title: Administration of chemotherapy by an arteriovenous fistula in a patient with metastatic rectal cancer after life-threatening, port thrombosis-associated cava superior syndrome. An option for patients without possibility of peripheral or central venous access.
abstract: BACKGROUND
  Patients with solid tumors have an increased risk of venous thromboembolism, potentially related to a venous port system. In case of catheter-related thrombosis despite full anticoagulation, further treatment administration is difficult.
  
  
  METHODS
  A 41-year-old female patient with a K-Ras wild-type adenocarcinoma of the rectum was diagnosed with systemic disease in June 2008 after several local recurrences treated with surgery and additive chemotherapy. To administer chemotherapy with FOLFIRI (folinic acid, 5-fluorouracil, irinotecan) and bevacizumab, a venous port system into the vena subclavia was implanted. In April 2009, the computed tomography (CT) scan revealed a portassociated thrombosis with cava superior syndrome, despite treatment with phenprocoumon and an international normalized ratio (INR) of 3.75 at the time of the event. The port system was explanted. According to the possible relationship to bevacizumab, treatment was discontinued, followed by rapid disease progression. Access to peripheral veins became virtually impossible. Therefore, a radiocephalic fistula was established. For 9 months, the patient has been receiving several therapeutic agents with 20 punctures of the fistula, revealing no locoregional events (e.g. arterial, venous or cutaneous).
  
  
  CONCLUSIONS
  The application of current therapeutic agents by an arteriovenous fistula seems to be a feasible option for patients with restricted peripheral or central vein status and/or medical history of thrombotic events disabling the use of a port system.
authors: Universitäres Cancer Center Hamburg, Universitätsklinikum Hamburg-Eppendorf, Germany. a.stein@uke.de
authors: Alexander
authors: A
authors: Stein
authors: Sonja
authors: S
authors: Hiemer
authors: Karin
authors: K
authors: Jordan
authors: Dirk
authors: D
authors: Arnold
authors: Hans-Joachim
authors: HJ
authors: Schmoll
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001163:Arteriovenous Anastomosis; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D013479:Superior Vena Cava Syndrome / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects*