A Spectrum of Chemoport-Associated Complications and Their Management in Cancer Patients.

INTRODUCTION: Chemotherapy is part and parcel of the multimodality approach to cancer treatment. Chemoports are frequently used to administer chemotherapy, preventing complications associated with the use of peripheral lines. However, chemoports have their own set of complications and can be very debilitating at times. Accurate knowledge and correct technique can help prevent and manage these complications properly. METHODS: We retrospectively analyzed all patients who underwent chemoport insertion for chemotherapy infusion over three years between July 2020 and June 2023. The patient's profile, type of cancer, the technique of chemoport insertion, complications related to chemoport, and its management were recorded retrospectively from patient records. RESULTS: The total number of patients in our study was 119. The age group of patients ranged from 13 years to 76 years. Of the 119 patients, 55 had breast cancer, 23 had ovarian cancers, 29 had GI cancers including gastroesophageal junction (GEJ)/ stomach/periampullary/colorectal, and 12 had leukemias. The most common intraoperative complication was catheter tip malposition (9.2%). The most common postoperative complications were infection (7.5%), followed by drug extravasation (5.0%), thrombosis (3.3%), wound dehiscence (2.5%), and skin necrosis (0.8%) in decreasing order of frequency. Serious complications such as hemothorax, pneumothorax, air emboli, brachial plexus injury, and pericardial tamponade, commonly reported in the literature, were not seen in any of our cases. CONCLUSION:  Totally implanted venous access devices (TIVAD)/chemoports are indispensable in the management of cancer patients, especially in patients requiring long duration of infusion and prolonged treatment. Although chemoports are associated with a spectrum of complications, proper technique of implantation and use makes it a safe and reliable tool.

Impact of insertion into the left internal jugular vein in chemoport-associated infections: a retrospective single-center study of 1690 cases.

We analyzed chemoport insertion procedures to evaluate infectious morbidity and factors causing infection. This single-center retrospective study included 1690 cases of chemoport implantation between January 2017 and December 2020. Overall, chemoports were inserted in 1582 patients. The average duration of chemoport use was 481 days (range 1-1794, median 309). Infections occurred in 80 cases (4.7%), with 0.098 per 1000 catheter-days. Among the 80 cases in which chemoports were removed because of suspected infection, bacteria were identified in 48 (60%). Significantly more cases of left internal jugular vein punctures were noted in the infected group (15 [18.8%] vs. 147 [9.1%]; p = 0.004). Pulmonary embolism was significantly different between the infection groups (3 [3.8%] vs. 19 (1.2%), p = 0.048). The hazard ratio was 2.259 (95% confidence interval [CI] 1.288-3.962) for the left internal jugular vein, 3.393 (95% CI 1.069-10.765) for pulmonary embolism, and 0.488 (95% CI 0.244-0.977) for chronic obstructive pulmonary disease. Using the right internal jugular vein rather than the left internal jugular vein when performing chemoport insertion might reduce subsequent infections.

Vertebral Venous Congestion That May Mimic Vertebral Metastasis on Contrast-Enhanced Chest Computed Tomography in Chemoport Inserted Patients.

OBJECTIVE: This study aimed to determine the prevalence of vertebral venous congestion (VVC) in patients with chemoport insertion, evaluate the imaging characteristics of nodular VVC, and identify the factors associated with VVC. MATERIALS AND METHODS: This retrospective single-center study was based on follow-up contrast-enhanced chest computed tomography (CT) of 1412 adult patients who underwent chemoport insertion between January 2016 and December 2016. The prevalence of venous stenosis, reflux, and VVC were evaluated. The imaging features of nodular VVC, including specific locations within the vertebral body, were analyzed. To identify the factors associated with VVC, patients with VVC were compared with a subset of patients without VVC who had been followed up for > 3 years without developing VVC after chemoport insertion. Toward this, a multivariable logistic regression analysis was performed. RESULTS: After excluding 333 patients, 1079 were analyzed (mean age ± standard deviation, 62.3 ± 11.6 years; 540 females). The prevalence of VVC was 5.8% (63/1079), with all patients (63/63) demonstrating vertebral venous reflux and 67% (42/63) with innominate vein stenosis. The median interval between chemoport insertion and VVC was 515 days (interquartile range, 204-881 days). The prevalence of nodular VVC was 1.5% (16/1079), with a mean size of 5.9 ± 3.1 mm and attenuation of 784 ± 162 HU. Nodular VVC tended to be located subcortically. Forty-four patients with VVC underwent CT examinations with contrast injections in both arms; the VVC disappeared in 70% (31/44) when the contrast was injected in the arm contralateral to the chemoport site. Bevacizumab use was independently associated with VVC (odds ratio, 3.45; P < 0.001). CONCLUSION: The prevalence of VVC and nodular VVC was low in patients who underwent chemoport insertion. Nodular VVC was always accompanied by vertebral venous reflux and tended to be located subcortically. To avoid VVC, contrast injection in the arm contralateral to the chemoport site is preferred.

Clinical Safety and Efficiency of the H-Port for Treatment of Leptomeningeal Metastasis.

Objective: To evaluate the usefulness of a cranial implantable chemoport, the H-port, as an alternative to the Ommaya reservoir for intraventricular chemotherapy/cerebrospinal fluid (CSF) access in patients with leptomeningeal metastasis (LM). Methods: One hundred fifty-two consecutive patients with a diagnosis of LM and who underwent H-port installation between 2015 and 2021 were evaluated. Adverse events associated with installation and intraventricular chemotherapy, and the rate of increased intracranial pressure (ICP) control via the port were evaluated for safety and efficacy. These indices were compared with published data of Ommaya (n=89), from our institution. Results: Time-to-install and installation-related complications of intracranial hemorrhage (n=2) and catheter malposition (n=5) were not significantly different between the two groups. Intraventricular chemotherapy-related complications of CSF leakage occurred more frequently in the Ommaya than in the H-port group (13/89 vs. 3/152, respectively, p<0.001). Intracranial hemorrhage during chemotherapy occurred only in the Ommaya group (n=4). The CSF infection rate was not statistically different between groups (14/152 vs. 12/89, respectively). The ICP control rate according to reservoir type revealed a significantly higher ICP control rate with the H-port (40/67), compared with the Ommaya result (12/58, p<0.001). Analyzing the ICP control rate based on the CSF drainage method, continuous extraventricular drainage (implemented only with the H-port), found a significantly higher ICP control rate than with intermittent CSF drainage (33/40 vs. 6/56, respectively, p<0.0001). Conclusion: The H-port for intraventricular chemotherapy in patients with LM was superior for ICP control; it had equal or lower complication rates than the Ommaya reservoir.

The External Jugular Vein Cut-Down Method for Chemoport Insertion from a Tertiary Cancer Treatment Center in Central India: A Prospective Study.

INTRODUCTION: In the realm of oncology, the development of TIVAD (chemoport) has been a blessing for cancer patients, freeing them from having to undergo numerous recurrent venepunctures throughout their treatment. The External Jugular Vein cut-down has been the standard procedure for administering chemotherapy to cancer patients at our institution. Here, we discuss our experience with the External Jugular Vein cut-down Chemoport Insertion Technique and the outcomes it produced. MATERIALS AND METHODS: We performed a prospective observational study and included all patients who underwent the open External Jugular Vein cut-down technique of Chemoport Insertion from January 2019 to January 2022 in the Department of Surgical Oncology at our hospital. RESULTS: Out of 136 patients, 3 (2.2%) had failed external jugular vein (EJV) cannulation, and alternative access (Internal Jugular Vein) was chosen for cannulation. The most common indication for chemoport insertion in our study was carcinoma of the breast, around 72.93% (97/133), and hence the majority of patients were females, about 84.21% (112/133). Only 18.04% (24/133) were male patients. The age distribution ranged from 2 years to 84 years. Out of 133 patients, complications were observed in 14 patients (10.52%). Around 6 patients (4.5%) had problems with catheter blockage after one cycle of chemotherapy. 4 patients (3%) had port infections at the chamber region (pectoral region). 3 patients (2.2%) had catheter tip displacement into the brachiocephalic vein. 1 patient (0.75%) had extravasation of chemotherapy. CONCLUSION: In conclusion, our study demonstrates that the External Jugular Vein cut-down technique offers several advantages in the realm of oncology, as it is a safe, efficient, and straightforward technique for chemoport insertion. With its minimal learning curve and simplicity, this technique represents a favorable initial option for successfully implanting chemoports in cancer patients. Further research and comparative studies are needed to validate and further explore the benefits of this technique in diverse patient populations and healthcare settings.

Improvement in Care and Maintenance of Port-A-Cath Following the Introduction of Care" Bundle.

Background: Port-a-cath is a type of indwelling central venous catheter used to manage pediatric patients who require long-term intravenous therapy. Objectives: The objective of this study was to improve the care and maintenance of port-a-cath among the nursing staff by introducing a care bundle. Materials and Methods: Pretraining and posttraining designs using PDSA (Plan, Do, Study, Act.) model were followed. We observed two sets of 30 procedures for accessing of port-a-cath by the nursing staff. Following the initial 30 observations of port-a-cath handling, a "care bundle" was designed as per the set standards of the maintenance of port-a-cath. It involved education and training and live audio-visual sessions. Two months after the initiation of the care bundle, the second set of 30 procedures was observed. Results: Following the introduction of the care bundle, the observed efficacy on obtaining verbal consent improved to 100% from 83%, arrangement of drugs and instruments before insertion to 100% from 90%, not touching the needle while inserting from 60%, administration of adequate amount saline flush from 83.3% (25/30), heparin administration from 71.1%, and looking out for signs of extravasation to 100% from 80%. Two nursing staff involvement improved from 23% to 63%. A 100% efficacy in the management of nonbleeding back scenarios was observed. The cross-checking of drug expiry improved from an initial 26.6% to 89.3%. The port-a-cath infections have significantly come down (3 vs. 0) (P < 0.05). Conclusion: Implementation of a "care bundle" has significantly improved the quality of handling of port-a-cath and reduction in infections.

Doxorubicin Extravasation from a Port-a-cath into Pleural Space in a Young Girl: A Case Report and Review of Literature.

Extravasation of chemotherapeutic agents from a peripheral cannula is a known problem, and to prevent that, oncology units use central vein access with indwelling catheters such as port-a-cath or Hickman catheter. The intrapleural extravasation of chemotherapeutic agents is a rare event. We describe a 9-year-old girl with newly diagnosed Ewing's sarcoma of the left upper humerus receiving neoadjuvant chemotherapy through a newly inserted port-a-cath device. The patient developed tachypnea and right-sided chest pain on day 2 of chemotherapy. The radiological investigations confirmed the extravasation of doxorubicin into the pleural space. The surgical washout with chest-drain insertion was done, and we continued flushing with normal saline until the drain fluid became clear. She has completed neoadjuvant therapy. This case report shines light into scenarios where extravasation of anthracycline into the pleural cavity or thorax can be managed conservatively and in settings where dexrazoxane is unavailable without causing much delay in restarting the chemotherapy.

External Jugular Venous Cutdown versus Percutaneous Technique for Chemoport Insertion in Children: A Comparative Study.

Aims: We aimed to compare the external jugular vein (EJV) cutdown technique with the percutaneous technique for difficulties in insertion, maintenance, and other complications of chemoport placement in children. Materials and Methods: A retrospective study was carried out in children who underwent chemoport insertion between January 2007 and December 2019 either by EJV cutdown or percutaneous technique in the department of pediatric surgery at a tertiary center. All children aged <18 years undergoing chemoport insertion by EJV cutdown or percutaneous technique were included in the study. Data collected included the indication, procedure time, early and late complications, and the time to removal of chemoport. Results: There was no significant difference between the EJV group and the percutaneous group in terms of the time taken for chemoport placement (40.9 ± 7.6 min vs. 37.6 ± 18.9 min; P = 0.14), failure to cannulate (one vs. six; P = 0.05), and the mean chemoport indwelling days (816.8 ± 729.2 days vs. 854.5 ± 705.1 days; P = 0.73). The chemoport placement by EJV cutdown method was found to have significantly fewer overall complications (4 vs. 14; P = 0.01) and a lesser rate of premature chemoport removal (4 vs. 12; P = 0.04) compared to the percutaneous group. Conclusions: Chemoport placement by the EJV cutdown was found to have fewer port-related complications and a lesser rate of premature chemoport removal compared to the percutaneous technique. The time taken for port placement and the mean chemoport-indwelling days were similar in both techniques.

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.

Successful recovery of central venous catheter fragment from coronary venous sinus and right ventricle: A case report.

Catheter fracture with subsequent embolization is a well known but a potentially serious late complication of central venous catheter placement. Central venous catheters are frequently implanted for the purpose of chemotherapy and parenteral nutrition. Most common vein used for the placement of central venous catheter is subclavian vein. According to case reports, catheter placed in subclavian vein is vulnerable for fracture and is often preceded by the "pinch-off sign", first described by Aikten and Minton. It is due to shearing forces between the clavicle and first rib. Broken catheter frequently embolises to Right atrium, Right Ventricle, Inferior vena cava, Pulmonary arteries and rarely into Coronary sinus. Migration to Coronary sinus is very uncommon and only 5 cases are reported in the literature as of now. We are presenting an unusual case where chemoport catheter severed and lodged partly in coronary venous sinus and partly in right ventricle taking a "U "shape. Fragment was successfully retrieved percutaneously using a snare after straightening it with a pigtail catheter. Though majority of patients deny symptoms however, some do have symptoms or complications. Catheter fragment can lead to arrhythmias, thrombosis, infection and perforation. Thrombosis of coronary sinus is a life threatening complication. Regular follow up with Chest x ray may recognize the fracture and embolization much earlier. In almost all cases the migrated portion can be retrieved safely percutaneously without recourse to surgery.

Chemoport Insertion-Less Is More.

Implantable chemoport is a very useful device for long-term venous access for infusion of chemotherapeutic drugs and other agents. There are few studies from resource poor countries reporting complications of chemoport. The aim of the present study is to evaluate the feasibility of chemoport insertion without image guidance and by closed technique without direct visualisation of a major vein (mainly IJV) and to study the complications associated with the procedure. This was a prospective observational study which analysed 263 patients who underwent chemoport insertion. The medical records of these patients were analysed for the patient characteristics, diagnosis, port-related complications, and their management. A total of 263 patients who were harbouring either locoregionally advanced or metastatic tumour requiring either chemotherapy or targeted treatment or both were included in the study. In total, 133 (50.57%) were female patients and 130 were male patients (49.43%). A total of 236 patients (89.73%) underwent port insertion procedures under local anaesthesia. None of the patients had any major intra-operative complications. Postoperatively, 4 patients (1.52%) were found to have port catheter malposition; 3 out of this 4 were corrected under IITV guidance as a second procedure under local anaesthesia only. One patient (0.38%) required formal removal and replacement of port. Four patients (1.52%) developed IJV thrombosis requiring port removal and anti-coagulation. One patient (0.38%) developed thrombus in the right atrium. There were 2 port site infections (0.74%) requiring port removal (SSI cat. 5). Low complication rates of port insertion were observed in the present, large, prospective study. Complication rates may be further reduced by using a well-designed procedure, experienced surgeons, an aseptic environment, ultrasound-guided puncture, and fluoroscopy with contrast media. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13193-020-01265-6.

Totally Implantable Venous Access Device (Chemoport) in Oncology: Study of 168 Polyurethane Chemoport Catheter System.

Background Chemoport (totally implantable venous access device) and its catheter system are used to administer long-term chemotherapy in cancer patients. The objective of this study was to analyze the complications associated with chemoport insertion in various cancer patients. Material and Methods A total number of 168 chemoports along with polyurethane catheters were inserted in various cancer patients over a period of 3 years. 9.6 F polyurethane catheters were put by a team of surgical oncologists in operation theater under general or local anesthesia. Analysis of the complications was done until the chemoport was removed due to any reason. Results Out of 168 patients, 30 (17.85%) developed complications. Complications included arterial puncture, malposition of the catheter tip, pneumothorax, hematoma, seroma, deep vein thrombosis, fracture of the catheter, a reversal of port, infections, and thrombosis of the catheter. Only a few required premature port and catheter removal. Conclusion There was a low rate of complications associated with chemoport using a polyurethane type of catheter system. However, infection-related complications were comparatively more common in our series. Chemoport requires expert handling, patient education, strict follow-up, and dedicated teamwork to minimize complications.

Implantable Venous Access Devices in Pediatric Malignancies - Institutional Experience in a Developing Nation.

BACKGROUND: Implantable venous access devices (IVAD) are preferred over long term external catheters in children due to less infection rates and better patient compliance in pediatric malignancies. Use of IVAD is a routine practice in developed part of the world. However it needs more emphasis for its widespread use in developing nation in order to improve the quality of care in children with malignancy. AIMS AND OBJECTIVES: We aimed at analyzing the outcome of IVAD in pediatric malignancies in a tertiary care set up of developing nation. Our objective is to enlighten the importance and feasibility of IVAD in childhood malignancies with review of literature. MATERIALS AND METHODS: There were 152 children who underwent IVAD insertion in the study period. The parameters analyzed were indications, patient demography, size of the port, laterality of insertion, method of access to internal jugular vein (IJV), duration of surgery, time for access, complications, indication for removal and the parental satisfaction. RESULTS: Mean age was 48 months. 112/152 patients had hematological malignancies. Right sided IJV was used by default in 97.4% patients, while remaining 2.6% had their left IJV cannulated. Open venotomy was used in 14 cases and 138 underwent ultrasound guided IJV access. The position of the catheter was reconfirmed in the X-ray, 6-8 hours after surgery. 149/152 ports were accessed 12 hours after surgery, whereas remaining 3 had a delay in access for 24 hours. Post operative complications were divided into early and late. 141 ports were removed after completion of chemotherapy, 4 were removed due to complications. 93 of parents gave the response as "satisfied". CONCLUSION: With proper training and expertise, insertion and care of IVAD is safe in pediatric malignancies without significant complications.

Chemoport-associated Complications and Its Management.

Chemoport is being routinely used to administer chemotherapy, blood, blood products, total parenteral nutrition, and also to draw blood for investigations. We started using chemoport in our institute. We use it exclusively to administer chemotherapy. We analyzed our results of chemoport usage and confirm that the rate of complications associated with chemoport usage is at par with the available literature. We also conclude that with regular use, the intra-op and post-op complications will reduce further.

External Jugular Cutdown Technique for Totally Implantable Venous Access Devices: a Single-Centre Study.

Chemotherapy drugs are the integral part of cancer treatment. Their administration is optimized by central venous access devices. We present our prospective study of chemoport implantation by external jugular vein cutdown technique. We studied 100 patients who underwent chemoport insertion over a span of 3 years for various solid and haematological malignancies via external jugular vein cutdown method. Outcomes such as type of disease, anaesthesia, choice of venous access, catheter tip position, length of the procedure, time to start chemotherapy and morbidity data were analysed. The Hundred /100 intravenous devices were implanted in 66% females and 33% males. Most common indication was breast cancer (64% of patients). A total of 80% of patients underwent procedure under local anaesthesia. Chemoports were inserted on the right side in 84 and left side in the remaining 16. The average surgical time was 32 min. The overall success rate was 97% with no intraoperative complications. Three postoperative complications were encountered due to displacement of catheter or wound infection. External jugular vein cutdown approach is a safe, reliable method for venous access device implantation. This approach has a high success rate and has minimal complications and can be easily learnt.

Port-a-Cath fracture and migration in paediatric cancer patients: incidence and management at a tertiary care centre - a 15-year experience.

INTRODUCTION: Port-a-Cath or chemoport provides prolonged central venous access for cancer patients requiring prolonged chemotherapy. Prolonged use of chemoport is associated with many complications. Dislodgement and migration of chemoport catheter is a rare and reportable complication with potentially serious consequences. METHODS: The medical charts of 1222 paediatric cancer patients admitted to the Children's Cancer Center in Lebanon who had chemoports inserted for long-term chemotherapy were retrospectively reviewed. Descriptive analysis of data was conducted. RESULTS: Chemoport fracture and migration were found in seven cases with an incidence of 0.57%. The duration of chemoport use before the event of dislodgement varied from 2 months to 102 months. Non-functioning chemoport was the most common presentation. Totally, six cases were managed successfully by loop snaring, three cases by paediatric cardiology team, and three cases by interventional radiology team. One case was managed surgically during chemoport removal. CONCLUSION: Fracture and migration of chemoport catheter is a rare complication of uncertain aetiology and with potentially serious consequences. Percutaneous retrieval, done by experienced cardiologist or interventional radiologist, is the first choice for management of this complication as it is considered as a safe and effective approach.

Bacteremia due to Rahnella aquatilis in a Patient with a Chemoport.

Rahnella aquatilis, a saprophytic organism, is a member of the Enterobacteriaceae family. The natural habitat of this organism is fresh water, and it is rarely found in clinical specimens. Clinical conditions ascribed to this organism include bacteremia, respiratory infection, urinary tract infection, wound infection in an immunocompromised host, and infective endocarditis in patients with congenital heart diseases. Here, we report a case of bacteremia due to R. aquatilis in a woman with breast cancer who had received chemotherapy through a chemoport. To our knowledge, this is the second case of bacteremia caused by this organism in a patient with cancer in Korea.

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.

Wound complications after chemo-port placement in children: Does closure technique matter?

PURPOSE: Wound dehiscence after chemo-port placement is a rare but potentially significant complication. We hypothesize that by using a simple running skin closure technique during chemo-port placement the rate of wound dehiscence and overall wound complications can be significantly decreased. METHODS: IRB approval was obtained and patients <18years that received a tunneled central line with port from June 2012 to April 2016 were analyzed. Data collected on patients included patient demographics, skin closure type, and wound complications within 30days. Chi-square was performed to examine the univariate association with skin closure technique and wound dehiscence. Logistic regression was performed to examine the multivariable association between skin closure type and wound dehiscence and to compute odds ratios. RESULTS: There were 259 ports placed in this cohort: 125 used simple running skin closure technique, and 134 used the subcuticular skin closure. Patients were found to not have any difference in rate of dehiscence or overall wound complications based on gender, age, location of port, or use of steroids or chemotherapy within 1week of port placement. When compared, only 1 case (0.80%) in the simple running group vs 10 cases (7.46%) in the subcuticular group experienced a wound dehiscence [unadjusted OR=14.07 (1.69, 116.99) p=0.0144]. When comparing overall wound complications the simple running group had 3 (2.4%) versus 12 (8.96%) in the subcuticular group [unadjusted OR=4.78 (1.27, 17.94) p=0.0203]. When adjusting for port-number both dehiscence and overall wound complications remained statistically significant. CONCLUSION: We conclude that the simple running skin closure for chemo-port placement in children has superior outcomes in regards to prevention of dehiscence and overall wound related complications when compared to the subcuticular technique.

Endovascular retrieval of foreign body in persistent left-sided superior vena cava.

Endovascular retrieval of a foreign body is becoming an increasingly common procedure in the management of complications resulting from more frequent endovascular procedures. Many procedures are performed on a regular basis in assessment of vascular anatomy, endovascular-guided therapy, and catheter placement. This case report depicts a complication of a chemoport placement resulting in a foreign body. Evaluation of the foreign body raised attention to aberrant anatomy, a persistent left-sided superior vena cava. We further discuss briefly the embryology behind a persistent left-sided superior vena cava, technical errors leading to the foreign body, and assessing the nature of the foreign body through different imaging modalities. This is followed by the subsequent endovascular retrieval by Interventional Radiology and a literature review and individual case assessment of endovascular foreign body retrieval. We discuss considerations for practice based upon our literature review.