Klin Onkol 2004; 17(4): 136-138.
Summary: The authors present the case of a patient who suffered at the age of 35 from a left breast ductal infiltrative adenocarcinoma. After mastectomy with the left axila exenteration the patient was treated with 3 cycles of the inductive chemotheraphy FAC which was followed by 2 cycles of the high dose chemotheraphy CECb. After 4 years of remission she suffered from a relapse. This time she received 6 cycles of paliative chemotheraphy and paliative actinotheraphy of the involved bones. Following this treatment she went again to remission lasting up to this day. Before the paliative
chemotheraphy the port-a-cath to vena cava cranialis through vena subclavia l.dx. was implanted by infraclavicular approach.
The procedure was uneventful. After finishing the paliative chemotheraphy the port-a-cath was used for blood sampling and was regularly flushed with heparin solution. In January 2004 the blood could not be taken from the port-a-cath. Chest X-ray revealed a catheter fracture in the area of the right clavicle and the embolisation of the distal fragment to the right atrium. The distal segment was removed with catheter technique and the other part of the system by surgical preparation. The patient remained asymptomatic when the catheter fracture was discovered. Our report shows the relatively rare case of the catheter fracture (incidence 0,1-1%) after the port-a-cath implantation by infraclavicular appoach. The authors discuss the significance of the pinch-off syndrom. According to the literature review and our own experience similar problems do not occur when using supraclavicular approach.
