Document Detail

Catheter rupture and distal embolisation: a rare complication of central venous ports.
MedLine Citation:
PMID:  17638217     Owner:  NLM     Status:  In-Data-Review    
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.
R Biffi; F Orsi; F Grasso; F De Braud; S Cenciarelli; B Andreoni
Related Documents :
2120467 - Abgs and arterial lines: the relationship to unnecessarily drawn arterial blood gas sam...
16155377 - Unusual complication of central venous catheter in hemodialysis.
9437697 - Central venous catheter access.
3523927 - Venous access techniques.
7841957 - The affinity of bopindolol and its two metabolites for a beta 2-adrenoceptor in the bov...
22391407 - Cervical carotid artery stenosis: latest update on diagnosis and management.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of vascular access     Volume:  1     ISSN:  1129-7298     ISO Abbreviation:  J Vasc Access     Publication Date:  2000  
Date Detail:
Created Date:  2007-07-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100940729     Medline TA:  J Vasc Access     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  19-22     Citation Subset:  -    
Division of General Surgery, European Institute of Oncology, Milano - Italy.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Vascular access for chronic haemodialysis in Lombardy.
Next Document:  Percutaneous intravascular retrieval of embolised fragments of long-term central venous catheters.