Catheter redundancy in the aortic arch increases the risk of stroke in left subclavian arterial port-catheter systems.
OBJECTIVE
The stroke rate after left subclavian arterial port-catheter placement was compared in two groups: one with minimal redundancy of the catheter and one with pronounced redundancy in the aortic arch designed to minimize the likelihood of catheter dislocation.


METHODS
One hundred forty-eight patients (102 men, 46 women; age range, 26-83 years; mean age, 64.3 years) with inoperable advanced liver cancers underwent percutaneous implantation of port-catheter systems via the left subclavian artery. In 33 patients, a pronounced redundancy of the catheter was intentionally looped in the aortic arch. Redundancy was intentionally avoided in the remaining 115 patients. The rates of brain infarction complications in these two groups were retrospectively compared.


RESULTS
Among the 33 patients with pronounced redundant catheter looping, brain infarctions occurred in four cases (12.1%). In contrast, brain infarctions occurred in only three of the 115 patients with minimal redundant catheter looping (2.6%). The frequency of brain infarction complications was significantly higher in the patients with pronounced redundant catheter looping in the aortic arch than in patients with minimal pronounced redundant catheter looping (P = .044, Fisher exact test).


CONCLUSIONS
Catheter redundancy in the aortic arch increases the risk of stroke in patients undergoing implantation of port-catheter systems via a left subclavian arterial approach for repeated hepatic arterial infusion chemotherapy.
Hirota
Tatsuya
T
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan. thirota@boat.zero.ad.jp
Yamagami
Takuji
T
Tanaka
Osamu
O
Iida
Shigeharu
S
Kato
Takeharu
T
Nishimura
Tsunehiko
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D020520:Brain Infarction / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002423:Cause of Death; D004867:Equipment Design; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology*; D013348:Subclavian Artery; D015996:Survival Rate; D013997:Time Factors