J Korean Soc Radiol.  2016 Nov;75(5):333-345. 10.3348/jksr.2016.75.5.333.

Complications of an Implantable Venous Access Port: Prevention and Treatment

Affiliations
  • 1Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul, Korea. g1q1papa@korea.ac.kr
  • 2Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.

Abstract

Placement of an implantable venous access port (IVAP) is a popular procedure for repeated and intermittent chemotherapy in patients with malignancy. In this article, we present various IVAP related complications. In addition, we review the technical tips to prevent and manage the complications. It is important that the operator should keep the mechanism of the complications in mind, perform a careful procedure for prevention, and manage the complication properly and immediately in case of its development for safety and satisfaction of the patients.


MeSH Terms

Central Venous Catheters
Disease Management
Drug Therapy
Humans

Figure

  • Fig. 1 Chest PA shows an implantable venous access port placed via the right internal jugular vein.

  • Fig. 2 Chest PA shows placement of an implantable venous access port (IVAP) with an asymmetric shape via the right axillary vein. The radiopaque "CT" marking indicates good position and availability of the IVAP without flip.

  • Fig. 3 A 68-year-old woman with stomach cancer presented with swelling in the right infraclavicular area 3 weeks after placement. She had a history of warfarinization after placement. Sonographic examination shows a heterogeneous echoic hematoma around the cuff (arrow).

  • Fig. 4 Clamping of the peel-away sheath is useful for prevention of air embolism during removal of the dilator and insertion of the catheter.

  • Fig. 5 A 77-year-old man with lung cancer presented with malfunction of the port due to occlusion 1 month after placement. Cathetogram shows leakage of contrast media into the axillary vein. Inspection of the catheter after removal showed a small laceration of the catheter that correlated with the direction of teeth of Kelly and the suggestive cause of catheter leakage was pinching of the catheter during placement.

  • Fig. 6 A 66-year-old man with colon cancer presented with pain, swelling and discoloration around the puncture site after the first infusion of the chemotherapeutic agent. Inspection of the catheter after removal showed perforation of the catheter near the apex of the curve and the suggestive cause of catheter leakage was puncture of the catheter during suturing of the vein puncture site. The lesion healed with local wound care.

  • Fig. 7 Palpation of the catheter on the skin can cause discomfort or cosmetic problem.

  • Fig. 8 Adhesive dermatitis. Erythema of the skin is correlated with the application site of the plaster for dressing.

  • Fig. 9 The photogram obtained 7 days after placement in a 59-year-old woman shows vesicle at the upper margin of the application site of the plaster for dressing (arrow).

  • Fig. 10 The photogram obtained the next day after closing the wound with Histoacryl shows complete approximation and good cosmetic results without any stitch marks caused by the suture.

  • Fig. 11 Neck CT obtained after placement via posterior triangular access shows the direction of the catheter (arrows) towards the posteromedial side lateral to the sternocleidomastoid muscle.

  • Fig. 12 The photogram of the patient with an infection of the pocket shows erythema and a small hole covered by a clot on skin over the implantable venous access port. There was pus-like discharge during removal.

  • Fig. 13 A fibrin sleeve covers the surface of the catheter.

  • Fig. 14 Chest PA obtained just after placement in a 72-year-old woman with colon cancer shows the location of the catheter tip at the junction of the right internal jugular and subclavian veins (A). Axial (B) and coronal reformatted (C) images of the chest CT obtained 2 months after placement show thrombosis of the right internal jugular vein (arrowheads) around the catheter (thin arrow) and stenosis of the right brachiocephalic vein (white arrows).

  • Fig. 15 Chest PA obtained after placement with puncture of the subclavian vein with use of an anatomical landmark by the surgeon shows extrinsic compression of the catheter (arrow) at the crossing point of the clavicle and the first rib. Pinch-off syndrome may develop due to repeated stress.

  • Fig. 16 Chest PA after placement via the right internal jugular vein in a 58-year-old woman with pendulous breast shows extravascular migration of the implantable venous access port and location of the catheter in the infraclavicular area.

  • Fig. 17 Chest PA obtained just after placement shows the catheter tip in the superior vena cava (SVC) (arrow) (A). Follow-up image obtained after 2 months shows location of the catheter tip (arrow) at the junction of both brachiocephalic veins due to failure of return to the SVC and downward migration of the implantable venous access port chamber (white arrows) (B).

  • Fig. 18 Chest PA shows intravascular migration of the catheter into the right internal jugular vein.

  • Fig. 19 Chest lateral view shows the base of the port towards the anterior direction due to flipping over.

  • Fig. 20 Protrusion of the implantable venous access port caused by thinning of the subcutaneous fat layer due to weight loss after placement.

  • Fig. 21 Exposure of the implantable venous access port caused by thinning of the subcutaneous fat layer and injury to the skin due to repeated puncture.


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