Abstract
Implantation of subcutaneous port systems is routinely performed in patients requiring repeated long-term infusion therapy. Ultrasound- and fluoroscopy-guided implantation under local anesthesia is broadly established in interventional radiology and has decreased the rate of complications compared to the surgical approach. In addition, interventional radiology offers the unique possibility of simultaneous management of venous occlusion. We present a technique for recanalization of central venous occlusion and angioplasty combined with port placement in a single intervention which we performed in two patients. Surgical port placement was impossible owing to occlusion of the superior vena cava following placement of a cardiac pacemaker and occlusion of multiple central veins due to paraneoplastic coagulopathy, respectively. In both cases the affected vessel segments were dilated with balloon catheters and the port systems were placed thereafter. After successful dilatation, the venous access was secured with a 25-cm-long, 8-Fr introducer sheath, a subcutaneous pocket prepared, and the port catheter tunneled to the venipuncture site. The port catheter was introduced through the sheath with the proximal end connected to a 5-Fr catheter. This catheter was pulled through the tunnel in order to preserve the tunnel and, at the same time, allow safe removal of the long sheath over the wire. The port system functioned well in both cases. The combination of recanalization and port placement in a single intervention is a straightforward alternative for patients with central venous occlusion that can only be offered by interventional radiology.
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Krupski G, Froschle GW, Weh FJ, Schlosser GA (1995) Central venous access devices in treatment of patients with malignant tumors: venous port, central venous catheter and Hickman catheter. Cost-benefit analysis based on a critical review of the literature, personal experiences with 135 port implantations and patient attitude. Chirurg 66(3):202–207
Flacke S, Standop J, Lohmaier S (2006) Transhepatic establishment of a port catheter system. Rofo 178(4):438–439
Kariya S, Tanigawa N, Kojima H, Komemushi A, Shomura Y, Ha-Kawa SK, Tokuda T, Kamata M, Sawada S (2009) Percutaneous translumbar inferior vena cava cannulation under computed tomography guidance. Jpn J Radiol 27(4):176–179
Meyer F, Buerger T, Gebauer T, Halloul Z (2002) Unusual implantation site of a port-a-cath system via the right femoral vein. J Cancer Res Clin Oncol 128(7):400–401
Irving JD, Dondelinger RF, Reidy JF, Schild H, Dick R, Adam A, Maynar M, Zollikofer CL (1992) Gianturco self-expanding stents: clinical experience in the vena cava and large veins. CardioVasc Interv Radiol 15(5):328–333
Smayra T, Otal P, Chabbert V, Chemla P, Romero M, Joffre F, Rousseau H (2001) Long-term results of endovascular stent placement in the superior caval venous system. CardioVasc Interv Radiol 24(6):388–394
Morris SL, Jaques PF, Mauro MA (1992) Radiology-assisted placement of implantable subcutaneous infusion ports for long-term venous access. Radiology 184(1):149–151
Gebauer B, El Sheik M, Vogt M, Wagner HJ (2009) Combined ultrasound and fluoroscopy guided port catheter implantation—high success and low complication rate. Eur J Radiol 69(3):517–522
Cil BE, Canyigit M, Peynircioglu B, Hazirolan T, Carkaci S, Cekirge S, Balkanci F (2006) Subcutaneous venous port implantation in adult patients: a single center experience. Diagn Interv Radiol 12(2):93–98
Maurer MH, Beck A, Hamm B, Gebauer B (2009) Central venous port catheters: evaluation of patients’ satisfaction with implantation under local anesthesia. J Vasc Access 10(1):27–32
Peynircioglu B, Canyigit M, Ergun O, Pamuk GA, Cil BE (2007) Radiologically placed venous ports in children. J Vasc Interv Radiol 18(11):1389–1394
Kostopoulou V, Tsiatas ML, Kelekis DA, Dimopoulos MA, Papadimitriou CA (2009) Endovascular stenting for the management of port-a-cath associated superior vena cava syndrome. Emerg Radiol 16(2):143–146
Bodner LJ, Nosher JL, Patel KM, Siegel RL, Biswal R, Gribbin CE, Tokarz R (2000) Peripheral venous access ports: outcomes analysis in 109 patients. CardioVasc Interv Radiol 23(3):187–193
Haller C, Deglise S, Saucy F, Mathieu C, Haesler E, Doenz F, Corpataux JM, Qanadli SD (2009) Placement of hemodialysis catheters through stenotic or occluded central thoracic veins. CardioVasc Interv Radiol 32(4):695–702
Sauter A, Triller J, Schmidt F, Kickuth R (2008) Treatment of superior vena cava (SVC) syndrome and inferior vena cava (IVC) thrombosis in a patient with colorectal cancer: combination of SVC stenting and IVC filter placement to palliate symptoms and pave the way for port implantation. CardioVasc Interv Radiol 31(Suppl 2):S144–S148
Miller JH, McBride K, Little F, Price A (2000) Malignant superior vena cava obstruction: stent placement via the subclavian route. CardioVasc Interv Radiol 23(2):155–158
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We thank the technicians Britta Scheubach and Katrin Madeja for their help.
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Krombach, G.A., Plumhans, C., Goerg, F. et al. Central Vein Dilatation Prior to Concomitant Port Implantation. Cardiovasc Intervent Radiol 33, 362–366 (2010). https://doi.org/10.1007/s00270-009-9699-z
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DOI: https://doi.org/10.1007/s00270-009-9699-z