Percutaneous Re-positioning of Dislocated Port-Catheters in Patients with Dysfunctional Central-Vein Port-Systems
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Observational analysis of percutaneous repositioning of displaced port-catheters in patients with dysfunctional central-venous port-systems.
A total of 1061 patients with dysfunctional venous pectoral port-systems were referred for port-angiography. Dislocated port-catheters were identified in 37 (3.5 %) patients (11 males, mean age 58.1 ± 7.2 [range 48–69] years; 26 females, 57.0 ± 13.5 [range 24–75] years) 3.9 ± 6.6 months (range 1 day–26 months) after port-implantation. Percutaneous repositioning in all patients was performed by transfemoral catheter maneuvers, snaring, or wire-assisted long-loop snaring. Primary endpoint was successful repositioning. Safety endpoints included port-damage or procedure-related complications. Follow-up encompassed routine clinical and radiological controls, including chest X-ray or computed tomography for 12.9 ± 17.9 (range 1–81) months.
Clinical signs of port-dysfunction due to dislocation of port-catheters included difficult aspiration in 23 (62.2 %), resistance or inability to inject in 17 (46.0 %), and pain during injection in 2 (5.4 %) patients. Primary technical success for repositioning displaced port-catheters was 97.3 % (36/37 patients). In 1 (2.7 %) patient, repositioning failed due to complete embedding of the port-catheter in an extensive chronic jugular vein thrombosis (Paget-von-Schroetter syndrome) that prevented endovascular access to the port-catheter. Redisplacement occurred after initial successful repositioning: immediately in two patients due to a too short port-catheter (two-tailed Fisher’s exact-test, p = 0.0101), and in two patients with appropriate catheter-length after 5, resp. 7 months. No procedure-associated complications, e.g., port-catheter disconnection or disruption, occurred.
Repositioning of dysfunctional displaced central-venous port-catheters with appropriate catheter-length is safe and effective. Even challenging conditions, e.g., wall-adherent port-catheter tip or a thrombosed catheter-bearing vein are feasible. Repositioning of too short port-catheters is ineffective.
KeywordsSuperior Vena Cava Brachiocephalic Vein Primary Technical Success Endovascular Access Ipsilateral Internal Jugular Vein
Conflict of interest
All authors have nothing to disclose.
Supplementary material 1 Video 1: The displaced port-catheter is hooked by a 100 cm 5F-pigtail-catheter and then gently pulled down for repositioning of the port-catheter into the superior vena cava. (MOV 3558 kb)
Supplementary material 8 Video 8: Upper extremity ab- and adduction combined with Valsalva-manoeuver and forceful coughing is used to verify a stable position of the corrected port-catheter. (MOV 1616 kb)
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