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Percutaneous Re-positioning of Dislocated Port-Catheters in Patients with Dysfunctional Central-Vein Port-Systems

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Abstract

Purpose

Observational analysis of percutaneous repositioning of displaced port-catheters in patients with dysfunctional central-venous port-systems.

Methods

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.

Results

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.

Conclusions

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.

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Conflict of interest

All authors have nothing to disclose.

Author information

Correspondence to Alexander Massmann MD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

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)

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 2 Video 2: The too soft pigtail-catheter slips off the port-catheter. (MOV 382 kb)

Supplementary material 3 Video 3: Twisting of the pigtail-catheter around the port-catheter similar to Asclepius’ rod assures stabilization and better fixation for successful repositioning. (MOV 4863 kb)

Supplementary material 4 Video 4: Snaring (covidien-ev3, goose-neck) guarantees a secure fixation of the port-catheter tip. (MOV 1329 kb)

Supplementary material 5 Video 5: After secure fixation of the port-catheter tip, the snare is gently pulled down for correction of the displaced port-catheter into the superior vena cava. Care has to be taken not to harm the port catheter by the snare. (MOV 366 kb)

Supplementary material 6 Video 6: After grasping the tip of the displaced port-catheter, the snare is gently pulled down for repositioning. (MOV 1642 kb)

Supplementary material 7 Video 7: An advanced wire-assisted long-loop repositioning technique is used for an inaccessible port-catheter tip e.g. due to wall-adherence or thrombosis of the catheter-bearing vein. A pigtail-catheter is placed over the port-catheter. A standard 0.89 mm (0.035”) tip-deflecting guidewire is advanced into the superior vena cava. The guidewire is snared and repositioning of the port-catheter is achieved by pulling down the proximal end of the guidewire together with the distal end of the guidewire that is fixated by the snare. (MOV 1684 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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Massmann, A., Jagoda, P., Kranzhoefer, N. et al. Percutaneous Re-positioning of Dislocated Port-Catheters in Patients with Dysfunctional Central-Vein Port-Systems. Ann Surg Oncol 22, 4124–4129 (2015). https://doi.org/10.1245/s10434-015-4549-5

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Keywords

  • Superior Vena Cava
  • Brachiocephalic Vein
  • Primary Technical Success
  • Endovascular Access
  • Ipsilateral Internal Jugular Vein