Difficult removal of totally implantable venous access devices in adult patients: Incidence, risk factors, and management.

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.

Evaluation of the degree of pancreatic fatty infiltration by area-based assessment of CT images: comparison with histopathology-based and CT attenuation index-based assessments.

PURPOSE: The purpose of this study was to evaluate the degree of fatty infiltration (FI) of the pancreas using area-based assessment on computed tomography (CT) (CT area-based assessment) in its correlation and agreement/concordance with histopathology-based assessment. Furthermore, we examined whether CT area-based assessment was better than CT attenuation index-based assessment. MATERIALS AND METHODS: We retrospectively evaluated the degree of FI of the pancreas in 37 pancreatic cancer patients who had undergone preoperative CT and pancreaticoduodenectomy. The degree of FI of the pancreas was examined by histopathology-based assessment using surgical resection samples, and CT area-based and CT attenuation index-based assessments. RESULTS: Mean values of pancreatic FI measured by area-based assessment on unenhanced CT and by histopathology-based assessments were 14.4 ± 23.2 % (range 0-77.7 %) and 16.2 ± 17.4 % (range 0.2-60.2 %), respectively. Area-based assessment on unenhanced CT showed higher correlation and concordance with histopathology-based assessment, demonstrating a Spearman correlation coefficient of 0.78 (P < 0.0001) and a Kendall's tau-b coefficient of 0.69 (P < 0.0001). For CT attenuation index-based assessment, the corresponding values were -0.66 (P < 0.0001) and -0.39 (P = 0.008), respectively. CONCLUSIONS: To order/categorize subjects according to the degree of FI of the pancreas, CT area-based assessment is suggested to be better than CT attenuation index-based assessment.