Spontaneously Migrated Tip of an Implantable Port Catheter into the Axillary Vein in a Patient with Severe Cough and the Subsequent Intervention to Reposition It

Migration of an implantable port catheter tip is one of the well-known complications of this procedure, but the etiology of this problem is not clear. We describe here a case of migration of the tip of a port catheter from the right atrium to the right axillary vein in a patient with severe cough. Coughing was suggested for this case as the cause of the catheter tip migration. We corrected the position of the catheter tip via transfemoral snaring.

The Safety and Efficacy of Hemostasis with Clo-Sur P.A.D. after Transcatheter Arterial Chemoembolization

PURPOSE: We wanted to evaluate the safety and efficacy of a new hemostatic device, Clo-Sur P.A.D., at an arterial access site after performing femoral arterial catheterization to achieve transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: From August 2002 to March 2005, 113 patients who underwent TACE and agreed on using the Clo-Sur P.A.D. were enrolled in this study. We evaluated the mean time interval from compression to the first movement and also to the first walk. We also evaluated such complications as rebleeding, pseudoaneurysm, vascular occlusion, hematoma, infection and pain. For 92 patients who had previous experiences with manual compression, we evaluated their preference of hemostatic method by asking them. RESULTS: Successful hemostasis was achieved with the Clo-Sur P.A.D. in 105 subjects (92%). The mean time interval from compression to the first movement was 201 minutes, and that to the first walk was 267 minutes. There was no statistical difference between the complicated and the uncomplicated groups for the mean time, prothrombin time, Child-Pugh class and platelet count (p > 0.05). Rebleeding occurred in 3 patients (2.7%) and mild hematoma around puncture site was noted in 5 patients (5.4%). Eighty-seven patients (95%) preferred Clo-Sur P.A.D. to the manual compression method. CONCLUSION: The Clo-Sur P.A.D. is a safe and effective hemostatic device and it provides early ambulation after TACE.

Percutaneous Catheter Drainage of Thoracic Fluid: The Usefulness and Safety of Bedside Trocar Placement under Ultrasound Guidance

PURPOSE: The author wanted to evaluate the usefulness and safety of the trocar technique for US-guided bedside catheter placement into thoracic fluid collections, and this technique has generally been reserved for the larger or superficial fluid collections. Materials and Methods: 42 drainage procedures were performed in 38 patients at the bedside. The patients were positioned supine or semi-upright. A drainage catheter system with a stylet and cannula assembly was used and all of the catheters were inserted using the trocar technique. The procedures consisted of drainage of empyema (n=14), malignant effusion (n=13), lung abscess (n=3), massive transudate (n=8), hemothorax (n=2) and chest wall hematoma (n=2). The clinical results were classified as successful (complete & partially successful), failure or undetermined. The medical records and images were retrospectively reviewed to evaluate the success rate, the complications and the procedure time. Results: Technical success was achieved in all of the 42 procedures. With using the trocar technique, all the catheters were placed into even the small collections without significant complications. Drainage was successful in 36 (85.7%) of the 42 procedures. The average volume of thoracic fluid that was aspirated manually at the time of catheter placement was 420 mL (range: 35 to 1470 mL). The procedure time was less than 10 minutes from US-localization to complete catheter placement in all of the procedures. Conclusion: The trocar technique under US guidance can be an efficient and safe alternative to the Seldinger or guide-wire exchange technique for bedside catheter placement in the critically ill or hemodynamically unstable patients.

Fixation Methods for Implantable Port Chamber: Comparative Study Using Glue, Self-stabilizing Leg and Suture Fixations in Rabbits

OBJECTIVE: To evaluate the fixation strength and tissue reaction of the glue fixation and self-stabilizing leg fixation methods and to compare the results with those of the conventional tagging suture fixation method. MATER AND METHODS: Twelve healthy rabbits were selected and three different methods of implanting the port chamber were employed on the back of each rabbit. A total of thirty six port chambers were implanted with these three different methods, viz. the glue fixation method using tissue adhesive, the self-stabilizing leg method using a self-expandable stabilizing leg, and the suture fixation method. The fixation strength and the gross and histopathologic changes of each fixation method were evaluated at three days, one week, two weeks and four weeks after port implantation. RESULTS: The glue fixation method showed a good fixation strength, which was similar to that of the tagging suture method (p=0.3486). Five of the six ports (83%) implanted with the glue fixation method which were examined after two weeks showed cracks on the external surface, but this had no adverse effects on their function. A large amount of granulation tissue reaction was found at the bottom of the chamber (p=0.0025). The fixation with the self-stabilizing leg showed relatively lower fixation strength (p=0.0043), but no turning-over of the chamber occurred. The fixation strength improved with time after the first week, and minimal granulation tissue reaction was observed with this method. CONCLUSION: The glue fixation method exhibited equal fixation strength compared to the suture fixation, but showed cracking and a large amount of granulation tissue, whereas the fixation with a self-stabilizing leg showed weaker fixation strength.

Implantable Central Venous Chemoport: Comparision of Results According to Approach Routes and Methods

PURPOSE: To evaluate the results and complications of placement of implantable port according to approach routes and methods. MATERIALS AND METHODS: Between April 2001 and October 2002, a total of 103 implantable chemoport was placed in 95 patients for chemotherapy using preconnected type (n=39) and attachable type (n=64). Puncture sites were left subclavian vein (n=35), right subclavian vein (n=5), left internal jugular vein (n=9), right internal jugular vein (n=54). We evaluated duration of catheterization days, complications according to approach routes and methods. RESULTS: Implantable chemoport was placed successfully in all cases. Duration of catheterization ranged from 8 to 554 days(mean 159, total 17,872 catheter days). Procedure related complications occurred transient pulmonary air embolism (n=1), small hematoma (n=1) and malposition in using preconnected type (n=2). Late complications occurred catheter migration (n=5), catheter malfunction (n=3), occlusion (n=1) and infection (n=11). Among them 15 chemoport was removed (14.5%). Catheter migration was occured via subclavian vein in all cases (13%, p=.008). Infection developed in 10.7% of patients(0.61 per 1000 catheter days). There were no catheter-related central vein thrombosis. CONCLUSION: Implantation of chemoport is a safe procedure. Choice of right internal jugular vein than subclavian vein for puncture site has less complications. And selection of attachable type of chemoport is convenient than preconnected type. Adequate care of chemoport is essential for long patency.

Radiologic Placement of Implantable Chest Ports in Pediatric Patients Under Sedation

PURPOSE: To evaluate the safety and efficacy of the radiologic placement of implantable chest ports under intravenous sedation in pediatric patients with malignancy. MATERIALS AND METHODS: Between October 2001 and June 2002, 20 chest ports were placed in 19 pediatric patients [13 boys and six girls aged 1-11 (mean, 4.7) years] for the purpose of long-term chemotherapy. In three patients, tunneled central venous catheters had been removed because of catheter extraction, infection, and tearing. Under intravenous sedation, the right internal jugular vein was used for access in 19 cases, and the left internal jugular vein in one. Venipucture was performed using a micropuncture needle with real-time ultrasound guidance. A port chamber was created at the infraclavicular fossa, and to prevent catheter kinking, a smooth-angled tunnel was created between the venipuncture site and the subcutaneous pocket. The catheter tip was positioned under fluoroscopy at the junction of the superior vena cava and right atrium. We observed techincal success, complications arouse during and after the procedure, and duration of catheter use. RESULTS: Implantation of the port system was successful in all cases, though slight hematoma, treated with manual compression, occurred at a chamber pocket in one case. In addition, the port system was removed from one patient because of wound infection leading to dehiscence and catheter malpositiong. A new port system was implanted through the left internal jugular vein. The median period during which catheter use was followed up was 118 (range, 18-274) days. CONCLUSION: For long-term chemotherapy in pediatric patients with malignancy, radiologic placement of an implantable chest port under intravenous sedation shows a high technical success rate, with few complications. This method may thus be used instead of surgical port placement.

Outcome of Tunneled Infusion Catheters Inserted via the Right Internal Jugular Vein

PURPOSE: To assess the outcome of tunneled central venous catheter placement via the right internal jugular vein. MATERIALS AND METHODS: Between June 2001 and May 2002, 670 consecutive Hickman catheters were placed in 654 patients via the right internal jugular vein. The procedural complications arising and follow-up data obtained from May to July 2002 were evaluated. RESULTS: The technical success rate for catheter placement was 99.9% (669/670). Procedural complications were limited to eight cases (1.2%), including three pneumothoraces, one early migration of the catheter, one clinically unimportant air embolism, one catheter injury, one catheter kinking and one primary malpositioning in the azygos vein. Catheter dwelling time ranged from 1 to 407 (mean 107.1) days. During the follow-up period, 416 catheters were removed for various reasons: treatment had ended (n=334), patients declined treatment or their drug regimen was changed (n=16), late complications arose (n=53), or other circumstances intervened (n=13). Late complications included 44 cases of catheter-related infection (6.6%), five of catheter migration (0.7%), two of catheter occlusion (0.3%), one of thrombophlebitis (0.15%), and one of catheter-related right atrial thrombosis (0.15%). Only one instance of symptomatic venous thrombosis or stenosis was noted , namely the one case of thrombophlebitis. CONCLUSION: Because the incidence of subsequent symptomatic venous thrombosis or stenosis is lower, the preferred route for tunneled central venous catheter placement is the right internal jugular vein.

Central Venous Catheterization: Comparison between Interventional Radiological Procedure and Blind Surgical Procedure

PURPOSE: To determine the usefulness and safety of radiological placement of a central venous catheter by prospectively comparing the results of interventional radiology and blind surgery. MATERIALS AND METHODS: For placement of a central venous catheter, the blind surgical method was used in 78 cases (77 patients), and the interventional radiological method in 56 cases (54 patients). The male to female ratio was 66:68, and the patients' mean age was 48 (range, 18-80) years. A tunneled central venous catheter was used in 74 cases, and a chemoport in 60. We evaluated the success and duration of the procedures, the number of punctures required, and ensuing complications, comparing the results of the two methods. RESULTS: The success rates of the interventional radiological and the blind surgical procedure were 100% and 94.8%, respectively. The duration of central catheterization was 3-395 (mean, 120) days, that of chemoport was 160.9 days, and that of tunneled central venous catheter was 95.1 days. The mean number of punctures of the subclavian vein was 1.2 for interventional radiology, and 2.1 for blind surgery. The mean duration of the interventional radiological and the blind surgical procedure was, respectively, 30 and 40 minutes. The postprocedural complication rate was 27.6% (37 cases). Early complications occurred in nine cases (6.7%): where interventional radiology was used, there was one case of hematoma, and blind surgery gave rise to hematoma (n=2), pneumothorax (n=2), and early deviation of the catheter (n=4). Late complications occurred in 32 cases (23.9%). Interventional radiology involved infection (n=4), venous thrombosis (n=1), catheter displacement (n=2) and catheter obstruction (n=5), while the blind surgical procedure gave rise to infection (n=5), venous thrombosis (n=3), catheter displacement (n=4) and catheter obstruction (n=8). CONCLUSION: The success rate of interventional radiological placement of a central venous catheter was high and the complication rate was low. In comparison with the blind surgical procedure, it is a very safe and useful method.

Tubular Foreign Body or Stent: Safe Retrieval or Repositioning Using the Coaxial Snare Technique

OBJECTIVE: To evaluate the utility and advantages of the coaxial snare technique in the retrieval of tubular foreign bodies. MATERIALS AND METHODS: Using the coaxial snare technique, we attempted to retrieve tubular foreign bodies present in seven patients. The bodies were either stents which were malpositioned or had migrated from their correct position in the vascular system (n=2), a fragmented venous introducer sheath (n=1), fragmented drainage catheters in the biliary tree (n=2), or fractured external drainage catheters in the urinary tract (n=2). After passing a guidewire and/or a dilator through the lumina of these foreign bodies, we introduced a loop snare over the guidewire or dilator, thus capturing and retrieving them. RESULTS: In all cases, it was possible to retrieve or reposition the various items, using a minimum-sized introducer sheath or a tract. No folding was involved. In no case were surgical procedures required, and no complications were encountered. CONCLUSION: The coaxial snare technique, an application of the loop snare technique, is a useful and safe method for the retrieval of tubular foreign bodies, and one which involves minimal injury to the patient.

Combined Therapy involving Hepatic Arterial Chemoinfusion through a Percutaneously Implanted Port, and External Irradiation for Advanced Hepatocellular Carcinoma

PURPOSE: To evaluate the efficacy of combined therapy involving intra-arterial hepatic chemoinfusion through a percutaneously implanted port and external irradiation for the treatment of advanced hepatocellular carcinoma. MATERIALS AND METHODS: Fifteen patients (12 males and 3 females; mean age=47.5 years) with advanced hepatocellular carcinoma localized in one lobe and with portal vein thrombosis (stage IVa) were included in this study. To permit chemoinfusion through the hepatic artery, a Chemoport(R); was implanted percutaneously in the right inguinal area via the femoral artery. Initial external radiation therapy lasted five weeks (44 Gy in a daily fraction of 1.8 Gy), with concurrent intra-arterial hepatic infusion of 5-fluorouracil. This initial treatment was followed by five cycles of intra-arterial hepatic infusion of cisplatin and 5-fluorouracil for three consecutive days every month. Two and six months after treatment was begun, the patients underwent CT scanning and angiography, and their response was assessed in terms of change in tumor size and vascularity, the degree of portal vein thrombosis and arterio-portal shunt, and alpha-fetoprotein levels. Any complications arising from this combined therapy and the clinical status of each patient were also followed up during the treatment period. RESULTS: The response rates at months 2 and 6 were 60% and 33.3%, respectively. One patient (6.7%) showed complete remission, and serum alpha-fetoprotein levels decreased significantly in all patients who responded. In five of the twelve patients, the thrombi in the main portal vein showed marked regression. The one-year survival rate was 30% and the median survival period was 10.6 (range, 3.7 to 28) months. The complications arising after treatment involved the catheter-port system (n=2) or were due to gastroduodenitis (n=9). CONCLUSION: In these patients with advanced hepatocellular carcinoma and portal vein thronbosis, combined therapy involving hepatic arterial chemoinfusion through a Chemoport(R) and external irradiation achieved favorable results. Further controlled studies aimed at evaluating the prognostic factors involved are, however, required.

Evaluation of Anterior Chest Wall Implanted Port: Technical Aspects, Results, and Complications

PURPOSE: To evaluate the technical aspects, results and complications of patients with implanted anterior chest wall port. MATERIALS AND METHODS: Between April 1997 and June 1999, a total of 63 implanted ports were placed at the anterior chest wall of 63 consecutive patients by interventional radiologists. The indications were chemotherapy in 61 patients and total parenteral nutrition in two. The peripheral portion of the subclavian vein was punctured under fluoroscopic guidance via ipsilateral peripheral vein during venography. A central venous catheter was placed in the superior vena cava, and using the subcutaneous tunneling method, a connected infusion port was implanted at the anterior chest wall. Results and complications were reviewed, and by means of Kaplan-Meier survival analysis, the expected patency of the port was determined. RESULTS: The technical success rate for implanted port at the anterior chest wall was 100%(63/63 patients). In two patients, hematoma and oozing were treated by compression. The duration of port implantation ranged from 12 to 855(mean, 187) days, and the port patency rate was 305.7 +/-47.6 days. In seven patients [completed chemotherapy (n=3), central venous thrombosis (n=3) catheter-related infection (n=1)], the port was re-moved. Catheter obstruction occurred in two patients, and in one, the use of urokinase led to successful re-canalization. Sixteen patients died of an underlying malignancy, but no catheter-related death was noted. CONCLUSION: Implantation of an anterior chest wall port is a safe and useful procedure, with long patency, for patients requiring chemotherapy and long-term venous access.

Sclerotherapy of Pelvic Lymphocele with Povidone-iodine and Ethanol

PURPOSE: To evaluate the efficacy of percutaneous transcatheter sclerotherapy using povidone-iodine andethanol for the treatment of postoperative pelvic lymphoceles MATERIALS AND METHODS: Between January 1995 andApril 1998, 22 lymphoceles in 21 women who had under-gone pelvic surgery were subjected to percutaneoustranscatheter sclerotherapy using povidone-iodine and ethanol. Biochemical and cytological examination revealedthat 16 lymphoceles were sterile and six were in-fected. The diameter of lymphoceles varied between 3 and 20(average; 7.9 cm) and the initial volume of drainage ranged from 10ml to 1200ml. When the amount of drainagedecreased to less than 5 -10 ml/day and when the lymphocele was collapsed on follow-up sinography, the catheterwas removed. By means of sonog-raphy, all patients were followed up. The duration of this ranged from 1 month to 3years 4 months (average, 18 months). RESULTS: After percutaneous transcatheter sclerotherapy, 21 of 22lymphoceles were seen to have collapsed. Three lymphoceles recurred during the follow-up period. Eventually 18 of22 lymphoceles (82 %) were suc-cessfully treated, without recurrence. The duration of catheter drainage rangedfrom 3 to 15 (average, 8.6) days. CONCLUSION: Because of its high initial success rate, low rate of recurrence,and the short duration of catheter drainage, percutaneous transcatheter sclerotherapy using povidone-iodine andethanol is thought to be an ef-fective treatment for postoperative pelvic lymphoceles.

GDC Embolization of Wide-necked Cerebral Aneurysms Using Balloon-Assisted Technique

PURPOSE: The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the a-neurysmal sac, especially the width of the neck. We describe an early experience and technical aspects of treating wide-necked cerebral aneurysm using a Guglielmi detachable coil (GDC) and simultaneous application of a temporary balloon. MATERIALS AND METHODS: Four cases of unruptured wide-necked cerebral aneurysm were treated with GDC, with simultaneous application of a temporary balloon. Patients were aged between 29 and 49 years. On admission, clinical presentation was subarachnoid hemorrhage (SAH) in all cases. Hunt and Hess grade was II in two cases, III in one case, and traumatic SAH in one case. In all patients angiography revealed an asymptomatic a-neurysm after rupture of another aneurysm or traumatic SAH. The aneurysms were occluded with GDC-10, and a Cirrus balloon occlusion system was used simultaneously. All procedures were performed under endo-tracheal general anesthesia and systemic heparinization. RESULTS: All cases were treated successfully, without parent artery compromise. The occlusion rate at the end of the procedure was total in three cases and subtotal in one. In one case a heparin-related hematoma occurred during post-procedural treatment and the patient eventually expired. One patient underwent follow-up angiography after 6 months, and the coil was not changed. CONCLUSION: An aneurysm may not be completely occluded, but with regard to coil compaction and parent artery preservation, the technique is an attractive alternative.

Interventional Radiologic Placement of Tunneled Central Venous Catheters: Results and Complications in 557Cases

PURPOSE: To evaluate prospectively the results of interventional radiologic placement of tunneled centralve-nous catheters, and subsequent complications. MATERIALS AND METHODS: Between April 1997 and April 1998, a totalof 557 tunneled central venous catheters were percutaneously placed in 517 consecutive patients in aninterventional radiology suite. The indications were chemotherapy in 533 cases, total parenteral nutrition in 23and transfusion in one. Complications were e-valuated prospectively by means of a chart review, chest radiography,central vein angiography and blood/catheter culture. RESULTS: The technical success rate for tunneled centralvenous catheter placement was 100% (557/557 cases). The duration of catheter placement ranged from 4 to 356 (mean,112 +/-4.6) days; Hickman catheters were re-moved in 252 cases during follow-up. Early complications included 3cases of pneumothorax(0.5%), 4 cases of local bleeding/hematoma(0.7%), 2 cases of primary malposition(0.4%), and 1case of catheter leakage(0.2%). Late complications included 42 cases of catheter-related infection(7.5%), 40 casesof venous thrombosis (7.2%), 18 cases of migration (3.2%), 5 cases of catheter / pericatheter of occlusion(0.8%),and 1 case of pseudoa-neurysm(0.2%) . The infection rate and thrombosis rate per 1000 days were 1.57 and 1.50,respectively. CONCLUSIONS: The technical success rate of interventional radiologic placement of tunneled centralvenous catheters was high. In comparison to conventional surgical placement , it is a more reliable method andleads to fewer complications.

Intra-arterial Port Implantation for Intra-arterial Chemotherapy: Comparison between PIPS(Pe rcutaneouslyImplantable Port System) and Port System

PURPOSE: To compare the techniques and complications of intra-arterial port implantation for intra-arterialchemotherapy between PIPS and the port system. MATERIALS AND METHODS: For intra-arterial port implantation, 27cases in 27 patients were retrospectively evalu-ated using PIPS(PIPS-200, William Cook Europe, Denmark) while for21 cases in 19 patients a pediatric ve-nous port system(Port-A-Cath, 5.8F, SIMS Deltec, U.S.A.) was used. Allintra-arterial port implantation was performed percuteneously in an angiographic ward. Hepatocellular carcinomawas diagnosed in 18 patients and hepatic metastasis in 16. Peripheral cholangiocarcinoma, and pancreatic gastric,ovarian, renal cell and colon carcinoma were included. We compared the techniques and complications between PIPSand the port system. The follow up period ranged from 23 to 494(mean, 163) days in PIPS and from 12 to 431(mean,150) days in the port system. RESULTS: In all cases, intra-arterial port implantations were technicallysuccessful. Port catheter tips were locat-ed in the common hepatic artery(n=8), proper hepatic artery(n=7), righthepatic artery(n=5), gastroduodenal artery(n=2), left hepatic artery(n=1), pancreaticoduodenal artery(n=1),inferior mesenteric artery(n=1), lum-bar artery(n=1), and renal artery(n=1) in PIPS, and in the proper hepaticartery(n=6), gastroduodenal artery(n=6), common hepatic artery(n=3), right hepatic artery(n=4), inferiormesenteric artery(n=1), and in-ternal iliac artery(n=1) in the port system. Port chambers were buried ininfrainguinal subcutaneous tissue. Using PIPS, complications developed in seven cases(25.9%) and of these, four(57.1%) were catheter or cham-ber related. In the port system, catheter or chamber related complications developedin four cases(19.0%). CONCLUSION: Because PIPS and the port system have relative merits and demetrits, successfulintra-arterial port implantation is possible if equipment is properly selected.

Intra-arterial Port Implantation for Intraarterial Chemoinfusion

PURPOSE: To evaluate, using various port systems, the technique and complications of intra-arterial portimplantation in visceral (mainly hepatic) arteries for intra-arterial chemoinfusion. MATERIALS AND METHODS: Weretrospectively evaluated 30 cases of intra-arterial port implantation in 29 patients. Angiography was performedin all cases, and insertion of an implantable polyurethane port catheter was followed by angiographic exchangewhich, utilizing a .035" hydrophilic guide wire, targeted the artery. If a change in the direction of flow wasrequired, arterial flow control was performed, using an enbolie coil. In order to insert the subcutaneous portchamber, an incision approximately 4cm long was made at the puncture site and subcutaneous tissue was dissected.The port chamber was inserted into the subcutaneous pocket and fixed with a black-silk tagging suture. When thefemoral artery was punctured, the port chamber was inserted into the supra-or infrainguinal area; when the leftsubclavian artery was used, the port chamber was inserted into the lateral one third of the left clavicle. Theport systems used in the procedure were as follows : 5.8F Port-A-Cath (SIMS, Deltec, U.S.A.)(n=20) ; 5.2F A-Port(Therex, U.S.A.)(N=5); 5F PU-Anthron(Deny, Japan)(n=4) ; 5.2F R-Port(Therex, U.S.A.)(n=1). The subcutaneouschambers were inserted into the infrainguinal (n=22), suprainguinal (n=6) or subclavian area(n=2). RESULTS: Theprocedure was technically successful in all 30 cases. Port catheter tips were located in the hepatic arteryproper(n=11), the right hepatic(n=9), gastroduodenal (n=6), common hepatic (n=2), inferior mesenteric (n=1) andinternal iliac artery(n=1). In 12 cases, flow was controlled using embolic coils. Follow-up study was performed in23 cases, with a mean follow up period of 55.8 (11-161) days. Complications were noted in four cases ; two wereprocedure related and two were catheter related. CONCLUSION: Intra-arterial port implantation is a safe procedureand can be performed easily by skilled radiologists; long-term observation is, however, still needed.

Efficacy of Percutaneous Transhepatic Choledochoplasty of the Biliary Stricture, Using a 16F Silastic Catheter, in Patients with Recurrent Pyogenic Cholangitis

PURPOSE: To evaluate the efficacy of percutaneous transhepatic choledochoplasty of the main biliary stricture, using a 16F silastic foley catheter, in patients suffering from recurrent pyogenic cholangitis MATERIALS AND METHODS: In nine patients who had undergone stenting procedure at the site of the main stricture after the total removal of biliary stones, a 16F silastic catheter was held in position for 1-4 (mean, 2.7) months. Using ultrasonogrophy, we assessed the diameter of the bile duct 5 cm above the main stricture. RESULTS: During the follow-up period of 1-30 (mean, 18.1) months, the diameter of the bile duct above the main stricture was, in all cases, under 3 mm. CONCLUSION: In patients with recurrent pyogenic cholangitis, choledochoplasty of the biliary stricture, using a 16F silastic catheter, was therapeutically effective.

Lymphocele Developed After Pelvic Lymphadenectomy: Treatment by Percutaneous Catheter Drainage

PURPOSE: To evaluate the efficacy of percutaneous catheter drainage for the treatment of postoperative lymphoceles following pelvic lymphadenectomy. MATERIALS AND METHODS: Between January 1995 and May 1996, 23 symptomatic lymphoceles in 20 patients who had undergone pelvic lymphadenectomy for uterine cancer were subjected to percutaneous catheter drainage under sonographic guidance. All the lymphoceles were confirmed by biochemical and cytological examination. When the amount of drainage decreased to less than 5-10ml/day and when the lymphocele was seen on US or sinography to have collapsed, the catheter was removed. US and sinography were performed to evaluate the efficacy of treatment at 1 week after catheter drainage, and all patients were followed up with US at 1, 3, and 6 months after catheter removal. RESULTS: On follow-up sonography, 20 of 23 lymphoceles (87.0%) were seen to have collapsed completely and three had recurred. Of these latter, two were treated by secondary percutaneous catheter drainage, and the other, which was asymptomatic and small, had collapsed spontaneously during the fifth months after catheter removal. Successful treatment of lymphocele was eventually achieved in all patients. The duration of catheter drainage ranged from 3 to 49 (mean, 22) days, and the size of lymphocele on initial sinogram varied from 5x4x3cm to 25x10x10cm; the total volume of drainage ranged from 300 to 17,240 (mean2,012)ml. Complications during the procedure and drainage arose in three cases. In one, there was secondary infection of the lymphocele, and in two, infection at the site of catheter insertion was seen; treatment involved changing the catheter and antibiotics. CONCLUSION: Percutaneous catheter drainage is thought to be a safe and effective alternative to surgery for the treatment of symptomatic lymphoceles following pelvic lymphadenectomy for uterine cancer.

Evaluation of the Safety of Iatrogenic Intestinal Perforation during Placement of Percutaneous Drainage Catheter in Rabbit

PURPOSE: To evaluate the safety of transgression of the bowel during intraperitoneal percutaneous catheter placement in an animal model. MATERIALS AND METHODS: Eight 8-F straight catheters were percutaneously insertedinto the small and large bowel of eight rabbits. In four animals, the catheters were left in place until autopsy, whereas in the remaining four, the catheters were withdrawn five days after insertion. Autopsy was performed inall animals ten days after catheter placement, and gross and microscopic examination was carried out. RESULTS: Transgressing the bowel during intraperitoneal percutaneous catheter placement did not contribute to any clinically significant complications. At autopsy, there was no bowel leakage, peritonitis, or abscess, although peritoneal adhesions were found around the catheter tract. CONCLUSION: Although further study is warranted, ourstudy with an animal model indicated that transgression of the intestine during percutaneous placement of an intraabdominal catheter did not produce significant complications.

Radiologic Placement of Tunneled Central Venous Catheter

PURPOSE: To evaluate the efficacy and safety of fluoroscopy-guided, radiologic placement of a tunneled central venous catheter into the superior vena cava (SVC). MATERIALS AND METHODS: Thirty five patients underwent tunneled central venous catheter placement to facilitate long-term chemotherapy. They included 33 leukemicpatients, one colon cancer patient, and one multiple myeloma patient. After confirming central venous patency witha injection of contrast media via the peripheral cephalic or basilic vein in the wrist joint, the subclavian veinwas punctured under fluoroscopic guidance. A 7F double lumen TPN catheter was placed into the SVC through asubcutaneous tunnel in the anterior chest wall. RESULTS: Catheter placements were successful in all patients. The mean procedure time was 17.2 minutes, mean fluoroscopy time was 1.3 minutes, mean number of punctures was 1.4, and mean volume of injected contrast media was 43.5 cc. Only two of all leukemic patients developed mild hematomas atthe puncture site, but these soon resolved themselves. None of the patients developed pneumothorax or hemothorax.but late complications included local infection in two patients (6%) and thrombotic occlusion of the catheter inone (3%). The occluded catheter was successfully recanalized with Urokinase infusion. CONCLUSION: Fluoroscopy-guided, radiologic placement of a tunneled central venous catheter is an easy and safe method, anduseful for patients requiring long-term venous access.