|
|
| Journal of Vascular Access 2000; 1: 19 - 22 |
| Catheter rupture and distal embolisation: a rare complication of central venous ports |
R. Biffi1, F. Orsi2, F. Grasso2, F. De Braud3, S. Cenciarelli1, B. Andreoni4
1Division of General Surgery, European Institute of Oncology, Milano - Italy
2Radiology, European Institute of Oncology, Milan - Italy
3Medical Oncology, European Institute of Oncology, Milan - Italy
4Division of General Surgery, European Institute of Oncology, Milan - Italy
|
|
|
|
Search Medline for articles by:
 R. Biffi
F. Orsi
F. Grasso
F. De Braud
S. Cenciarelli
B. Andreoni
|
|
 Printable Format (PDF)
|
|
|
|
|
|
|
ABSTRACT
Central venous access devices placed through a percutaneous subclavian approach may be compressed by neighbouring bony structures, leading to biomaterial fatigue, catheter fracture at the compression site, and possible embolisation of distal fragment into the central veins. The aim of this paper is to review the experience of the authors, including more than 1300 subclavian port placements, carried out during a five-year period, discussing possible causes and therapeutic options of this rare complication. Nine patients out of 1320 (0.68%) experienced this complication during the five-year period of this study. Two patients only showed a retrospective radiologic evidence of the “pinch-off sign” (e.g. initial compression of the catheter at the costo-clavicular junction). No patients had symptoms from the embolised catheter fragment; the most frequent symptom (8 out of 9 cases) was a painful swelling around the port area during infusion, related to the extravasation of medications or fluids into the subcutaneous tissue. The site of embolised segment varied from azygos vein to
right pulmonary artery; however, these findings did not affect the outcome, and all the embolised fragments were successfully retrieved through a transfemoral approach using a radiologic interventional technique. No fatality occurred.
The catheter fracture and embolisation of the distal fragment are a well-known complication of subclavian central venous long-term cannulation, whose estimated overall incidence is 0.5-1%. Diagnosis is usually based on the radiologic appearance of the catheter compression (so called “pinch-off sign”), which is far from being constant; a clinical suspicion can derive from intermittent malfunction, which claims differential diagnosis with the pres-ence
of a fibrin sleeve around the tip of the catheter. Once diagnosed, the treatment is always an interventional radiologic approach, which has a very high success rate. When it fails, the possibility to leave the fragment embolised in the central veins, heart or pulmonary arteries, should be considered, being the thoracotomy and open
catheter retraction questionable, at present time, in patients who have no symptoms and limited life-expectancy.
Key Words. Central venous catheters, Ports, Pinch-off syndrome, Catheter embolization
null
REFERENCES
|
|
