Vascular Surgery Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Vascular Surgery Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
J Vasc Surg Venous Lymphat Disord. 2021 Jul;9(4):998-1006. doi: 10.1016/j.jvsv.2020.10.010. Epub 2020 Oct 31.
The incidence of totally implantable catheter fracture ranges from 0.48% to 5.00%, and these fractures represent a potentially fatal complication. The fracture mechanism of catheters implanted via the jugular vein is unclear, and whether extreme arm movements represent an additional risk factor for repetitive stress of the material remains unknown. The aim of this study was to demonstrate and classify catheter deformations caused by extreme arm mobilization and associations with changes in catheter function and displacement.
We analyzed the fluoroscopy images of 60 consecutive patients undergoing long-term indwelling port implantation via the jugular vein. Three images were taken: arm in maximal abduction, maximal frontal elevation, and maximal adduction. The images were compared with an image of the remainder of the arm. We analyzed three catheter regions to classify the deformity: A, connection between catheter and reservoir; B, the catheter's subcutaneous tunnel; and C, the catheter's entrance in the jugular vein. The deformations were classified in comparative manner as follows: 0 (no changes), 1 (minor changes, new slightly curvatures with an angle of >90°), and 2 (major changes, new severe curvatures with angles of ≤90°). In each position, catheter function (injection and aspiration) and displacement of the reservoir and tip were analyzed.
Only 15% of patients did not show a deformity; 33.3% had a deformity in only one position, 47.7% in two positions, and 10% in three positions. Minor deformities were observed in 70% of patients and major deformities in 40%. Moreover, 25% of patients presented both major and minor deformities. Major deformities were observed in 25.0% of patients on maximal frontal elevation, in 23.3% on maximal adduction and in none on maximal abduction. Region B was the most affected, with 57.8% of all minor deformities and 78.1% of all major deformities. No change in function was noted in 91.7% of the catheters. Maximal arm adduction resulted in greater vertical and horizontal displacement of the catheter tip and horizontal displacement of the reservoir. Higher body mass index values were associated with major deformities.
Maximal frontal elevation and maximal adduction were associated with major catheter deformities, and the subcutaneous tunnel region was the most deformed catheter region. An association between major catheter deformity and high body mass index was noted; in contrast, no association between the severity of catheter deformity, tip or reservoir displacement, or worsened functioning was observed.
完全植入式导管断裂的发生率为 0.48%至 5.00%，这些断裂是潜在的致命并发症。经颈静脉植入导管的断裂机制尚不清楚，手臂过度运动是否代表材料重复应力的额外危险因素仍不清楚。本研究旨在展示和分类因手臂过度活动导致的导管变形，并探讨其与导管功能和移位变化的关系。
我们分析了 60 例经颈静脉长期留置港植入患者的透视图像。手臂分别处于最大外展、最大前举和最大内收位时拍摄 3 张图像，并与其余手臂的图像进行比较。我们分析了导管的 3 个区域，以对变形进行分类：A、导管与储液器之间的连接；B、导管的皮下隧道；C、导管在颈静脉中的入口。以比较的方式对变形进行分类：0（无变化）、1（轻微变化，新出现的轻微弯曲，角度>90°）和 2（明显变化，新出现的严重弯曲，角度≤90°）。在每个位置分析导管功能（注射和抽吸）以及储液器和尖端的移位。
仅 15%的患者未出现变形；33.3%的患者仅在一个位置出现变形，47.7%的患者在两个位置出现变形，10%的患者在三个位置出现变形。70%的患者出现轻微变形，40%的患者出现严重变形。此外，25%的患者同时出现轻微和严重变形。25.0%的患者在前举位出现严重变形，23.3%的患者在内收位出现严重变形，而在外展位则无严重变形。受影响最严重的是 B 区，轻微变形占 57.8%，严重变形占 78.1%。91.7%的导管功能无变化。最大手臂内收导致导管尖端的垂直和水平移位以及储液器的水平移位更大。较高的体重指数与严重变形相关。
最大前举和最大内收与导管的严重变形有关，皮下隧道区是最变形的导管区。导管严重变形与高体重指数之间存在相关性，而导管变形严重程度、尖端或储液器移位以及功能恶化之间无相关性。
