Surgical challenges in the removal of entrapped port-a-caths: a case series of 3 patients

Contemporary cancer management often necessitates repeated venous access for therapeutic administration and blood sampling. Long-term central venous access devices, such as port-a-cath (PaC) systems, are routinely used to preserve peripheral venous integrity. Device removal or replacement is indicated after prolonged use or upon the development of complications. Although PaC retrieval is generally straightforward, resistance to removal may occasionally occur despite adequate traction, and excessive manipulation can lead to serious adverse events. We conducted a retrospective analysis of 94 consecutive PaC removal procedures performed at our center between 2009 and 2025, focusing on cases involving catheter retrieval difficulties. Three cases exhibited significant resistance to standard removal techniques. One was successfully managed through interventional radiology consultation. In a second case, a catheter fracture led to migration and pulmonary embolization, resulting in limited pulmonary ischemia. In the third case, catheter entrapment within the venous system necessitated abandonment of the retrieval attempt. Our findings highlight that difficult PaC removals, particularly in long-term implants, require a systematic approach that includes thorough preoperative planning, timely specialist consultation when complications arise, and rigorous postoperative monitoring to minimize the risk of serious complications.