Hemostatic Sealant Used in Managing Delayed Extravascular Migration of a Totally Implantable Venous Access Device

以血管封合劑處理全植入性靜脈導管之延遲性上腔靜脈穿出

陳震謙(Zhen-Chian Chen) ； 黃文傑(Wen-Chien Huang) ； 詹梅麟(Mei-Lin Chan)

《胸腔醫學》 33卷3期 (2018/06) Pp. 111-116

摘要

For patients who require frequent long-term venous access for treatment, a totally implantable venous access device (TIVAD) provides a safe and effective alternative to repeated venipuncture. However, on rare occasions, the TIVAD tip may cause complications, such as vascular erosion and vascular penetration after prolonged use. A 54-year-old female cervical cancer patient presented with recurrent hydrothorax after 3 recent courses of chemotherapy. A TIVAD had been implanted through the left cephalic vein 17 months prior to admission for adjuvant chemotherapy. During this admission, the venography through the TIVAD showed a contrast infusion leak into the mediastinum and right pleural cavity, suggesting extravasation at the catheter tip. We removed the device under thoracoscopic monitoring and applied hemostatic sealant to the entry site of the migrating TIVAD tip, to close the potential fistula between the superior vena cava and the pleural cavity.

關鍵字

totally implantable venous access device (TIVAD) ； port-a-cath ； hemostatic sealant ； delayed migration ； complication

並列摘要

當病人需要長期、間歇性的靜脈治療，全植入性靜脈導管（totally implantable venous access device(TIVAD)）提供了一個安全又有效的選擇。但少數情形下，長期使用後的全植入性靜脈導管也可能造成血管損傷甚至穿破血管。一位五十四歲罹患子宮頸癌的女性病人因反覆的複雜性胸水而轉診至胸腔外科治療。病史發現，病人近三個月診斷出子宮頸癌復發，並接受二線化療。而複雜性胸水反覆發作三次，皆於化療後產生。此次住院後透過靜脈導管進行血管攝影，發現顯影劑滲漏至右側胸腔，意即導管尖端發生延遲性穿出上腔靜脈（superior vena cava）。病人接受胸腔鏡手術處理胸腔感染問題，並在胸腔鏡監測下移除穿出上腔靜脈之靜脈導管。考慮到導管移除後併發肋膜腔及上腔靜脈之間廔管的潛在風險，我們進一步使用血管封合劑於導管穿出處。

並列關鍵字

全植入性靜脈導管（totally implantable venous access device (TIVAD)） ； 人工血管 ； 血管封合劑（hemostatic sealant） ； 延遲性血管穿出 ； 併發症