Research Day
WHAT GOES IN, MUST COME OUT: SUPERIOR VENA CAVA SYNDROME IN RETAINED LONG-TERM IMPLANTED PORTS
Document Type
Abstract
Date
2021
Abstract
Implanted central venous port catheters (ports) are widely used for chemotherapy, total parenteral nutrition and blood monitoring. If placed in the subclavian vein, up to 15% of patients who receive implanted ports have immediate complications, including venous injury, pneumothorax and pneumomediastinum. Long-term ports are associated with delayed complications, including thrombosis, occurring in 1.9-21.5% of patients. Although rare, if thrombosis of the port's catheter occurs, it can cause significant occlusion of the vein and result in superior vena cava (SVC) syndrome. We report this feared, potentially avoidable complication in two cases of SVC syndrome that developed in patients with previous diffuse large B cell lymphoma (DLBCL) in remission with retained long-term implanted ports.
Case Series: Case 1: A 93-year-old woman with a history of DLBCL status post port placement, treated with R-CHOP and R-CVP with adriamycin chemotherapy, now in remission for 3 years presented with a positional headache for 4 weeks. Associated symptoms included facial flushing, dizziness, dyspnea, chest tightness, and fluctuating left arm swelling over the same period of time. Her exam revealed normal vital signs, but distended neck vessels, facial plethora and a port in the right chest wall. Computed tomography (CT) of the chest with contrast revealed an acute-to-subacute occlusion of the SVC due to thrombosis of the distal tip of the port catheter. Case 2: A 34-year-old man with a history of DLBCL status post port placement, treated with R-CHOP chemotherapy, now in remission for 2 years presented with facial swelling for 2 days. Associated symptoms included a positional headache, facial flushing and dizziness.
Our cases highlight the importance of removing the implanted port catheter soon after chemotherapy is completed, and remission is confirmed. This can prevent port catheter-related complications like thromboembolism and reduce the burden, risk and cost associated with systemic anticoagulation.