Pulmoner Artere Embolize Olan Venöz Port Kateterinin Perkutan Yolla Çıkarılması; Olgu Sunumu Ve Literatürün Gözden Geçirilmesi

Öz

Subkutanöz port kateter sistemleri uzun sureli vaya aralıklı infüzyon tedavi gereksinimi olan hastalarda giderek artan sıklıkta uygulanmaya başlamıştır.  Farklı endikasyonlarla port sistemi kullanımının, aynı zamanda potansiyel olarak ciddi olabilecek birçok komplikasyona yol açtığı bildirilmiştir. Kateterin ayrılması ve embolizasyonu nadir görülen bir komplikasyon olmakla birlikte, tanısı konulduğunda kateterin çıkarılması gerekmektedir.  Perkutanöz yaklaşım, minimal invavif, basit, güvenli ve konvansiyonel cerrahi seçeneklere gore daha düşük komplikasyon oranlarına sahip olduğundan altın standard tedavi yöntemi olarak kabul edilmektedir. Bu makalede tekrarlayan dirençli nöbetleri olması nedeniyle port kateteri takılan, takibinde kateterde ayrılma ve embolizasyon gelişmesi nedeniyle kateteri transvenöz yolla çıkarılan 2 yaşında bir kız hasta sunulmuştur.

 

 

Anahtar Kelimeler

• ayrılmış port kateter, embolizasyon, snareloop kateter, çocuk

Percutaneous Retrieval Of A Venous Port Catheter Embolizing To Pulmonary Artery With A Snare Loop Catheter; A Case Report And Review Of The Literature

Öz

Subcutaneous port catheter systems are widely used with increasing frequency in patients requiring long-term or intermittant infusion therapy. Usage of port systems for a wide variety of indications also leads to well-documented wide spectrum of complications that can be potentially serious.  Venous catheter dislodgement and migration is one of the rare complications of venous port implantation, however once diagnosed it must be removal of the catheter is indicated.  Percutaneous approach for removal is considered a gold standard treatment because it is a minimally invasive, relatively simple, safe procedure, with low complication rates compared to conventional surgical treatment. In this report we present a 2-year-old girl who had a port catheter implanted because of recurrent intractable seizures and subsequently dislodgement and embolizing of entire catheter, which was removed with a snare-loop catheter via transvenous approach. 

Anahtar Kelimeler

• detached port catheter, embolization, snare-loop catheter, child

Kaynakça

1. McGee DC, Gould MK. Preventing Complications of Central Venous Catheterization. N Engl J Med 2003;348:1123-33.
2. Cheng CC, Tsai TN, Yang CC, Han CL. Percutaneous retrieval of dislodged totally implantable central venous access system in 92 cases: experience in a single hospital. Eur J Radiol. 2009;69:346-50
3. Wang PC, Liang HL, Wu TH, Huang JS, Lin YH, Huang YL, Chou CP, Yang TL, Pan HB. Percutaneous retrieval of dislodged central venous port catheter: experience of 25 patients in a single institute. Acta Radiol. 2009;50:15-20.
4. Chuang MT, Wu DK, Chang CA, Shih MC, Ou-Yang F, Chuang CH, Tsai YF, Hsu JS. Concurrent use of pigtail and loop snare catheters for percutaneous retrieval of dislodged central venous port catheter. Kaohsiung J Med Sci. 2011;27:514-9
5. Woodhouse JB, Uberoi R. Techniques for Intravascular Foreign Body Retrieval. Cardiovasc Intervent Radiol (2013) 36:888–897
6. Kock HJ, Pietsch M, Krause U, Wilke H, Eigler FW. Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems. World Journal of Surgery 1998;22(1):12- 6.
7. Teichgräber UK, Kausche S, Nagel SN, Gebauer B. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol. 2011 Jun;21(6):1224-32
8. Barçın C, Kurşaklıoğlu H, Balta Ş, Küçük U, Demirkol S, Yıldırım V. Embolize olan Port-A-Cath kateterin perkütan yolla çıkarılması. Gülhane Tıp Derg 2013; 55: 231-233

9. Thomas J, Sinclair-Smith B, Bloomfield D, Davachi A. Non-surgical retrieval of a broken segment of steel spring guide from the right atrium and inferior vena cava. Circulation 1964; 30:106–108
10. Kapısız NS, Kapısız HF, Doğan OV, Kocakavak C, Yücel E. Central Venous Catheter Embolization: Case Report. Turkish J Thorac Cardiovasc Surg 2003;11:54-56
11. Liu JC, Tseng HS, Chen CY, Chern MS, Chang CY. Percutaneous retrieval of 20 centrally dislodged Port-A catheter fragments. Clin Imaging 2004;28:223-9.
12. Şenocak F, Örün UA, Ceylan Ö, Doğan V, Keskin M, Karademir S. Percutaneous Transvenous Removal of an Entire Detached Port Catheter by Using a Snare-Loop Catheter in a 13-Month-Old Child. İnönü Üniversitesi Tıp Fakültesi Dergisi 2011;18:263-5.
13. Teragawa H, Sueda T, Fujii Y, Takemoto H, Toyota Y, Nomura S, Nakagawa K. Endovascular technique using a snare and suture for retrieving a migrated peripherally inserted central catheter in the left pulmonary artery. World J Cardiol 2013; 26: 369-372
14. Wolf F, Schernthaner RE, Dirisamer A, Schroder M, Funovics M, Kettenbach J, Langenberger H, Stadler A, Loewe C, Lammer J, Cejna M. Endovascular management of lost or misplaced intravascular objects: experi- ences of 12 years. Cardiovasc Intervent Radiol 2008;31:563–568