title: Port-a-Cath complicated by infection or migration not removed by manual traction: usefulness of cardiac pacing leads extraction techniques.
abstract: BACKGROUND
  Long-term use of Port-a-Caths (PACs) is related to device-related delayed complications. The aim of this study is to describe the high success rate and safety of cardiac pacing lead extraction techniques used for PACs complicated by infection or migration and not removed by manual traction.
  
  
  METHODS
  During a 13-year period (1997-2010), 19 consecutive PAC recipients (54.1±13 years, 11 females) were referred to our hospital for PAC-related delayed complications and PACs not removable by manual traction (mean dwelling time 29.3±31 months).
  
  
  RESULTS
  PAC implantation indications included gastrointestinal cancer (21%), breast cancer (15.7%), other malignant diseases (52.6%), and nonmalignant diseases (10.5%). PAC removal indications were breakdown due to subclavian crush (63.1%), breakdown due to unsuccessful previous removal attempt (21%), sepsis (10.5%), or malfunction (5.3%). Removal of fractured free-floating catheters (16) migrated toward the venous blood course was attempted by tool-guided traction in all cases except 1 in whom mechanical dilation was necessary. For the 3 intact ones (2 infected and one malfunctioning) we used tool-guided traction and single-sheath mechanical dilation, depending on the vascular/cardiac-catheter setting. By using multiple venous approaches we removed 18 catheters completely and 1 partially, achieving clinical success in all of the patients. The most commonly used venous approach was transfemoral (TFA; 73.6%), followed by the original venous entry site approach (VEA; 15.7%) and internal transjugular approach (ITA; 10.5%). No major or minor complications were observed.
  
  
  CONCLUSIONS
  In experienced centers, cardiac pacing lead extraction techniques may be considered as an additional, efficacious, safe option for extraction of otherwise nonremovable entrapped PACs before surgery.
authors.affiliation: Second Cardiology Division, Cardiothoracic and Vascular Department, Santa Chiara University Hospital, Pisa, Italy. raffaele_de_lucia@yahoo.it
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Lucia
authors.forename: Luca
authors.initials: L
authors.lastname: Segreti
authors.forename: Ezio
authors.initials: E
authors.lastname: Soldati
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Cori
authors.forename: Guilio
authors.initials: G
authors.lastname: Zucchelli
authors.forename: Maria G
authors.initials: MG
authors.lastname: Bongiorni
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects*