Ces radiol. 2024, 78(4):203-207 | DOI: 10.55095/CesRadiol2024.029

Difficult removal of the intravenous portsystemsOriginal article

Vendelín Chovanec^{1, 2}, Pavlína Vyletová¹, Peter Priester³, Pavel Žák^{2, 4}, Jan Raupach^{1, 2}, Ondřej Renc^{1, 2}, Zdeněk Bělobrádek¹, Jan Mašek^{1, 2}, Viktor Maňásek⁵, Miroslav Podhola^{2, 6}, David Astapenko^{2, 7, 8}

¹ Radiologická klinika FN, Hradec Králové

² Lékařská fakulta v Hradci Králové, Univerzita Karlova, Hradec Králové

³ Klinika onkologie a radioterapie FN, Hradec Králové

⁴ IV. interní hemato-onkologická klinika FN, Hradec Králové

⁵ Komplexní onkologické centrum, Nemocnice Nový Jičín

⁶ Fingerlandův ústav patologie FN, Hradec Králové

⁷ Klinika anesteziologie, resuscitace a intenzivní medicíny FN, Hradec Králové

⁸ Fakulta zdravotnických studií, Technická univerzita v Liberci

Objective: To evaluate the experience with difficult extraction of portcatheters during 10 years in a retrospective single-center study.

Method: From January 2014 to December 2023, 5731 intravenous portcatheters were implanted, and 1588 were removed in our center. All venous port system implantations and all porcatheters removals except 2 cases were performed in the radiology interventional unit. Difficult catheter extraction was defined as a removal by using a guidewire, dissection with sheath, and transvenous extraction with a snare.

Results: All portcatheters were removed by an interventional radiologist. Thirthy four extractions (2.4%) were classified as difficult. There were 17 males and 21 females with a median age of 67 years (9-82 years) in this group. The primary diagnosis for implantation was malignancy in 36 patients and asthma bronchiale and haemophilia A in one patient. The jugular vein was cannulated in 16 patients and the axillary vein in 21 patients. One patient had an arm port inserted through the left basilic vein. The reason for removal in patients with difficult extraction was therapy termination in 28 patients (73.7%), dysfunction in 7 patients (18.4%), and infection in 3 patients (7.9%).

The median indwelling portcatheter time in patients with difficult extraction was 101.5 months (6-178 months). The port chamber was explanted in all patients. The complete removal was performed in 28 patients, the partial removal (length of catheter left in the vein less than 5 cm) was in 3 patients and unsuccessful catheter removal was in 7 patients. The catheter was successfully removed using guidewire in 1 case and skin cut above catheter in 1 case, using sheath and guidewire in 2 cases, and using a snare in 27 cases. In the remaining 7 unsuccessful cases, the sheath was used in 2 patients and the snare in 5 patients. The success rate for transfemoral extraction was 84.8% (28 out of 33) and the overall success removal rate was 81.6 % (31 out of 38). During the procedure a vagal reflex (hypotension, bradycardia) emerged in 2 patients. It was terminated successfully by pharmacotherapy.

Conclusion: The incidence of difficult portcatheter removal was low (2.4%) and the median indwelling time for difficult portcatheter removal was almost 9 years (101.5 months) in our cohort. Interventional radiological techniques including extraction with the snare under fluoroscopy is safe and effective in cases of difficult portcatheter removal.

Keywords: intravenous, portcatheter, portsystem, complication of extraction, difficult extraction

Accepted: August 15, 2024; Published: December 12, 2024  Show citation