92 - Postersitzung
17. Mai 2019, 12:30 - 14:00, Bellavista 2, 6. OG
Stuck catheters: 2 cases of complex removal of Port-A-Cath
M. Martelli, S. Engelberger, G. Prouse, A. Bianchi, R. Trunfio, K. Dessì, L. Ettorre, A. Leoncini, J. Van Den Berg, L. Giovannacci, Presenter: M. Martelli (Lugano)
To present two cases of stuck Port-A-Caths (PAC) highlighting the endovascular technical challenges in this rare complication.
A 44-year old female patient with a history of multiple surgical interventions for breast cancer underwent placement of a PAC in the right subclavian vein 6 years before for chemotherapy. A 69-year old male patient with a past of intestinal cancer underwent PAC placement 5 years before in the left subclavian vein. Both patients became cancer free and there was an indication for the removal of the device. Our surgical approach consists of skin incision, subcutaneous dissection in order to release the port and to expose the catheter at the entry site at the origin of the cephalic vein. In both patients the procedure failed due to the impossibility to remove the catheter. In the first patient a CT-angiogram was performed after the failed removal, which showed a severe tortuosity of the catheter at the jugular-subclavian junction
In the angiography suite we performed an intra-luminal dilatation of the catheter with a 3,5 mm angioplasty balloon which did not allow immediate removal in the first patient. We thereafter catheterized the femoral vein to catch the tip with a snare. This procedure allowed the straightening of the catheter which was then removed from the incision in the PAC area. In the second patient there was no evidence of tortuosity and the catheter was successfully removed after the balloon dilatation of the catheter. There were no procedure related complications.
Stuck catheters in patients with long term PAC are a rare complication. Different approaches may be attempted with the endovascular options playing a crucial role. Amongst these, the intraluminal catheter dilatation with high pressure PTA balloons has the ability to break the fibrin sleeve that is responsible for the blockage and should be considered as a first attempt.