Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-29T14:35:57.417Z Has data issue: false hasContentIssue false
  • English
  • Français

Port-a-Cath fracture and migration in paediatric cancer patients: incidence and management at a tertiary care centre – a 15-year experience

Published online by Cambridge University Press:  22 June 2020

Amr Elgehiny Open the ORCID record for Amr Elgehiny [Opens in a new window] ,
Khaled Ghanem ,
Haytham Bou Hussein ,
Mohamed Ahmed ,
Mostafa Abohelwa ,
Mohsen Aboelella ,
Mohamed Mohamed ,
Fadi Bitar Open the ORCID record for Fadi Bitar [Opens in a new window] ,
Miguel Abboud  and
Samir Akel
...Show all authors
Amr Elgehiny
Affiliation:
Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Khaled Ghanem
Affiliation:
Children’s Cancer Institute, Beirut, Lebanon
Haytham Bou Hussein
Affiliation:
Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Mohamed Ahmed
Affiliation:
Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Mostafa Abohelwa
Affiliation:
Department of Internal medicine, American University of Beirut Medical Center, Beirut, Lebanon
Mohsen Aboelella
Affiliation:
Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Mohamed Mohamed
Affiliation:
Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Fadi Bitar
Affiliation:
Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Miguel Abboud
Affiliation:
Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Samir Akel
Affiliation:
Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
Aghiad Al-Kutoubi
Affiliation:
Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
Ghina Fakhri
Affiliation:
Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
Mariam Arabi*
Affiliation:
Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
*
Author for correspondence: Mariam Arabi, MD, Director of In and Outpatient Clinical Services, Head, Fetal Heart Program-Children’s Heart Center, Department of Pediatrics of Adolescent Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh1107 2020, Beirut, Lebanon. Tel: +961 1 374374x5872/5881/5889; Fax: +961 1 370781. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Port-a-Cath or chemoport provides prolonged central venous access for cancer patients requiring prolonged chemotherapy. Prolonged use of chemoport is associated with many complications. Dislodgement and migration of chemoport catheter is a rare and reportable complication with potentially serious consequences.

Methods:

The medical charts of 1222 paediatric cancer patients admitted to the Children’s Cancer Center in Lebanon who had chemoports inserted for long-term chemotherapy were retrospectively reviewed. Descriptive analysis of data was conducted.

Results:

Chemoport fracture and migration were found in seven cases with an incidence of 0.57%. The duration of chemoport use before the event of dislodgement varied from 2 months to 102 months. Non-functioning chemoport was the most common presentation. Totally, six cases were managed successfully by loop snaring, three cases by paediatric cardiology team, and three cases by interventional radiology team. One case was managed surgically during chemoport removal.

Conclusion:

Fracture and migration of chemoport catheter is a rare complication of uncertain aetiology and with potentially serious consequences. Percutaneous retrieval, done by experienced cardiologist or interventional radiologist, is the first choice for management of this complication as it is considered as a safe and effective approach.

Keywords

Port-a-Cathchemoportfracturemigrationpaediatricscancer
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 7 , July 2020 , pp. 986 - 990
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aparna, S, Ramesh, S, Appaji, L, et al.Complications of chemoport in children with cancer: experience of 54,100 catheter days from a tertiary cancer center of Southern India. South Asian J Cancer 2015; 4: 143.Google ScholarPubMed
Niederhuber, J, Ensminger, W, Gyves, J, Liepman, M, Doan, K, Cozzi, E. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery 1982; 92: 706–712.Google ScholarPubMed
Freytes, CO, Reid, P, Smith, KLLong-term experience with a totally implanted catheter system in cancer patients. J Surg Oncol 1990; 45: 99–102.CrossRefGoogle ScholarPubMed
Poorter, R, Lauw, F, Bemelman, W, Bakker, P, Taat, C, Veenhof, C. Complications of an implantable venous access device (Port-a-Cath®) during intermittent continuous infusion of chemotherapy. Eur J Cancer 1996; 32: 2262–2266.10.1016/S0959-8049(96)00274-2CrossRefGoogle Scholar
Binnebösel, M, Grommes, J, Junge, K, Göbner, S, Schumpelick, V, Truong, S. Internal jugular vein thrombosis presenting as a painful neck mass due to a spontaneous dislocated subclavian port catheter as long-term complication: a case report. Cases J 2009; 2: 7991.10.4076/1757-1626-2-7991CrossRefGoogle ScholarPubMed
Torramade, J, Hernández, J, Cienfuegos, J, et al.Implantable devices for central venous access in cancer patients. Our experience in 217 cases. Med Clin 1992; 98: 731–733.Google ScholarPubMed
Al-Hathal, M, Malmfors, G, Garwicz, S, Békéssy, AN. Port-a-Cath in children during long-term chemotherapy: complications and outcome. Pediatric Hematol Oncol 1989; 6: 17–22.CrossRefGoogle ScholarPubMed
Robinson, M, Halverson, P. Port-a-Cath: a study of complication rates. South Dakota J Med 1991; 44: 187–190.Google ScholarPubMed
Wang, S-C, Tsai, C-H, Hou, C-P, et al.Dislodgement of port-A catheters in pediatric oncology patients: 11 years of experience. World J Surg Oncol 2013; 11: 191.CrossRefGoogle Scholar
Faraj, W, Zaghal, A, El-Beyrouthy, O, Kutoubi, A. Complete catheter disconnection and migration of an implantable venous access device: the disconnected cap sign. Ann Vasc Surg 2010; 24: 692.e11–692.e15.CrossRefGoogle ScholarPubMed
Çilingiroğlu, M, Akkuş, Nİ. Embolization of a PORT-A-CATH device in the main pulmonary artery and its percutaneous extraction in a patient with pinch-off syndrome. Turk Kardiyol Dern Ars 2012; 40: 162–164.10.5543/tkda.2012.01821CrossRefGoogle Scholar
Cheng, C-C, Tsai, T-N, Yang, C-C, Han, C-L. Percutaneous retrieval of dislodged totally implantable central venous access system in 92 cases: experience in a single hospital. Eur J Radiol 2009; 69: 346–350.CrossRefGoogle Scholar
Ribeiro, RC, Monteiro, ÁCF, Menezes, QC, Schettini, ST, Vianna, SMR. Totally implantable catheter embolism: two related cases. Sao Paulo Med J 2008; 126: 347–349.CrossRefGoogle ScholarPubMed
Wassef, AW, Kass, M, Parmar, G, Ravandi, A. An unusual cause of ventricular tachycardia: port-A-Cath fracture and embolization into the pulmonary artery. Heart Int 2014; 9: 30.CrossRefGoogle ScholarPubMed
Gowda, MR, Gowda, RM, Khan, IA, et al.Positional ventricular tachycardia from a fractured mediport catheter with right ventricular migration: a case report. Angiology 2004; 55: 557–560.CrossRefGoogle ScholarPubMed
Ho, C-L, Chou, C-M, Chang, T-K, Jan, S-L, Lin, M-C, Fu, Y-CDislodgment of port-A-Cath catheters in children. Pediatr Neonatol 2008; 49: 179–182.CrossRefGoogle ScholarPubMed
Ballarini, C, Intra, M, Ceretti, AP, et al.Complications of subcutaneous infusion port in the general oncology population. Oncology 1999; 56: 97–102.CrossRefGoogle ScholarPubMed
Biffi, R, De Braud, F, Orsi, F, et al.Totally implantable central venous access ports for long-term chemotherapy: a prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days. Ann Oncol 1998; 9: 767–773.CrossRefGoogle ScholarPubMed
Charvat, J, Linke, Z, Horaekova, M, Prausova, JImplantation of central venous ports with catheter insertion via the right internal jugular vein in oncology patients—single center experience. Support Care Cancer 2006; 14: 1162–1165.CrossRefGoogle Scholar
Vlasveld, L, Rodenhuis, S, Rutgers, E, et al.Catheter-related complications in 52 patients treated with continuous infusion of low dose recombinant interleukin-2 via an implanted central venous catheter. Eur J Surg Oncol 1994; 20: 122–129.Google ScholarPubMed
Babu, R, Spicer, R. Implanted vascular access devices (ports) in children: complications and their prevention. Pediatr Surg Int 2002; 18: 50–53.CrossRefGoogle ScholarPubMed
Dillon, PA, Foglia, RP. Complications associated with an implantable vascular access device. J Pediatr Surg 2006; 41: 1582–1587.CrossRefGoogle ScholarPubMed
Plumhans, C, Mahnken, AH, Ocklenburg, C, et al.Jugular versus subclavian totally implantable access ports: catheter position, complications and intrainterventional pain perception. Eur J Radiol 2011; 79: 338–342.CrossRefGoogle ScholarPubMed
Wu, P-Y, Yeh, Y-C, Huang, C-H, Lau, H-P, Yeh, H-M. Spontaneous migration of a port-a-Cath catheter into ipsilateral jugular vein in two patients with severe cough. Ann Vasc Surg 2005; 19: 734–736.CrossRefGoogle ScholarPubMed
Tsai, T-N, Han, C-L, Lin, W-S, et al.Transcatheter retrieval of dislodged Port-A catheter fragments: experience with 47 cases. Acta Cardiolog Sin 2006; 22: 221–228.Google Scholar
Karam, AR, Hourani, MH, Al-Kutoubi, AO. Catheter fracture and migration into the coronary sinus—an unusual migration site: case report and review. Clin Imag 2009; 33: 140–143.CrossRefGoogle Scholar
Dillon, PA, Foglia, RP. Complications associated with an implantable vascular access device. J Pediatr Surg 2006; 41: 1582–1587.CrossRefGoogle ScholarPubMed
Kirvelä, O, Satokari, K. In situ breakage of a totally implanted venous access system. J Parent Enteral Nutr 1989; 13: 99–101.CrossRefGoogle ScholarPubMed
Liu, J-C, Tseng, H-S, Chen, C-Y, Chern, M-S, Chang, C-Y. Percutaneous retrieval of 20 centrally dislodged Port-A catheter fragments. Clin Imag 2004; 28: 223–229.CrossRefGoogle ScholarPubMed
Mirza, B, Vanek, VW, Kupensky, DT. Pinch-off syndrome: case report and collective review of the literature. Am Surg 2004; 70: 635–644.Google ScholarPubMed
D’Angelo, F, Ramacciato, G, Caramitti, A, et al. [Totally implantable venous access systems. Analysis of complications]. Minerva Chirurg 1997; 52(–): 937–942.Google ScholarPubMed
Yedlicka, JW Jr, Carlson, J, Hunter, D, Castañeda-Zúñiga, W, Amplatz, K. Nitinol gooseneck snare for removal of foreign bodies: experimental study and clinical evaluation. Radiology 1991; 178: 691–693.CrossRefGoogle ScholarPubMed
Behrend, M, Paboura, E, Raab, R. Late embolization of an unfractured port catheter into the heart: report of a case. Surg Today 2002; 32: 724–726.CrossRefGoogle ScholarPubMed
Aitken, DR, Minton, JP. The “pinch-off sign”: a warning of impending problems with permanent subclavian catheters. Am J Surg 1984; 148: 633–636.CrossRefGoogle ScholarPubMed