Difficult removal of implantable venous access system: stepladder approach with wire stenting of a catheter—single-center experience

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Abstract

Background
Port-a-catheter insertion and removal are common procedures performed for children with chronic disease or cancer. Although its removal is usually straightforward, some difficulties during the procedure can be encountered. Several methods have been described in the literature to handle those cases where lines have become stuck.
Aim
To describe our simple technique in dealing with stuck port-a-catheters during removal. We will additionally report the incidence and factors associated with this complication.
Methods
A retrospective chart review study was performed between January 2009 and December 2019. Of a collective 2040 ports that were removed during the research interval, cases of difficult port removal were collected and reviewed. In 42 cases, catheter removal difficulty is encountered, and a second incision at the venous access site is performed. Failure of this procedure in removing the stuck catheter is then followed by catheter stenting and removal over a guide wire.
Results
Difficult removal of port-a-catheters was experienced in 42 cases (2%). The mean age at removal for those cases was 6.6 years. Most of the port-a-cath removals were done after treatment completion (74%). Ports had been left in situ for a mean duration of 44 months. The stepladder technique with wire stenting of the catheter was successful in 37 cases (88%), while the rest were only partially removed (distal part). The retained part was extracted using an angiographic technique. No short- or long-term complications were encountered in any of those 42 patients.
Conclusions
Stepladder with wire stenting of catheters approach deals with difficult line removals. Our technique is, therefore, simple, feasible, and effective.
Level of evidence
IV.

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