Complications of Port-A-Caths in Children with Hematologic/Oncologic Diseases

Dear Editor: We have read with keen interest the article titled, “Usefulness of percutaneous puncture in insertion of totally implantable venous access devices in pediatric patients” by Choi et al. [1] published in the September 2017 issue of Vascular Specialist International. We congratulate the authors for extensive research and we would like to share our experience with Port-A-Caths (PACs) in children with hematologic/oncologic diseases. PACs are commonly used in children who require longterm central venous access for medications or nutrition [1]. Although these devices are extremely necessary, they pose a serious risk of complications including infection, thrombosis, and mechanical occlusions [2-4]. Over 8 years period (January 2008-December 2015), we managed 55 children with malignant hematologic disorders who need a PAC placement for chemotherapeutic treatment. Thirtyfour patients (61.8%) were male and 21 patients (38.2%) were female. Mean age was 5 years (range, 1-16 years). Fifty patients (90.9%) had acute lymphocytic leukemia, four patients (7.3%) had lymphoblastic lymphoma, and one patient (1.8%) had acute myeloid leukemia. The most common site of insertion was the right internal jugular vein (94.5%) followed by the left internal jugular vein (3.6%) and the right subclavian vein (1.8%) (Fig. 1). All ports were placed under physician-controlled fluoroscopic guidance. Sixteen patients (29.1%) had postoperative complications including infection (n=10), malfunction (n=3), occlusion (n=2), and fracture (n=1). The management of these complications required the removal of the PAC in 8 cases (50.0%) (Table 1). The average duration over which the PAC remained in place was 18 months (range, 4-48 months). The total complication rate in our series was 29.1%, which is comparable to other reported rates of up to 31.0%