Catheter-tip fixation of a percutaneously implanted port-catheter system to prevent dislocation

Abstract

The aim of this study was to evaluate the incidence of catheter tip dislocation in patients with percutaneously implanted port-catheters for hepatic arterial chemotherapy with catheter tip fixation. Forty-seven patients (31 men and 16 women; mean age 66 years) with unresectable advanced liver cancers (primary liver cancer, n=19; metastatic liver cancer, n=28) underwent percutaneously implantable port-catheter system placement with the tip fixed at the gastroduodenal artery with coils and side hole opened at the common hepatic artery. In 39 patients, n-butyl cyanoacrylate (NBCA) mixed with Lipiodol was added for fixation. The position of the side hole after the indwelling port-catheter system was investigated, and the correction method in cases with catheter dislocation was determined. In 2 (25%) of the 8 patients without NBCA fixation, dislocation of the catheter was noted, in contrast to none (0%) of 37 patients with NBCA fixation. Two patients in whom NBCA was used could not undergo long-term intra-arterial chemotherapy because of hepatic arterial thrombotic occlusion which occurred after placement of the indwelling catheter, and were excluded from the evaluation. Fixation of the catheter tip with combined use of coils and NBCA--Lipiodol mixture to the gastroduodenal artery is important to prevent dislocation of the port-catheter system.

Guidelines for the use of NBCA in vascular embolization devised by the Committee of Practice Guidelines of the Japanese Society of Interventional Radiology (CGJSIR), 2012 edition

“…In addition, NBCA has been indicated for arterial redistribution and hepatic arterial catheter fixation during hepatic arterial infusion chemotherapy [68,159,180,181]. In the venous system, retrospective studies examining the use of NBCA for percutaneous transhepatic portal venous embolization have also been reported [19,45,48,49,77], and there have been several studies about the use of NBCA for pelvic congestion syndrome and varicoceles [27,65,109,157].…”

“…The injection should be stopped when blood flow arrests or undesirable migration of the NBCA into the distal portion of the target vessel, the spilling of NBCA along the catheter tip, severe symptoms, or other risky situations occur [13,16,134,141]. (5) The catheter should be retracted immediately after the injection of NBCA to avoid inadvertent adherence to the surrounding vascular tissue [61,116,125,130,181]. Syringe aspiration is acceptable in order to induce negative pressure in the catheter to prevent NBCA migration during the removal of the catheter [46,96].…”

“…NBCA has also been occasionally used to fix the tips of indwelling catheters in place during hepatic arterial infusion chemotherapy [173,181]. Operators should keep in mind that the blood flow of the target vessel can change dramatically after or during the use of other embolic materials.…”

J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system

“…Complications vary depending on the technique and the approach. Dislocation is one major problem and occurs in between 0 [5] and 36% [18,19] of cases. The frequency of dislocation appears to be particularly high when the axillary or brachial artery is used [10,19,20].…”

“…Until now, regional treatment was performed by means of a catheter placed surgically in the hepatic artery, after isolation of the gastroduodenal artery, and then connected to a reservoir placed in a subcutaneous pocket [2]. Recently, radiologic placement of subcutaneous, implantable chest ports has become accepted because it compares favorably with surgical placement [3,4,5]; however, placement in the subclavian artery exposes the patient to the small but potentially lethal risks of pneumothorax, hemothorax, cerebral embolism [6], numbness of the arm [7], arterial dissection, and hematoma.…”