Fractura de catéter implantable con reservorio por síndrome de pinch-off / Totally implantable venous access device fracture due to pinch-off syndrome

RESUMEN La fractura y embolización de un catéter implantable con reservorio es una complicación infrecuente, pero potencialmente grave. El síndrome pinch-off fue descripto en los accesos venosos subclavios, cuando la sección del catéter se produce por la compresión intermitente entre la primera costilla y la clavícula. Informamos el caso de una paciente oncológica a quien se le colocó un catéter implantable con reservorio por acceso percutáneo ecoguiado y control radioscópico en la vena subclavia. Luego de varias sesiones de quimioterapia comenzó con mal funcionamiento del catéter; la radiografía de tórax evidenció la fractura completa del catéter a nivel del espacio costoclavicular con embolia de un fragmento a las cavidades cardíacas. Se realizó la extracción endovascular del catéter fracturado me diante lazo de nitinol por acceso percutáneo femoral, sin complicaciones. Se analizan la incidencia, los factores de riesgo y las medidas para prevenir el síndrome de pinch- off en los catéteres implantables con reservorio.

ABSTRACT Fracture and migration of totally implantable venous access devices is a rare but potentially serious complication. Pinch-off syndrome was described in subclavian venous accesses when the intermittent compression of the catheter between the first rib and the clavicle produces catheter fracture. The report the case of a patient with cancer who underwent implantation of a totally implantable venous access device through the subclavian vein under ultrasound and radioscopy guidance. After several cycles of chemotherapy, the patient started with malfunctioning of the device. The chest X-ray showed a complete fracture of the catheter at the level of the costoclavicular space with migration of a fragment of the catheter to the right cardiac chambers. The fractured catheter was percutaneously removed via the right femoral vein using nitinol gooseneck snare without complications. The incidence of the pinch-off syndrome, risk factors and prevention measures in totally implantable venous access devices are analyzed.

Pinch-Off Syndrome, a Rare Complication of Totally Implantable Venous Access Device Implantation: A Case Series and Literature Review

BACKGROUND: Pinch-off syndrome (POS) is a rare complication after totally implantable venous access device (TIVAD) implantation. In cancer patients, it is important to prevent this rare complication and to recognize it early if it does occur. We present a case series of POS after TIVAD implantation and the results of a literature search about this complication. METHODS: From July 2006 to December 2015, 924 permanent implantable central venous catheter implantation procedures were performed. The most common indication was vascular access for chemotherapy. RESULTS: POS occurred in 5 patients in our clinic. Two patients experienced POS within 2 weeks, and the other 3 patients were admitted to department of surgery, Istanbul Faculty of Medicine at 6 to 14 months following implantation. The catheters were found to be occluded during medication administration, and all patients complained of serious pain. The transected fragments of the catheters had migrated to the heart. They were successfully removed under angiography with a single-loop snare. CONCLUSION: POS is a serious complication after TIVAD implantation. It is important to be aware of this possibility and to make an early diagnosis in order to prevent complications such as drug extravasation and occlusion events.

A Retrospective Clinical Study: Complications of Totally Implanted Central Venous Access Ports

BACKGROUND: When managing patients who require repeated venous access, gaining a viable intravenous route has been problematic. To improve the situation, various studies on techniques for venous access have been conducted. The aim of this study is to evaluate the clinical results of complications following totally implanted central venous access port (TICVAP) insertion. METHODS: A retrospective analysis was conducted on 163 patients, from December 2008 to March 2013. The occurrence of complications was studied in three separate periods of catheter use: the intraoperative period, postoperative period, and period during the treatment. RESULTS: A total of 165 cases of TICVAP insertions involving 156 patients were included in the final analysis. There were 35 complications (21%) overall. Among these, 31 cases of complications (19%) occurred during the treatment period and the other 4 cases were intraoperative and postoperative complications (2%). There were no statistically significant differences in age and gender of the patients between the two groups to be risk factors (p=0.147, p=0.08). Past history of chemotherapy, initial laboratory findings, and the locations of TICVAP insertion also showed no statistical significance as risk factors (p>0.05). CONCLUSION: Because the majority of complications occurred after port placement and during treatment, meticulous care and management and appropriate education are necessary when using TICVAPs.

Ultrasound and Fluoroscopy-Guided Placement of Central Venous Ports via Internal Jugular Vein: Retrospective Analysis of 1254 Port Implantations at a Single Center

OBJECTIVE: To assess the technical success and complication rates of the radiologic placement of central venous ports via the internal jugular vein. MATERIALS AND METHODS: We retrospectively reviewed 1254 central venous ports implanted at our institution between August 2002 and October 2009. All procedures were guided by using ultrasound and fluoroscopy. Catheter maintenance days, technical success rates, peri-procedural, as well as early and late complication rates were evaluated based on the interventional radiologic reports and patient medical records. RESULTS: A total of 433386 catheter maintenance days (mean, 350 days; range 0-1165 days) were recorded. The technical success rate was 99.9% and a total of 61 complications occurred (5%), resulting in a post-procedural complication rate of 0.129 of 1000 catheter days. Among them, peri-procedural complications within 24 hours occurred in five patients (0.4%). There were 56 post-procedural complications including 24 (1.9%, 0.055 of 1000 catheter days) early and 32 (2.6%, 0.074 of 1000 catheter days) late complications including, infection (0.6%, 0.018 of 10000 catheter days), thrombotic malfunction (1.4%, 0.040 of 1000 catheter days), nonthrombotic malfunction (0.9%, 0.025 of 1000 catheter days), venous thrombosis (0.5%, 0.014 of 1000 catheter days), as well as wound problems (1.1%, 0.032 of 1000 catheter days). Thirty six CVPs (3%) were removed due to complications. Bloodstream infections and venous thrombosis were the two main adverse events prolonging hospitalization (mean 13 days and 5 days, respectively). CONCLUSION: Radiologic placement of a central venous port via the internal jugular vein is safe and efficient as evidenced by its high technical success rate and a very low complication rate.

Kinking of the Advanced Venous Access Device during Insertion of the Superior Vena Cava Cannula and the Pulmonary Artery Catheter in the Minimally Invasive Robot-assisted Cardiac Surgery: A case report / 대한마취과학회지

A 59-year-old woman was scheduled for mitral valvuloplasty and Maze operation. As operation was planed to use the robotically controlled camera (Aesop 3000, Computermotion(r), USA) for the minimally invasive robot-assisted thoracotomy, a superior vena cava (SVC) cannula (Femoral arterial cannula [21 Fr], Medtronic(r), USA) was inserted in the right internal jugular vein. After insertion of the SVC cannula, a pulmonary artery (PA) catheter (Swan-Ganz CCOmbo V [7.5 Fr], Edwards(r), USA) was inserted through an advanced venous access device (AVA 3Xi [8.5 Fr], Edwards(r), USA) in the right subclavian vein. The tip of the PA catheter could not be advanced into SVC and blood was not regurgitated. In the chest AP X-ray, it was found that the advanced venous access device was kinked by the SVC cannula. So the advanced venous access device was withdrawn about 5 cm and the PA catheter was advanced easily to the destination.