Cardiac Migration of Chemoport Catheter-A Rare Complication: Review of Literature and Our Experience.

Chemoport devices are commonly used for the administration of chemotherapeutic medication in cancer patients and can also be used for total parenteral nutrition and long term intravenous therapy. They are usually inserted through the internal jugular vein or the subclavian vein. The common complications of the procedure include pneumothorax, bleeding, arrhythmia and venous thrombosis. One of the rare complications of chemoport is catheter fracture/dislodgement and subsequent migration, with an incidence of 0.1-2.1%. Other rare complications are vascular erosion and embolization, vocal cord palsy and mediastinal hematoma. The aims and objectives are as follows: (1) to report a rare case of chemoport catheter migration between the right ventricle and pulmonary artery and (2) to review the literature on the rare complication of cardiac migration of a chemoport. A 56-year-old lady, known case of carcinoma right breast, post modified radical mastectomy was advised adjuvant chemotherapy. A chemoport catheter was placed in the right internal jugular vein and was positioned over the left upper chest. The 1st cycle of chemotherapy was given through chemoport and was uneventful. On the second chemotherapy schedule, catheter dysfunction was found. For the same, she was evaluated with chest radiography, which showed the migrated catheter in the heart. The migrated catheter was retrieved by snare technique using percutaneous transvenous route. The procedure was uneventful. The literature on the topic was reviewed. Chemoport catheter fracture or dislodgement and its subsequent cardiac migration are a rare but serious complication. High index of suspicion in case of catheter dysfunction, early detection by chest radiography, and timely multi-disciplinary intervention is crucial.

A rare pinch-off case embolized to the pulmonary artery.

The pinch-off syndrome is defined as the embolization of the central catheter inserted via the subclavian approach due to the mechanical compression between the clavicle, the first rib, the subclavius muscle, and the costoclavicular ligament. Embolization to the pulmonary artery is an extremely rare condition. In this article, we present a rare case with ovarian cancer who had multiple metastases both locally and lungs, the port catheter was fractured into three parts, the proximal part was removed, the middle part was left between the subclavian vein and the skin, and the long distal part was embolized to the pulmonary artery.

Successful percutaneous transvenous approach for pinch-off syndrome: a case report.

Background: Pinch-off syndrome is a rare late complication characterized by the occurrence of spontaneous fracture and embolization of a port-a-cath implanted via subclavian venous access. It may lead to serious cardiovascular outcomes. Case presentation: We report a successful percutaneous transvenous removal of intravascular fractured port catheter embolized into the right ventricle by using the 'lasso' technique in an 85-year-old man with type B non-Hodgkin lymphoma undergoing chemotherapy and long estimated life expectancy. Discussion: Knowledge of pinch-off syndrome among physicians is essential for early intervention, thereby preventing adverse events. Percutaneous approach seems an effective, safe, and simple procedure.

Spontaneous rupture of chemotherapy catheter diagnosed using chest X-ray oblique projections: An interventional radiology approach.

Totally implanted central venous port systems are widely used to access central veins for patients needing long-term therapy. These devices have low rates of complications and are commonly used to administer medications like chemotherapeutic agents. Spontaneous rupture of a catheter segment is a rare mechanical complication, usually belatedly diagnosed and presenting with complications. We present a case of a spontaneously ruptured chemotherapy catheter diagnosed using a novel approach via oblique projections on chest X-rays and successfully removed using an endovascular approach.

Chemoport Fracture due to Catheter Pinch Off Syndrome: A Rare Complication of Subclavian Vein Approach Revisited.

Chemoports are routinely used for administering chemotherapeutic agents, drugs, blood, and blood products. Chemoport insertion is associated with inherent complications. Fracture of chemoport due to pinch off syndrome is a rare life-threatening complication. We report our experience of fracture chemoport in patients with carcinoma breast and its management. We also present a detailed review of literature about this complication, clinical features, warning signs, diagnostic workup, management, and prevention. From a prospectively maintained database of chemoport insertion patients, a retrospective analysis was done from 2017 to 2020. During this period, the incidence of fracture chemoport was evaluated and their management. Out of 560 chemoport insertions, there were 3 patients with chemoport fracture, with an incidence of 0.5%. All the three patients were hemodynamically stable, with no clinical signs of pulmonary embolism. The chemoports were non-functional and on radiologic evaluation fracture of chemoport with embolization of distal segment was demonstrated. All the patients were managed by retrieval of the embolized catheters by a snare and removal of port chambers under local anesthesia. Choose internal jugular vein over subclavian vein for placing central venous access devices. When subclavian vein is chosen, point of entry should be lateral part of costochondral space. The incidence of chemoport fractures is 0.5% which present as non-functioning chemoports. Identify pinch off sign, especially with an upright check X-ray after chemoport placement. Consider repositioning of chemoport if pinch off sign is present.

A delayed complication of a port-a-cath insertion via subclavian venous access: Case report of a "pinch-off syndrome".

INTRODUCTION: Port-a-caths are long-stay central catheters often used for chemotherapy or parenteral nutrition. The implantation of a port-a cath, despite being involved in routine procedures, is also associated with immediate and delayed complications. Complications are rare but must be known and managed by operators. CASE REPORT: A delayed complication related to the presence of a port-a-cath, consisting in the fragmentation of the catheter, has been reported, in a 63-years-old female patient. The port was placed via subclavian venous access and affected by pinch-off syndrome, which resulted in catheter malfunction and then in fragmentation from compression by the subclavius-costoclavicular complex. The onset symptom was device malfunction. DISCUSSION AND CONCLUSION: The focus in the management of this rare but possible complication was the quick removal of the device and of the catheter fragment in the endovascular lumen with collaboration between different medical specialists.

Detachment and embolization of totally implantable central venous access devices: diagnosis and management.

BACKGROUND: Detachment and embolization (DE) is a rare complication of totally implantable central venous access devices (TIVADs). This study aimed to analyze clinical findings, etiology, and treatment options in DE of TIVADs. METHODS: Patients who experienced DE between 2010-2019 were included. Indications, implantation techniques, time to diagnosis, patient complaints, diagnostic methods, rupture site, location of embolization, treatment methods, and chest X-rays prior to detachment were analyzed retrospectively. RESULTS: DE of TIVAD was detected in 12(1.2%) patients. Eleven patients had breast cancer and one had colon cancer. Mean age at implantation was 45.3 ± 9.6(31-61.3) years. Seven (58%) patients were asymptomatic, four (33.3%) had TIVAD malfunction, and one (8.3%) had pain and swelling at port site after injection. Mean time from implantation to diagnosis was 1149.92(16-2795) days. The etiologies comprised Pinch-off Syndrome (POS) in eight (66%) patients, detachment directly adjacent to the lock mechanism in three (25%) patients, and probable iatrogenic injury during explantation in one (9%) patient. The most common site of embolism was the superior vena cava (25%). While the embolized fragment was removed percutaneously in 11 patients, medical follow-up was treatment choice for one patient. CONCLUSIONS: DE is a rare complication with an incidence rate of 1.2% in this study. Since most patients were asymptomatic, chest radiography plays an important role in diagnosis. The most common cause was POS, and it can be prevented by inserting the catheter from lateral third of the clavicle during subclavian vein catheterization. The first-choice treatment was percutaneous femoral retrieval. However, if not technically possible, alternative treatment options are thoracotomy or follow-up with anticoagulant therapy.

Pinch-off syndrome from a chemoport catheter successfully managed with endovascular retrieval.

INTRODUCTION AND IMPORTANCE: A totally implantable venous access device (TIVAD), also referred to as 'chemoport', is frequently used for oncology patients. Chemoport insertion via the subclavian vein access may compress the catheter between the first rib and the clavicle, resulting in pinch-off syndrome (POS). The sequela includes catheter transection and subsequent embolization. It is a rare complication with incidence reported to be 1.1-5.0% and can lead to a devastating outcomes. CASE PRESENTATION: 50-year-old male had his chemoport inserted for adjuvant chemotherapy 3 years ago. During the removal, remaining half of the distal catheter was not found. There was no difficulties during the removal. Chest xray revealed that the fractured catheter had embolized to the right ventricle. Further history taking, he did experienced occasional palpitation and chest discomfort for the past six months. Electrocardiogram and cardiac enzymes were normal. Urgent removal of the fractured catheter via the percutaneous endovascular approach, under fluoroscopic guidance by an experience interventional radiologist was done. The procedure was successful without any complication. Patient made an uneventful recovery. He was discharged the following day, and was well during his 3rd month follow up. CONCLUSION: Early detection and preventive measures can be done to prevent pinch-off syndrome. Unrecognized POS can result in fatal complications such as cardiac arrhythmia and septic embolization. Retrieval via the percutaneous endovascular approach provide excellent outcome in the case of embolized fractured catheter.

Totally implantable venous access ports: A prospective randomized study comparing subclavian and internal jugular vein punctures in children.

BACKGROUND AND OBJECTIVES: Totally implantable venous access ports (TIVAPs) are essential in children who require long-term intermittent intravenous therapy. METHODS: Patients who needed to undergo TIVAP implantation were randomly assigned to the internal jugular vein group or the subclavian vein group. The medical histories, operative details and major complications from the time of port implantation to 48 h after port removal were collected. During the use of TIVAPs, satisfaction surveys were regularly conducted for the children and guardians and compared in the two groups. RESULTS: A total of 216 patients in the subclavian vein group and 199 patients in the internal jugular vein group were included. TIVAPs were successfully implanted in all children. The incidence of postoperative venous access occlusion in the subclavian vein group and internal jugular vein group was 1.5% and 5%, respectively, and the difference was statistically significant (P < 0.05). The average satisfaction score of the children and guardians in the subclavian vein group was 9.6 ±â€¯0.3, and that in the internal jugular vein group was 8.3 ±â€¯0.8. There was a significant difference between the 2 groups (P < 0.05). CONCLUSIONS: Subclavian vein should be the first choice for TIVAP implantation in children. THE LEVEL OF EVIDENCE RATING: Treatment study level I.

Managing chemotherapy extravasation in totally implantable central venous access: Use of subcutaneous wash-out technique.

BACKGROUND: Totally implanted venous access is widely used in chemotherapy administration. With over 1 million intravenous chemotherapy infusions given worldwide each day, complications are frequent. Accidental cases of extravasation in the presence of a catheter are rare yet very serious and may require discontinuation of chemotherapy. The aim of this study was to evaluate the feasibility and efficacy of the subcutaneous wash-out technique for chemotherapy extravasation treatment. METHODS: We retrospectively reviewed the medical charts of patients who had received chemotherapy and sustained extravasation in our hospital between October 2013 and October 2016. Subcutaneous wash-out treatments were carried out exclusively, without the application of antidotes or the use of specific antidotes. RESULTS: We documented seven cases of chemotherapy extravasation. Two cases were treated with antidotes and suffered necrosis in the following weeks. The five patients treated using subcutaneous wash-out had no necrosis and had a steady decrease in the inflammatory reaction of the cutaneous and subcutaneous soft tissues. For these five patients, chemotherapy was restarted within 1 month following extravasation. CONCLUSION: This study would argue for the feasibility and effectiveness of subcutaneous wash-out in the treatment of chemotherapy extravasations.

Fracture and embolization of an implantable venous access device in patient with atrial septal defect.

Totally implantable venous access devices (TIVADs) are frequently used for the administration of chemotherapy or parenteral nutrition and have proved to be safe and improve patient quality of life during treatment. Catheter-related infections are the most common complication, whereas catheter fracture and embolization is rarely seen. We present a case of a 61-year-old cancer patient in which the TIVAD fractured and embolized to the patient's left knee 18 months after its initial placement. An endovascular procedure with intraoperative imaging revealed that the catheter had embolized to the popliteal artery and was successfully removed, the only explanation being the presence of an atrial septal defect. A bubble echocardiogram was unsuccessful in confirming the diagnosis. The catheter fracture could be related to an intravascular procedure that was performed 18 months prior to remove fibrin sheaths as a cause of port malfunction, or it could be a case of pinch-off syndrome.

Endovascular management of the peripherally inserted central venous catheter iatrogenic pinch-off syndrome: A case report.

The recent increase in the number of patients with implanted peripherally inserted central catheters (PICCs) requires physicians to be familiar with rare and unusual complication-pinch-off syndrome (POS). We present a case of a 40-years-old female with human epidermal growth factor receptor type 2 (HER2)-positive breast cancer and implanted Groshong PICC (BARD). The patient was admitted for an elective chest and abdomen CT angiography control after finishing her trastuzumab and paclitaxel chemotherapy course a month earlier. Immediately after the contrast media power injection, the PICC line was embolized to the right segmental pulmonary artery. Due to the low complications rate and early patient ambulation percutaneous foreign body retrieval is a primary option for the pinch-off syndrome, especially in frail, and vulnerable cancer patients. This case underscores the feasibility and safety of percutaneous venous interventions in patients with embolized venous infusion devices.

Catheter Fracture of Subclavian Venous Chemoport Device at Costoclavicular Junction: Pinch-off Syndrome.

Chemoport is most commonly used venous access devices for instillation of chemotherapeutic drugs in cancer care. Mechanical complications like catheter fracture can lead to serious morbidity, albeit occurring rarely. We present a case of a 35-year-old lady, a case of carcinoma breast, who had spontaneous fracture of chemoport access device in subclavian vein at the level of clavicle after four successful cycles of chemotherapy. The fracture was suspected on chest x-ray and was subsequently confirmed on contrast linogram. The patient was successfully managed with endovascular interventional technique without suffering any ill effects. It is a rare presentation of pinch-off syndrome.

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.

Fracture and atypical migration of an implantable central venous access device.

Distal embolization of a fractured indwelling central catheter is a rare complication. The pinch-off syndrome (POS) should be known, prevented and early detected. We present a case in which further radiological exams were required to find the fragmented catheter with an atypical migration, requiring local surgery for removing. After chest and abdominal CT scan, neck X-ray, and heart echography, the catheter was found on the lower limbs X-ray on the internal side of right knee corresponding to a location of saphenous vein. Implanted catheters should be removed after completion of treatment and the integrity of the system should be monitored. To avoid POS, a catheter must be inserted into the subclavian vein as laterally as possible.

Chest pain due to Pinch-off syndrome: radiological findings and endovascular rescue.

Port-a-cath is widely used as a route for administration of drugs in hematology and oncology patients and, recently, has been adapted also for hemodialysis patients. Major complications include infection, thrombosis, arrhythmia, and embolization. The Pinch-off-syndrome (POS) means the clavicle and the first rib compress the long-term central venous catheter. The reported incidence rate ranges from 1.4% to 4.1%. This syndrome can be recognized on chest radiography by observing a thinning of the catheter lumen through the passage between the clavicle and the first rib. Catheter fracture is a rare but potentially life-threatening complication that must be recognized and treated promptly. Management of dislodged ports includes percutaneous transcatheter retrieval, open thoracotomy retrieval and oral anticoagulant therapy. Among these techniques, percutaneous transcatheter retrieval is an easy, safe and efficient method. We report the successful percutaneous endovascular retrieval of dislodged intracardiac catheter, separated from its port, in a 58 year-old male patient who presented with chest pain.

Pinch-off syndrome.

Subclavian venous catheterization was previously frequently performed, but because of life-threatening complications such as hemothorax, pneumothorax, mediastinal hematoma, and myocardial injury, its use has become less common. However, this practice has some advantages in patient mobility, secured dressing, and rapidity and adequacy of vascular access. In some situations where patient comfort is an especially important consideration, such as with totally implantable venous port insertion for chemotherapy, the subclavian route can be a good choice if an experienced and well-trained faculty is available. The authors have had recent experience with pinch-off syndrome-in other words, spontaneous catheter fracture-in 3 patients who had undergone venous port implantation through the right subclavian route. Through these cases, we intend to review the dangers of subclavian venous catheterization, the causes of pinch-off syndrome, and its clinical presentation, progress, treatments, and prevention.