Extravasation of a Percutaneous Femoral Hepatic Infusion Device

93 [1]. Unlike permanent devices that have to be implanted surgically under general anesthesia, percutaneous catheter-ports may be installed under local anesthesia, a benefit for the many cancer patients who have already undergone cancer surgery. The subclavian route is also an option; however, there exists a risk of pneumothorax, reported to be around 4%, and also other complications such as local hematoma and brain infarction [2,3]. Thus, many institutions have been compiling their experience with femoral access and have reported relatively low complication rates [1,2]. Unfortunately, as with any injection device, there is always the possibility of extravasation, the leakage of injection material into tissue other than that targeted. Chemotherapeutic agents are generally cytotoxic and may cause necrosis of the surrounding tissue in the thigh and groin area; therefore, this medical emergency must never be underestimated. A 29-year-old male patient was referred to the plastic surgery department for infection signs in his right inguinal area (Fig. 1). A hepatitis B carrier through vertical transmission, he had been diagnosed with hepatocellular carcinoma one month previously, and had received his first cycle of chemotherapy by way of a percutaneous intra-arterial catheter port device via his femoral artery. While being started on his second cycle, he reported pain in the port area, and administration of epirubicin was immediately stopped. An estimated 15 mL of epirubicin had been administered. The port function was tested, and was found to be normal. Inflammation signs increased, and the port device growth. Therefore, drainage of fluid and removal of the cavity was needed before the infection occurred. For that reason, early detection is important, and knowledge of Morel-Lavallee syndrome and a high index of suspicion are needed.