Pinch-off syndrome from a chemoport catheter successfully managed with endovascular retrieval

Abstract

Introduction and importance A totally implantable venous access device (TIVAD), also referred to as ‘chemoport’, is frequently used for oncology patients. Chemoport insertion via the subclavian vein access may compress the catheter between the first rib and the clavicle, resulting in pinch-off syndrome (POS). The sequela includes catheter transection and subsequent embolization. It is a rare complication with incidence reported to be 1.1–5.0% and can lead to a devastating outcomes . Case presentation 50-year-old male had his chemoport inserted for adjuvant chemotherapy 3 years ago. During the removal, remaining half of the distal catheter was not found. There was no difficulties during the removal. Chest xray revealed that the fractured catheter had embolized to the right ventricle. Further history taking, he did experienced occasional palpitation and chest discomfort for the past six months. Electrocardiogram and cardiac enzymes were normal. Urgent removal of the fractured catheter via the percutaneous endovascular approach, under fluoroscopic guidance by an experience interventional radiologist was done. The procedure was successful without any complication. Patient made an uneventful recovery. He was discharged the following day, and was well during his 3 rd month follow up. Conclusion Early detection and preventive measures can be done to prevent pinch-off syndrome. Unrecognized POS can result in fatal complications such as cardiac arrhythmia and septic embolization. Retrieval via the percutaneous endovascular approach provide excellent outcome in the case of embolized fractured catheter.

An unusual cause of chest pain

“…Some causes that might lead to a port fracture and displacement include the type of port used, the site of placement, and the duration of catheter use 2 . An endovascular approach is used to retrieve the fractured catheter 3 . Knowledge of this complication can help emergency physicians when evaluating a post‐chemotherapy patient because catching it early can prevent fatal complications such as cardiac arrhythmias and septic embolization 3 …”

“…2 An endovascular approach is used to retrieve the fractured catheter. 3 Knowledge of this complication can help emergency physicians when evaluating a post-chemotherapy patient because catching it early can prevent fatal complications such as cardiac arrhythmias and septic embolization. 3…”