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.
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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)
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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
- Superior Vena Cava
- Brachiocephalic Vein
- Primary Technical Success
- Endovascular Access
- Ipsilateral Internal Jugular Vein