Stuck Port-A-Cat: A Case Report of a Successful Removal

Introduction: Totally Implantable Venous Access Devices (TIVADs) are critical for efficient drug administration in cancer treatment, but their use can lead to serious complications, including catheter fractures. These fractures may result in severe conditions such as pulmonary embolism, arrhythmias, endocarditis, and myocardial perforation. In pediatric patients, TIVADs are often removed after therapy, but removal can be complicated if the catheter adheres to the central vein wall due to prolonged use. This study presents a novel technique to simplify the removal of catheters that have adhered to vessel walls. Case Presentation: A 67-year-old man with bronchial adenocarcinoma, who had undergone neoadjuvant chemotherapy via a port-a-cath for a year, required catheter removal after six treatment sessions. During removal under local anesthesia, the catheter was found to be obstructed and could not be extracted without risking vein rupture or catheter fracture. The anesthesiologist proposed using a metallic guide from the central line kit to stiffen the catheter. This method successfully facilitated removal without complications. Post-removal, localized epithelialization was observed around the catheter. Discussion: Removing long-term tunneled or port catheters can be challenging due to adhesion to central veins, with risks including catheter fracture or vascular injury. Various advanced techniques, such as oversheathing with an introducer sheath or balloon dilation, have been described. Our method, utilizing a metallic guide to stiffen the catheter, reduces stress points and the risk of fracture, while also allowing easier percutaneous transvenous retrieval if needed. This approach enhances the safety and efficacy of catheter removal at minimal additional cost. Conclusion: The removal of a stuck peripherally inserted central catheter (PAC) presents significant risks, but employing a metallic guide can facilitate safer and more effective removal. This technique, .......