Spontaneous Chemoport Fracture and Cardiac Migration

Abstract

Central venous access devices are routinely used in oncology for delivering chemotherapy of which implantable chemoports are the most common. Spontaneous breakage and migration of the catheters is a very rare but known complication of the procedure. Patients will usually present with cardiac manifestations in form of chest pain or arrythmias. Herein we report a case of spontaneous breakage and cardiac migration in which the patient was asymptomatic. Patient was successfully managed by an interventional cardiologist.Keywords Chemoport . Fracture . Migration A 3 year old male child was diagnosed as having Hodgkins lymphoma and subsequently planned for chemotherapy in our hospital. A chemoport catheter (bard, 6.6f) was placed in the right internal jugular vein and port was placed in the chest wall for chemotherapy. After the procedure, a chest x ray revealed good placement of the chemoport. Then the child underwent 6 cycles of chemotherapy in next 6 months through this port and had a very good response. Patient was then planned for port removal. On examination it was found that the port was in situ but the catheter was not palpable in the subcutaneous tissue of the neck. A chest radiograph was performed due to suspicion of catheter migration secondary to spontaneous breakage (dislodgement) of chemoport catheter. It showed that the chemoport catheter had migrated from its original location up to the right ventricle, travelling across the right atrium and right ventricle through pulmonary artery. (Fig. 1). Surprisingly the child was asymptomatic and there were no ECG changes as well. Patient was then referred to a cardiology department for a possible percutaneous retrieval of the migrated catheter. As the patient was asymptomatic and stable so an elective procedure was planned. On the next day patient was taken to cath lab and retrieval was done under fluoroscopic guidance under general anesthesia. The right femoral vein was punctured, and a 6Fr sheath was inserted. Percutaneous retrieval of migrated catheter was performed with a 6 Fr snare (peripheral snare, Cordis) (Fig. 2). Floating end of the migrated catheter in right atrium was snared and pulled down via inferior vena cava towards right femoral vein under fluoroscopic guidance and finally the port catheter fragment along with retrieval set were removed through right femoral vein (Fig. 1). The length of the migrated piece was 8cm, and no thrombus was observed at the tip (Fig. 1). No major complication occurred during and after the procedure and the patient was discharged on the next day. This is a unique case because spontaneous breakage of venous access devices is very rare and patients are usually symptomatic. DiscussionTotally implantable venous devices have been used increasingly in cancer patients since the mid-1980s. TIVDs facilitate effective long-term chemotherapy as well as parenteral nutrition, fluid replacement, and frequent blood sampling.However, TIVDs are not without complications. Early complications include incorrect position, improper a...

Fracture of the Port Catheter and Migration Into the Coronary Sinus: Case Report and Brief Review of the Literature

“…2,4 Catheter fracture and rupture was used to be more prevalent in 1970s; it became much rarer (approximately 0.1% of TIVD placement) in recent years. 2,7,8 This improvement may result from a better port catheter technology which affords more resistance to shearing and higher pressure infusion. 9 Modern TIVD consists of an injection port and a radiopaque silicone or polyurethane catheter.…”

“…Port Catheter fracture is a late mechanical complication of TIVD placement. 2,4 Catheter fracture and rupture was used to be more prevalent in 1970s; it became much rarer (approximately 0.1% of TIVD placement) in recent years. 2,7,8 This improvement may result from a better port catheter technology which affords more resistance to shearing and higher pressure infusion.…”

“…Late mechanical complications include catheter fracture and cardiac migration which are rarely occurring in approximately 0.1% to 1% of patients. 2 This may cause arrhythmia, thromboembolism, infection, and cardiac arrest prompting fragment extraction through endovascular or surgical removal. 3 The site to which the fractured fragments migrate varies, with the most prevalent being the right heart chambers.…”

Successful recovery of central venous catheter fragment from coronary venous sinus and right ventricle: A case report

“…Delayed complications occurring beyond 30 days include infection, catheter thrombosis, vessel thrombosis, and stenosis, catheter fracture with extravasation, or fracture with embolization of catheter material. Catheter fracture with consequent embolization is rare occurring in 1.1%-2.1% [2] . The site to which the fractured fragments migrate varies, with the most prevalent being the right heart chambers [3] .…”

Spontaneous Migration of Central Venous Catheter to Anterior Mediastinum

“…Implantable central venous access devices are widely used for administration of chemotherapeutic drugs [1]. However, many complications are well known and the complication rate ranges from 0.4% to 29% [2,3,4,5]. Spontaneous central venous catheter migration is a rare complication with an unknown cause that occurs in about 0.9 to 2% of patients [2,3,6].…”