With the propensity-score-matching method, 180 cases were selected in each catheter group. Comparison of the two propensity-score-matched groups showed that fracture rates for SC catheters remained significantly (p = 0.018) higher than those for PU catheters. Conclusions Ports connected to Groshong SC catheters – when implanted via the internal jugular vein – posed a higher risk of fracture than did ports connected to PU catheters.
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Ko SY, Park SC, Hwang JK, Kim SD. Spontaneous fracture and migration of catheter of a totally implantable venous access port via internal jugular vein--a case report. J Cardiothorac Surg 2016; 11:50. [PMID: 27067705 PMCID: PMC4827203 DOI: 10.1186/s13019-016-0450-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 04/04/2016] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Seung Yeon Ko
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Cheol Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Kye Hwang
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Dong Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyong-Gu, Incheon, 403-720, Korea.
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