Totally implantable venous devices (TIVD) are increasingly being utilized for venous access for chemotherapy of oncological patients. These devices considerably improve the quality of life of patients requiring long-term chemotherapy. However, despite the great usefulness of TIVDs, their insertion and maintenance is not free of complications. Many early as well as late complications associated with these devices have been reported. We report an unusual, silent, but potentially hazardous complication of catheter fracture and cardiac migration in a 16year-old girl, in whom the port had been unused for 9 months before presentation. Percutaneous retrieval was unsuccessful as the catheter end was embedded in the myocardium. The catheter was removed via a midline sternotomy without any further complications. We have also reviewed the literature about the possible mechanism of this complication and discussed methods to recognize and avoid it.
PE occurs frequently in Indian patients with symptomatic DVT. Increasing awareness will provide us with clearer ideas about the prevalence of venous thromboembolism in Asian countries.
Regarding "Value of the duplex waveform at the common femoral artery for diagnosing obstructive aortoiliac disease"We read with interest the article the value of femoral duplex waveform for diagnosing aortoiliac arterial disease by Spronk et al. 1 Although it is known that spectral Doppler waveforms beyond a critical stenosis or occlusion may appear normal (triphasic or biphasic) at rest, they often become abnormal when reactive hyperemia is used. 2 We have a limited experience of patients (n ϭ 46) with disabling claudication in whom we used the exercise test (patients were asked to walk on level ground until initial claudication distance). We repeated the femoral duplex waveform analysis and compared it with the same at rest (unpublished data) The apparently normal waveform turned monophasic in 32 patients (70%). Out of the 46 patients, angiography was performed in 38, and the findings encountered were iliac artery diameter stenosis greater than 50% in 26 and iliac artery occlusion in 8. On correlating postexercise duplex findings with the angiography findings, we found the duplex results to be abnormal in 80% (22 of 26) of patients with iliac artery stenosis and in 88% (7 of 8) of patients with iliac occlusive disease.This limited experience also has other limitations: angiography could not be performed in eight patients for various reasons, and blinding was not used, thus raising the possibility of observer bias. However, further experience with use of adjuvant methods may provide us with more data regarding the diagnostic utility of common femoral artery duplex scanning in aortoiliac artery disease.
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