title: Percutaneous Re-positioning of Dislocated Port-Catheters in Patients with Dysfunctional Central-Vein Port-Systems.
abstract: OBJECTIVE
  Observational analysis of percutaneous repositioning of displaced port-catheters in patients with dysfunctional central-venous port-systems.
  
  
  METHODS
  A total of 1061 patients with dysfunctional venous pectoral port-systems were referred for port-angiography. Dislocated port-catheters were identified in 37 (3.5 %) patients (11 males, mean age 58.1 ± 7.2 [range 48-69] years; 26 females, 57.0 ± 13.5 [range 24-75] years) 3.9 ± 6.6 months (range 1 day-26 months) after port-implantation. Percutaneous repositioning in all patients was performed by transfemoral catheter maneuvers, snaring, or wire-assisted long-loop snaring. Primary endpoint was successful repositioning. Safety endpoints included port-damage or procedure-related complications. Follow-up encompassed routine clinical and radiological controls, including chest X-ray or computed tomography for 12.9 ± 17.9 (range 1-81) months.
  
  
  RESULTS
  Clinical signs of port-dysfunction due to dislocation of port-catheters included difficult aspiration in 23 (62.2 %), resistance or inability to inject in 17 (46.0 %), and pain during injection in 2 (5.4 %) patients. Primary technical success for repositioning displaced port-catheters was 97.3 % (36/37 patients). In 1 (2.7 %) patient, repositioning failed due to complete embedding of the port-catheter in an extensive chronic jugular vein thrombosis (Paget-von-Schroetter syndrome) that prevented endovascular access to the port-catheter. Redisplacement occurred after initial successful repositioning: immediately in two patients due to a too short port-catheter (two-tailed Fisher's exact-test, p = 0.0101), and in two patients with appropriate catheter-length after 5, resp. 7 months. No procedure-associated complications, e.g., port-catheter disconnection or disruption, occurred.
  
  
  CONCLUSIONS
  Repositioning of dysfunctional displaced central-venous port-catheters with appropriate catheter-length is safe and effective. Even challenging conditions, e.g., wall-adherent port-catheter tip or a thrombosed catheter-bearing vein are feasible. Repositioning of too short port-catheters is ineffective.
authors: Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany. Alexander.Massmann@uks.eu.
authors: Alexander
authors: A
authors: Massmann
authors: Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
authors: Philippe
authors: P
authors: Jagoda
authors: Clinic of Internal Medicine, Oncology, Hematology, Immunology and Rheumatology, Saarland University Medical Center, Homburg/Saar, Germany.
authors: Nicole
authors: N
authors: Kranzhoefer
authors: Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
authors: Arno
authors: A
authors: Buecker
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013902:Radiography, Thoracic; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult