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LETTER TO THE EDITOR
Year : 2017  |  Volume : 54  |  Issue : 1  |  Page : 361
 

Chemo port insertion through femoral vein approach: A rare indication and a rare complication


1 Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
2 Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India

Date of Web Publication1-Dec-2017

Correspondence Address:
Dr. S G Dholaria
Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_193_17

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How to cite this article:
Dholaria S G, Yadav D, Gupta A K. Chemo port insertion through femoral vein approach: A rare indication and a rare complication. Indian J Cancer 2017;54:361

How to cite this URL:
Dholaria S G, Yadav D, Gupta A K. Chemo port insertion through femoral vein approach: A rare indication and a rare complication. Indian J Cancer [serial online] 2017 [cited 2020 Apr 5];54:361. Available from: http://www.indianjcancer.com/text.asp?2017/54/1/361/219562


Sir,

A 56-year-old obese female with metastatic carcinoma breast had partial thrombosis in superior vena cava (SVC) on computed tomography scan. Hence, we used femoral vein approach (Seldinger technique) for port insertion as internal jugular vein (IJV) or subclavian approach could not be used. Under anesthesia, through right femoral vein, catheter was placed in the inferior vena cava just below the diaphragm which was confirmed by fluoroscopy [Figure 1]. Port was placed over the rectus sheath just below the umbilicus on the right side.
Figure 1: Fluoroscopy image showing tip of catheter

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We encountered two very different types of complication. First, because of obesity, we needed the help of sonography to locate the port properly for the first three cycles of chemotherapy. After that, we could locate it by palpation. The second most weird complication was because of the abdominal fat. The distance between the skin and port was more than the length of port needle. Hence, constant pressure on the needle was required to keep the needle inside the port which was not possible practically and so we had to use spinal needle for chemotherapy infusion for the first three cycles of chemotherapy. After that, we could use Huber needle. However, we did not have any complications such as extravasation or leakage of drugs because of spinal needle. The patient had completed her full course of chemotherapy.

In general, chemo port is placed over the chest wall after the access through the subclavian or IJV.[1] Femoral approach is indicated when massive cutaneous metastases or severe radiodermatitis in the upper part of the torso is present where one cannot place the port.[2] In our case, it was due to SVC thrombosis which is a very rare indication itself.

Common complications are groin hematoma (2.3%), local port-site infection (2.3%), groin wound infection (1.3%), and catheter occlusion (3.5%).[3] In a study by Bertoglio et al., the rate of port removal because of late morbidity was 4.9% for femoral route and 5.9% for subclavian route.[2] We were not able to find complications in any literature related with obesity or abdominal fat that we encountered in our case.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Harish K, Madhu YC. Femoral port placement – Report of two cases. Indian J Surg Oncol 2011;2:31-3.  Back to cited text no. 1
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2.
Bertoglio S, DiSomma C, Meszaros P, Gipponi M, Cafiero F, Percivale P. Long-term femoral vein central venous access in cancer patients. Eur J Surg Oncol 1996;22:162-5.  Back to cited text no. 2
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3.
Chen SY, Lin CH, Chang HM, Hsu HM, Yu JC. A safe and effective method to implant a totally implantable access port in patients with synchronous bilateral mastectomies: Modified femoral vein approach. J Surg Oncol 2008;98:197-9.  Back to cited text no. 3
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