Background: The incidence of totally implantable catheter fracture ranges from 0.48 to 5%, 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.
Methods: 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 to 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 angle greater than 90o) and 2 (major changes, new severe curvatures with angles of 90o or less). In each position, catheter function (injection and aspiration) and displacement of the reservoir and tip were analyzed.
Results: 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% 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. The greatest body mass index values were associated with major deformities.
Conclusion: 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 BMI was noted; in contrast, no association between the severity of catheter deformity, tip or reservoir displacement, or worsened functioning was observed.
Diamante Leiderman DB, Souza KP, Tomé Binatti CE, de Almeida Mendes C, Teivelis MP, Brito CF, Diamante Leiderman DB, Wolosker N. Arm mobilization provokes deformity of long-term indwelling ports implanted via the jugular vein. J Vasc Surg Venous Lymphat Disord. 2020 Oct 29:S2213-333X(20)30555-2. doi: 10.1016/j.jvsv.2020.10.010. Epub ahead of print. PMID: 33130283.