Case of Dr. Elisa Ruiz de la Cuesta
The full case can be viewed in the app SurgSchool, where Dr. Elisa Ruiz de la Cuesta (Miguel Servet University Hospital, Zaragoza, Spain) shows in detail the Removal of implantable venous reservoir via jugular access, a common procedure in interventional radiology after the completion of cancer treatments or in the event of device complications.
Removal of implantable venous reservoir: indications and clinical context
Removal of a subcutaneous venous port (port-a-cath) is a common procedure in non-vascular interventional surgery. The main indications include:
- Completion of systemic treatment (chemotherapy)
- Device infection
- Associated dysfunction or thrombosis
- Pain or mechanical complications
In this case, Dr. Elisa Ruiz de la Cuesta addresses the removal by right internal jugular access, a strategy that allows direct control of the intravascular path of the catheter.
Ultrasound planning and control of jugular access
The procedure begins with ultrasound identification of the internal jugular vein, allowing safe access and minimizing the risk of complications.
The use of real-time ultrasound is standard in interventional radiology, facilitating:
- Precise venipuncture
- Avoidance of adjacent structures (carotid artery, nerves)
- Reduction of complications such as hematomas or arterial punctures
Dr. Elisa Ruiz de la Cuesta performs the puncture under direct ultrasound guidance, establishing a stable access for catheter control.
Endovascular reservoir removal technique
Once jugular access is achieved, cannulation of the central venous system is performed. The objective is to capture and withdraw the catheter from the reservoir in a controlled manner.
The technique includes:
- Introduction of intravascular guidewire
- Use of snare systems if necessary
- Release of catheter from possible adhesions
In this context, Dr. Elisa Ruiz de la Cuesta demonstrates a precise technique, avoiding sudden traction that could cause catheter breakage or embolization of fragments.
Management of the subcutaneous tract and removal of the reservoir
The subcutaneous reservoir is dissected either simultaneously or sequentially. This step requires:
- Incision over the previous scar
- Release of the reservoir from its fibrous capsule
- Complete system extraction
Control of the intravascular end via jugular access provides additional safety, especially in cases where adhesions or catheter fragility are suspected.
Complication control and final verification
One of the key aspects is ensuring complete removal of the device. Dr. Elisa Ruiz de la Cuesta verifies:
- Catheter integrity
- Absence of retained fragments
- Proper closure of venous access
Fluoroscopic control can be used to confirm the absence of residual intravascular material.
Advantages of the jugular access approach
Internal jugular access offers several advantages in the removal of reservoirs:
- Direct control of the central venous system
- Greater security in complex cases
- Possibility of endovascular rescue in case of complications
This approach is especially useful in situations where the catheter has adhesions or is at risk of fragmentation.
Technical considerations in interventional radiology
The removal of venous ports, although considered a minor procedure, requires meticulous technique. Dr. Elisa Ruiz de la Cuesta's experience highlights this.
- The importance of ultrasound monitoring
- The value of complementary endovascular access
- The need to avoid aggressive maneuvers
Knowledge of the long-term behavior of catheters, including fibrosis and adhesions, is key to planning the procedure.
Role of interventional procedures in the management of venous devices
La interventional radiology It plays a fundamental role not only in the placement, but also in the removal and management of complications of central venous devices.
Procedures like this reflect the evolution towards minimally invasive techniques, with lower morbidity and greater intraoperative control.
The technique demonstrated by Dr. Elisa Ruiz de la Cuesta exemplifies a safe, reproducible approach aligned with current best practices in vascular intervention.
