Pinch-off syndrome: a complication of implantable subclavian venous access devices.

Abstract

Implantable central venous access devices placed via the subclavian vein may become obstructed by thrombosis, impingement against a vein wall, or compression between the clavicle and first rib. The latter has been termed pinch-off syndrome (POS). Eleven patients with POS were studied, including one whose catheter had fractured and one whose catheter had fragmented. They were compared with 22 matched control patients and 100 consecutive routine clinic patients. Each catheter was graded: 0 = normal, 1 = abrupt change in course with no luminal narrowing, 2 = luminal narrowing, and 3 = complete catheter fracture. POS was present in most (eight of 11) cases within 3 weeks after placement. A grade 1 catheter was common (33%) among control subjects, but grades 2 and 3 were uncommon (1%). Catheter fracture or fragmentation was seen in two of five cases with long-term (greater than 3 weeks) pinching (grade 2 catheter). The following conclusions were reached: Grade 2 represents significant catheter compression and the potential for serious complications. Grade 1 is of uncertain clinical significance, due to its high prevalence in control subjects.

Central venous catheter pinch-off and fracture: recognition, prevention and management

“…3,4 A rare but serious complication is catheter fragmentation with subsequent embolization through the heart into the pulmonary artery occurring in approximately 40% of patients who develop the possible precursor warnings of catheter fragmentation, the so-called pinchoff sign described by Aitken and Minton in 1984. [5][6][7] As long-term indwelling, CVCs have often become the patient's lifeline and are used with increasing frequency worldwide, we report a representative case of our own experience and summarize the current literature on this specific topic in order to emphasize preventive practice guidelines.…”

“…Although the large variety of catheter complications 3,4,7,8 and their impact on catheter function are well documented in the literature, catheter fragmentation with subsequent embolization is an event reported only sporadically (Table 1; 7,[9][10][11][12][13][14][15][16][17][18][19] ). Reviewing our experience with 763 percutaneously inserted soft silicon catheters (Hickman catheters and implantable port-a-caths) from 1992 to 2000 we identified catheter fragmentation in only the one patient described here (0.13%).…”

“…The clinical symptomatology is typically recognized earlier in catheters used for highvolume or continuous infusions than in catheters used for intermittent infusions or for low-volume, continuous 24-h infusions as well as in catheters used more frequently. 9 Although a radiographic grading of the pinch-off syndrome (grade 0-3) was proposed many years ago, 7 it is not incorporated into daily clinical practice. Pinch-off syndrome grade 0 is charcterized by normal catheter lines, grade 1 by an abrupt change in course without luminal narrowing, grade 2 by luminal narrowing and grade 3 by a complete catheter fracture.…”

“…In the latter position the catheter caliber is known to return to normal with consequently restored fluid flow. 7 Radiographic follow-up of long-term infraclavicular indwelling CVCs should generally be performed routinely to avoid diagnosis of pinch-off being dependent on frequency of catheter use. 9,17 With the occurrence of any clinical symptom and/or catheter malfunction, and even in the event of doubt, an immediate chest radiograph is mandatory.…”

A Comparative Study of Low-Profile and Regular Type Totally Implantable Venous Access Devices in Patients with Malignant Tumors: Retrospective Analysis of 4501 Implantations.

“…13,23,[27][28][29][30][31] Right IJV is the preferred site for TIVAD implantation by the interventional radiologists because of its straight course that reduces catheter complications like thrombosis and low risk of catheter pinch-off phenomen between the first rib and the clavicle. [32][33][34][35] Femoral veins are usually not preferred for puncture however it might be advantageous in conditions like tumoral involvement or stenosis/thrombosis of superior vena cava and puncture problems related to low central venous pressure or obesity. 32 Studies on ultrasound-guided vessel punctures demonstrated success rates over 90%.…”