Interventional Cardiology Transcatheter Retrieval of Dislodged Port-A Catheter Fragments: Experience with 47 Cases

Objective: The purpose of the present study was to investigate the incidence and location of dislodged Port-A catheter fragments and the efficacy and safety of transcatheter retrieval of dislodged Port-A catheter in our hospital. Materials and Methods: Forty-seven cancer patients, mean age 56 years old with 53.2 % male, were referred to our catheterization laboratory for retrieval of fractured Port-A catheter, were enrolled from January 2005 to March 2006. The procedures were performed under hospital guidelines and the patients followed in the outpatient department for at least 1 month after procedures. The characteristics of all fractured Port-A catheters were recorded. The procedure-related clinical status was evaluated. Results: The most common location of fractured catheter tip was found between the right atrium and inferior vena cava (11/47). Forty-six of the forty-seven (97.8%) dislodged catheters were successfully retrieved by the transcatheter method. Only one patient received surgical intervention because of failure to retrieve a dislodged catheter. Most of the procedures were performed with standard vascular tools (loop snares and pigtail catheters). In our experience, more sophisticated devices such as grasping forceps, baskets, or flexible triple grasping forceps have the drawback of limited valve compared to loop snare and even carry considerable risk of perforation. The complication rate of this procedure was fairly low (2/47, 4.3%), only one patient develop hematoma at right groin due to concomitant thrombocytopenia, and the other had flail of tricuspid valve damaged by a fragment passing though the valve. Conclusion: The most frequent location of dislodged Port-A catheter was found to situate between the right atria and inferior vena cava, where it was technically easier to be removed by the endovascular approach, with few complications reported. Therefore retrieval of dislodged Port-A catheters by endovascular approach might be the first choice of treatment because it is both safe and effective. Key Words: Transcatheter retrieval Dislodged Port-A cathete