Syltern Julie, Jørgensen Geir, Norstein Jarle, Augestad Knut Magne
Department of Surgery, Helgeland Hospital Trust, Sandnessjøen NO-8800, Norway.
Department of Vascular Surgery, Nordland Hospital, Bodø NO-8005, Norway.
J Surg Case Rep. 2020 Dec 31;2020(12):rjaa548. doi: 10.1093/jscr/rjaa548. eCollection 2020 Dec.
Totally implantable venous access devices (TIVADs) are frequently used for the administration of chemotherapy or parenteral nutrition and have proved to be safe and improve patient quality of life during treatment. Catheter-related infections are the most common complication, whereas catheter fracture and embolization is rarely seen. We present a case of a 61-year-old cancer patient in which the TIVAD fractured and embolized to the patient's left knee 18 months after its initial placement. An endovascular procedure with intraoperative imaging revealed that the catheter had embolized to the popliteal artery and was successfully removed, the only explanation being the presence of an atrial septal defect. A bubble echocardiogram was unsuccessful in confirming the diagnosis. The catheter fracture could be related to an intravascular procedure that was performed 18 months prior to remove fibrin sheaths as a cause of port malfunction, or it could be a case of pinch-off syndrome.
全植入式静脉通路装置（TIVADs）常用于化疗或肠外营养的给药，并且已被证明在治疗期间是安全的，可改善患者生活质量。导管相关感染是最常见的并发症，而导管断裂和栓塞则很少见。我们报告一例61岁癌症患者，其TIVAD在初次植入18个月后发生断裂并栓塞至患者左膝。一项术中成像的血管内手术显示，导管已栓塞至腘动脉并成功取出，唯一的解释是存在房间隔缺损。气泡超声心动图未能确诊。导管断裂可能与18个月前为解决端口故障而进行的去除纤维蛋白鞘的血管内手术有关，或者可能是一例夹闭综合征。
