Causes of Fracture at Catheter of Totally Implantable Venous Access Port: A Systematic Review
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Abstract
A totally implantable venous access port (TIVAP) plays a crucial role in the treatment of patients in oncology. Catheter fracture is a serious complication with an estimated incidence of 0, 1% - 1%. The objective of this systematic review is to analyze the mechanism of TIVAP fracture to make physicians aware of this fatal entity. A search of the literature between 1980 and 2019 was conducted using PubMed, Ovid, MEDLINE, and Cochrane Systematic Review databases. The search identified 18 case reports and 8 retrospective studies. Fracture of the middle part of the catheter may be induced by constant compression of the catheter between the first-rib and clavicle, which is called the pinch-off syndrome. Catheter fracture at the port-catheter junction may be caused by extrinsic compression near the port-catheter junction combined with material fatigue due to repeated bending of the catheter with shoulder movement. There is no specific cause for the fracture of a catheter tip. An annual chest X-ray is recommended for the early detection of TIVAP catheter fracture. Percutaneous endovascular retrieval of a dislodged Port-A catheter is both safe and effective.
1. Yildizeli B, Lacin T, Baltacioglu F, Batirel HF, Yuksel M. Approach to fragmented central venous catheters. Vascular 2005;13:120-3.
2. Mirza B, Vanek VW, Kupensky DT. Pinch-off syndrome: Case report and collective review of the literature. Am Surg 2004;70:635-44.
3. Chang HM, Hsieh CB, Hsieh HF, Chen TW, Chen CJ, Chan DC, et al. An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases. Eur J Surg Oncol 2006;32:90-3.
4. Chang HM, Chou YC, Hsu SD, Liao GS, Chen TW, Hsieh CB, et al. Predictive Risk Factors for Fracture at Catheter of Totally Implantable Venous Access Devices via Subclavian Vein Insertion. J Med Sci 2014;34:161-5.
5. Rebahi H, El Adib AG, Mouaffak Y, El Hattaoui M, Chaara A, Sadek H, et al. Catheter fracture and pulmonary embolization of the distal fragment: A rare complication of the totally implantable venous access port. Rev Med Interne 2015;36:42-6.
6. Nagasawa Y, Shimizu T, Sonoda H, Chou H, Mekata E, Tani T. Is catheter rupture rare after totally implantable access port implantation via the right internal jugular vein. Report of a case. Surg Today 2014;44:1346-9.
7. Cortés-Flores AO, Morgan-Villela G, Juárez-Uzeta EA, Fuentes-Orozco C, Jiménez-Tornero J, González-Ojeda A. Totally implantable central venous access devices in patients with cancer. Experience at a private oncology center. Cir Cir 2012;80:429-34.
8. Doley RP, Brar P, Chaudhary S, Bedi R, Swami AC, Wig JD. Port catheter fracture and migration in Internal Jugular Vein. Am J Case Rep 2012;13:14-6.
9. Kim JT, Oh TY, Chang WH, Jeong YK. Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy. Med Oncol 2012;29:1361-4.
10. Shimizu T, Mekata E, Murata S, Yamamoto T, Tani T. A case of catheter fracture of a totally implantable access port introduced through the right internal jugular vein. J Surg Oncol 2011;103:460-1.
11. Nishinari K, Wolosker N, Bernardi CV, Yazbek G. Totally implantable ports connected to valved catheters for chemotherapy: Experience from 350 Groshong devices.
J Vasc Access 2010;11:17-22.
12. Lin CH, Wu HS, Chan DC, Hsieh CB, Huang MH, Yu JC. The mechanisms of failure of totally implantable central venous access system: Analysis of 73 cases with fracture of catheter. Eur J Surg Oncol 2010;36:100-3.
13. Wang CS, Yang CY, Chen SC, Chen HC, Huang MS. Hepatic migration of a catheter fragment followed by disconnection of a totally implantable venous access port. Int J Artif Organs 2008;31:1059-61.
14. Ghayyda SN, Roland D, Cade A. Seat belt associated central line fracture: A previously unreported complication in cystic fibrosis. J Cyst Fibros 2008;7:448-9.
15. Chang HM, Hsieh CB, Hsieh HF, Chen TW, Chen CJ, Chan DC, et al. An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases. Eur J Surg Oncol 2006;32:90-3.
16. Kapadia S, Parakh R, Grover T, Yadav A. Catheter fracture and cardiac migration of a totally implantable venous device. Indian J Cancer 2005;42:155-7.
17. Gowda MR, Gowda RM, Khan IA, Punukollu G, Chand SP, Bixon R, et al. Positional ventricular tachycardia from a fractured mediport catheter with right ventricular migration: A case report. Angiology 2004;55:557-60.
18. Schummer W, Schummer C, Schelenz C. Case report: The malfunctioning implanted venous access device. Br J Nurs 2003;12:210, 212-4.
19. Denny MA, Frank LR. Ventricular tachycardia secondary to Port-A-Cath fracture and embolization. J Emerg Med 2003;24:29-34.
20. Iannelli A, Kianmanesh R, Msika S, Marano A, Levesque M, Grandjean M, et al. Post-traumatic fracture and migration in the pulmonary artery of the catheter of a totally implantable venous access device. Unusual complication. Minerva Chir 2001;56:303-6.
21. Ferrari A, Nahas S, Maccaferri R, Malacarne P. Pinch-off syndrome and rupture of totally implanted venous access. Report of a case. Recenti Prog Med 2000;91:297-300.
22. Kock HJ, Pietsch M, Krause U, Wilke H, Eigler FW. Implantable vascular access systems: Experience in 1500 patients with totally implanted central venous port systems. World J Surg 1998;22:12-6.
23. Klotz HP, Schöpke W, Kohler A, Pestalozzi B, Largiadèr F. Catheter fracture: A rare complication of totally implantable subclavian venous access devices. J Surg Oncol 1996; 62:222-5.
24. Raungaard B, Thuesen L. Percutaneous removal of an in-situ embolised catheter fragment in a patient with Port-A-Cath. Ugeskr Laeger 1995;157:7152-3.
25. Lorenz M, Hottenrott C, Seufert RM, Encke A. A totally implantable permanent central venous access, longterm experience with subcutaneous infusion chambers. Langenbecks Arch Chir 1988;373:302-9.
26. Balsorano P, Galducci G, De Fanti I, Evans SK, De Gaudio AR, Pelagatti C. Fractures of totally implantable central venous ports: more than fortuity. A three-year single center experience. J Vasc Access. 2014, 391-5.
27. Pignataro BS, Nishinari K, Wolosker N, Bomfim GA. Fracture and migration into the coronary sinus of a totally implantable catheter introduced via the right internal jugular vein. BMJ Case Rep 2014;2014:207276.
28. Ben Kridis W, Sahnoun M, Maraoui H, Amari N, Frikha M. Fracture at catheter of totally implantable venous access port with migration into the right pulmonary artery: A serious complication. Acta Clin Belg 2016;13:1-4.
29. Ko SY, Park SC, Hwang JK, Kim SD. Spontaneous fracture and migration of catheter of a totally implantable venous access port via internal jugular vein a case report. J Cardiothorac Surg. 2016 11;11:50.
30. Lukito A, Pranata R, Huang I, Thengker A, Wirawan M. Fracture of the Port Catheter and Migration Into the Coronary Sinus: Case Report and Brief Review of the Literature Clin Med Insights Case Rep 2019;12:1179547619832282.
31. Saijo F, Mutoh M, Tokumine J, Yoshinobu O, Hama H, Namima T et al. Late fracture of Groshong ports: A report of the three cases. J Vasc Access 2019;20:563-6.
32. Nas H, Bowe D, Soubani AO. An unusual complication after placement of an inferior vena cava filter via right internal jugular vein access. J Vasc Access 2019;20:102-4.
33. Vandoni RE, Guerra A, Sanna P, et al. Randomised comparison of complications from three different permanent central venous access systems. Swiss Med Wkly 2009;139:313-6.
34. Wu CY, Fu JY, Feng PH, Kao TC, Yu SY, Li HJ, et al. Catheter fracture of intravenous ports and its management. World J Surg 2011;35:2403-10.
35. Gabelmann A, Kramer S, Gorich J. Percutaneous retrieval of lost or misplaced intravascular objects. Am J Roentgenol 2001;176:1509-13.
2. Mirza B, Vanek VW, Kupensky DT. Pinch-off syndrome: Case report and collective review of the literature. Am Surg 2004;70:635-44.
3. Chang HM, Hsieh CB, Hsieh HF, Chen TW, Chen CJ, Chan DC, et al. An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases. Eur J Surg Oncol 2006;32:90-3.
4. Chang HM, Chou YC, Hsu SD, Liao GS, Chen TW, Hsieh CB, et al. Predictive Risk Factors for Fracture at Catheter of Totally Implantable Venous Access Devices via Subclavian Vein Insertion. J Med Sci 2014;34:161-5.
5. Rebahi H, El Adib AG, Mouaffak Y, El Hattaoui M, Chaara A, Sadek H, et al. Catheter fracture and pulmonary embolization of the distal fragment: A rare complication of the totally implantable venous access port. Rev Med Interne 2015;36:42-6.
6. Nagasawa Y, Shimizu T, Sonoda H, Chou H, Mekata E, Tani T. Is catheter rupture rare after totally implantable access port implantation via the right internal jugular vein. Report of a case. Surg Today 2014;44:1346-9.
7. Cortés-Flores AO, Morgan-Villela G, Juárez-Uzeta EA, Fuentes-Orozco C, Jiménez-Tornero J, González-Ojeda A. Totally implantable central venous access devices in patients with cancer. Experience at a private oncology center. Cir Cir 2012;80:429-34.
8. Doley RP, Brar P, Chaudhary S, Bedi R, Swami AC, Wig JD. Port catheter fracture and migration in Internal Jugular Vein. Am J Case Rep 2012;13:14-6.
9. Kim JT, Oh TY, Chang WH, Jeong YK. Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy. Med Oncol 2012;29:1361-4.
10. Shimizu T, Mekata E, Murata S, Yamamoto T, Tani T. A case of catheter fracture of a totally implantable access port introduced through the right internal jugular vein. J Surg Oncol 2011;103:460-1.
11. Nishinari K, Wolosker N, Bernardi CV, Yazbek G. Totally implantable ports connected to valved catheters for chemotherapy: Experience from 350 Groshong devices.
J Vasc Access 2010;11:17-22.
12. Lin CH, Wu HS, Chan DC, Hsieh CB, Huang MH, Yu JC. The mechanisms of failure of totally implantable central venous access system: Analysis of 73 cases with fracture of catheter. Eur J Surg Oncol 2010;36:100-3.
13. Wang CS, Yang CY, Chen SC, Chen HC, Huang MS. Hepatic migration of a catheter fragment followed by disconnection of a totally implantable venous access port. Int J Artif Organs 2008;31:1059-61.
14. Ghayyda SN, Roland D, Cade A. Seat belt associated central line fracture: A previously unreported complication in cystic fibrosis. J Cyst Fibros 2008;7:448-9.
15. Chang HM, Hsieh CB, Hsieh HF, Chen TW, Chen CJ, Chan DC, et al. An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases. Eur J Surg Oncol 2006;32:90-3.
16. Kapadia S, Parakh R, Grover T, Yadav A. Catheter fracture and cardiac migration of a totally implantable venous device. Indian J Cancer 2005;42:155-7.
17. Gowda MR, Gowda RM, Khan IA, Punukollu G, Chand SP, Bixon R, et al. Positional ventricular tachycardia from a fractured mediport catheter with right ventricular migration: A case report. Angiology 2004;55:557-60.
18. Schummer W, Schummer C, Schelenz C. Case report: The malfunctioning implanted venous access device. Br J Nurs 2003;12:210, 212-4.
19. Denny MA, Frank LR. Ventricular tachycardia secondary to Port-A-Cath fracture and embolization. J Emerg Med 2003;24:29-34.
20. Iannelli A, Kianmanesh R, Msika S, Marano A, Levesque M, Grandjean M, et al. Post-traumatic fracture and migration in the pulmonary artery of the catheter of a totally implantable venous access device. Unusual complication. Minerva Chir 2001;56:303-6.
21. Ferrari A, Nahas S, Maccaferri R, Malacarne P. Pinch-off syndrome and rupture of totally implanted venous access. Report of a case. Recenti Prog Med 2000;91:297-300.
22. Kock HJ, Pietsch M, Krause U, Wilke H, Eigler FW. Implantable vascular access systems: Experience in 1500 patients with totally implanted central venous port systems. World J Surg 1998;22:12-6.
23. Klotz HP, Schöpke W, Kohler A, Pestalozzi B, Largiadèr F. Catheter fracture: A rare complication of totally implantable subclavian venous access devices. J Surg Oncol 1996; 62:222-5.
24. Raungaard B, Thuesen L. Percutaneous removal of an in-situ embolised catheter fragment in a patient with Port-A-Cath. Ugeskr Laeger 1995;157:7152-3.
25. Lorenz M, Hottenrott C, Seufert RM, Encke A. A totally implantable permanent central venous access, longterm experience with subcutaneous infusion chambers. Langenbecks Arch Chir 1988;373:302-9.
26. Balsorano P, Galducci G, De Fanti I, Evans SK, De Gaudio AR, Pelagatti C. Fractures of totally implantable central venous ports: more than fortuity. A three-year single center experience. J Vasc Access. 2014, 391-5.
27. Pignataro BS, Nishinari K, Wolosker N, Bomfim GA. Fracture and migration into the coronary sinus of a totally implantable catheter introduced via the right internal jugular vein. BMJ Case Rep 2014;2014:207276.
28. Ben Kridis W, Sahnoun M, Maraoui H, Amari N, Frikha M. Fracture at catheter of totally implantable venous access port with migration into the right pulmonary artery: A serious complication. Acta Clin Belg 2016;13:1-4.
29. Ko SY, Park SC, Hwang JK, Kim SD. Spontaneous fracture and migration of catheter of a totally implantable venous access port via internal jugular vein a case report. J Cardiothorac Surg. 2016 11;11:50.
30. Lukito A, Pranata R, Huang I, Thengker A, Wirawan M. Fracture of the Port Catheter and Migration Into the Coronary Sinus: Case Report and Brief Review of the Literature Clin Med Insights Case Rep 2019;12:1179547619832282.
31. Saijo F, Mutoh M, Tokumine J, Yoshinobu O, Hama H, Namima T et al. Late fracture of Groshong ports: A report of the three cases. J Vasc Access 2019;20:563-6.
32. Nas H, Bowe D, Soubani AO. An unusual complication after placement of an inferior vena cava filter via right internal jugular vein access. J Vasc Access 2019;20:102-4.
33. Vandoni RE, Guerra A, Sanna P, et al. Randomised comparison of complications from three different permanent central venous access systems. Swiss Med Wkly 2009;139:313-6.
34. Wu CY, Fu JY, Feng PH, Kao TC, Yu SY, Li HJ, et al. Catheter fracture of intravenous ports and its management. World J Surg 2011;35:2403-10.
35. Gabelmann A, Kramer S, Gorich J. Percutaneous retrieval of lost or misplaced intravascular objects. Am J Roentgenol 2001;176:1509-13.
| Files | ||
| Issue | Vol 57, No 12 (2019) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/acta.v57i12.3463 | |
| Keywords | ||
| Totally implantable venous access port Fracture Mechanism Oncology Pinch off syndrome | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ben Kridis W, Toumi N, Khanfir A. Causes of Fracture at Catheter of Totally Implantable Venous Access Port: A Systematic Review. Acta Med Iran. 2020;57(12):686-689.
