Difficult removal of totally implantable venous access devices in adult patients: Incidence,risk factors,and management

Abstract

Background:

Totally implantable venous access devices (TIVADs) have played an important role of medical oncology practice. However, operators sometimes encounter considerable difficulty when removing TIVADs. This study aimed to investigate the incidence of difficult TIVAD removal, determine associated risk factors, and investigate interventional radiology (IR) approaches to difficult removal.

Methods:

A total of 514 TIVAD removal procedures performed in a single-center between January 2014 and May 2021 were retrospectively analyzed to determine incidence of difficult removal and associated risk factors. IR approaches applied in difficult removal cases were also reviewed.

Results:

The incidence of difficult removal was 7.4% (38/514). In univariable analysis, indwelling duration, silicone catheter, and subcutaneous leakage of fluid were identified as significant risk factors for difficult removal. Multivariable analysis showed that indwelling duration per year (odds ratio (OR), 1.46; 95% confidence interval (CI), 1.28–1.67; p < 0.01) and subcutaneous leakage of fluid (OR, 6.04; 95% CI, 2.45–14.91; p < 0.01) were significantly associated with difficult removal. In the 38 difficult removal cases, 32 TIVADs could be removed using more dissection and traction than the standard removal method. In the other 6, TIVADs were successfully removed by using several IR techniques, including insertion of a guide wire (n = 1), dissection using an introducer sheath (n = 2), pushing with a dilator (n = 1), and pulling with a snare (n = 2).

Conclusion:

Difficult TIVAD removal is uncommon. However, operators should expect it when removing long indwelling TIVADs and those with subcutaneous leakage. IR approaches to difficult removal are minimally invasive and can be useful.

Keywords

TIVAD port complication interventional radiology oncology access techniques and procedures catheters dialysis access

Get full access to this article

View all access options for this article.

References

Niederhuber

Ensminger

Gyves

, et al. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery 1982; 92: 706–712.

Biffi

Toro

Pozzi

, et al. Totally implantable vascular access devices 30 years after the first procedure. What has changed and what is still unsolved? Support Care Cancer 2014; 22: 1705–1714.

Tumay

Guner

. Availability of totally implantable venous access devices in cancer patients is high in the long term: a seven-year follow-up study. Support Care Cancer 2021; 29: 3531–3538.

Voog

Campion

du Rusquec

, et al. Totally implantable venous access ports: a prospective long term study of early and late complications in adult patients with cancer. Support Care Cancer 2018; 26: 81–89.

Fischer

Knebel

Schroder

, et al. Reasons for explantation of totally implantable access ports: a multivariate analysis of 385 consecutive patients. Ann Surg Oncol 2008; 15: 1124–1129.

Dede

Akmangit

Yildrim

, et al. Ultrasonography and fluoroscopy-guided insertion of chest ports. Eur J Surg Oncol 2008; 34: 1340–1343.

Tsuruta

Goto

Miyake

, et al. Late complications associated with totally implantable venous access port implantation via the internal jugular vein. Support Care Cancer 2020; 28: 2761–2768.

Walser

. Venous access ports: indications, implantation technique, follow-up, and complications. Cardiovasc Intervent Radiol 2012; 35: 751–764.

Denny

Jr.

Placement and management of long-term central venous access catheters and ports. AJR Am J Roentegenol 1993; 161: 385–393.

10.

Patel

Parra

Bath

, et al. IR Approaches to difficult removals of totally implanted venous access port catheters in children: a single-center experience. J Vasc Interv Radiol 2016; 27: 876–881.

11.

Wilson

van Noesel

Hop

, et al. The catheter is stuck: complications experienced during removal of a totally implantable venous access device. A single-center study in 200 children. J Pediatr Surg 2006; 41: 1694–1698.

12.

Jones

Giacomantonio

. A complication associated with central line removal in the pediatric population: retained fixed catheter fragments. J Pediatr Surg 2003; 38: 594–596.

13.

Chan

Rupasinghe

Hennessey

, et al. Retained central venous lines (CVLs) after attempted removal: an 11-year series and literature review. J Pediatr Surg 2013; 48: 1887–1891.

14.

Milbrandt

Beaudry

Anderson

, et al. A multiinstitutional review of central venous line complications: retained intravascular fragments. J Pediatr Surg 2009; 44: 972–976.

15.

Huang

Tsai

Lai

. A new technique to remove a “stuck” totally implantable venous access catheter. J Pediatr Surg 2009; 44: 1465–1467.

16.

Hong

. An easy technique for the removal of a hemodialysis catheter stuck in central veins. J Vasc Access 2010; 11: 59–62.

17.

Forauer

Theoharis

. Histologic changes in the human vein wall adjacentto indwelling central venous catheters. J Vasc Interv Radiol 2003; 14: 1163–1168.

18.

Forauer

Theoharis

Dasika

. Jugular vein catheter placement: histologic features and development of catheter-related (fibrin) sheaths in a swine model. Radiology 2006; 240: 427–434.

19.

Suojanen

Brophy

Nasser

. Thrombus on indwelling central venous catheters: the histopathology of “Fibrin sheaths.” Cardiovasc Intervent Radiol 2000; 23: 194–197.

20.

Xiang

Verbeken

Van Lommel

, et al. Intimal hyperplasia after long-term venous catheterization. Eur Surg Res 2000; 32: 236–245.

21.

Upton

Mulliken

Murray

. Major intravenous extravasation injuries. Am J Surg 1979; 137: 497–506.

22.

Boulanger

Ducharme

Dufour

, et al. Management of the extravasation of anti-neoplastic agents. Support Care Cancer 2015; 23: 1459–1971.

23.

Hinke

Zandt-Stastny

Goodman

, et al. Pinch-off syndrome: a complication of implantable subclavian venous access devices. Radiology 1990; 177: 356–366.

24.

Akgun

Tugrular

, et al. Median sternotomy for an unexpected complication of permanent hemodialysis catheters: “stuck catheter.” Vasa 2008; 37: 293–296.

25.

Balsorano

Galducci

De Fanti

, et al. Fractures of totally implantable central venous ports: more than fortuity. A three–year single center experience. J Vasc Access 2014; 15: 391–395.

26.

Ryan

Hadziomerovic

Aquino

. Endoluminal dilation technique to remove “stuck” tunneled hemodialysis catheters. J Vasc Interv Radiol 2012; 23: 1089–1093.

27.

Hong

. A breakthrough technique for the removal of a hemodialysis catheter stuck in the central vein: endoluminal balloon dilatation of the stuck catheter. J Vasc Access 2011; 12: 381–384.

28.

Hassan

Khalifa

Al-Akraa

, et al. Six cases of retained central venous haemodialysis access catheters. Nephrol Dial Transplant 2006; 21: 2005–2008.

29.

Field

Pugh

Asquith

, et al. A stuck hemodialysis central venous catheter. J Vasc Access 2008; 9: 301–303.

30.

Mortensen

Afshari

Henneberg

, et al. Stuck long-term indwelling central venous catheters in adolescents: three cases and a short topical review. Acta Anaesthesiol Scand 2010; 54: 777–780.