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Case Reports
. 2021 Apr 13:65:102294.
doi: 10.1016/j.amsu.2021.102294. eCollection 2021 May.

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

Jun Sen Chuah  1   2 , Wei Li Wong  3 , Salinawati Bakin  3 , Raymond Zhun Ming Lim  2 , Ee Peng Lee  2 , Jih Huei Tan  2
Affiliations
Case Reports

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

Jun Sen Chuah et al. Ann Med Surg (Lond). .

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 3rd 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.

Keywords: Case report; Interventional radiologist; Oncology; Pinch-off syndrome.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
(A) Chemoport was inserted via right subclavian vein access. (B) Chest radiography revealed the embolized catheter fragment at right ventricle (arrow).
Fig. 2
Fig. 2
(A) Fractured catheter (B) The length of the migrated catheter was 10cm.
Fig. 3
Fig. 3
(A) Modified snare system using Cobra catheter and Terumo guidewire manoeuvred to surround the catheter fragment. (B) Successful ensnaring of the catheter fragment which was removed simultaneously with the catheter and sheath.
See this image and copyright information in PMC

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