Mediastinal infusion with tracheal necrosis: an unusual complication of Port-a-cath devices

Interact Cardiovasc Thorac Surg. 2011 Jun;12(6):1007-9. doi: 10.1510/icvts.2010.264903. Epub 2011 Mar 1.

Abstract

The Port-a-cath (PAC) is a catheter totally implanted under the skin. It is commonly used in oncology for permanent venous access. It provides a more simple way to infuse chemotherapies, antibiotics or parenteral nutrition, while offering improved comfort to patients. The usual complications of these devices (infections and catheter obstructions) are well documented. More exceptional events are catheter fractures with systemic migration, and endopleural perfusions due to a wrong positioning of the catheter. Since 1998, 10 cases of mediastinal infusion of cytotoxics have been reported. Surgical management was necessary in only two cases. We are reporting the case of a 57-year-old female suffering from a multimetastatic sigmoid adenocarcinoma. A mediastinal infusion of Folfiri and bevacizumab with a tracheal necrosis complicated the PAC use and required a latissimus dorsi myoplasty to fill up the tracheo-bronchial defect.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma / drug therapy*
  • Adenocarcinoma / secondary
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Bevacizumab
  • Bronchoscopy
  • Camptothecin / administration & dosage
  • Camptothecin / adverse effects
  • Camptothecin / analogs & derivatives
  • Catheters, Indwelling / adverse effects*
  • Equipment Design
  • Equipment Failure
  • Female
  • Fluorouracil / administration & dosage
  • Fluorouracil / adverse effects
  • Humans
  • Infusions, Intravenous
  • Leucovorin / administration & dosage
  • Leucovorin / adverse effects
  • Middle Aged
  • Necrosis
  • Sigmoid Neoplasms / drug therapy*
  • Sigmoid Neoplasms / pathology
  • Surgical Flaps
  • Thoracotomy
  • Tomography, X-Ray Computed
  • Trachea / drug effects*
  • Trachea / pathology
  • Trachea / surgery
  • Tracheal Diseases / chemically induced*
  • Tracheal Diseases / pathology
  • Tracheal Diseases / surgery

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Bevacizumab
  • Leucovorin
  • Fluorouracil
  • Camptothecin

Supplementary concepts

  • IFL protocol