Le syndrome de la pince costoclaviculaire: Principale cause d'embolie de catheter

Objective: To assess the incidence of the pinch-off syndrome (POS) in catheter fracture and embolism. Study design: Retrospective clinical study. Patients: The medical files of 56 patients who had since 1989 an embolized fragment or entire catheter removed by an interventional radiologic procedure have been retrospectively analysed. Methods: A POS was considered the causative factor when a chest X-ray showed a rupture of the catheter at the site of the costoclavicular space. Results: From 1989 to the end of 1996, 56 catheter embolisms by fracture or disconnection occurred in our institution. The rupture from a POS was the main cause of embolism (24 patients out of 56). The incidence was 8‰ of implanted ports inserted via a subclavian access [95% confidence interval: 4‰-13‰]. Preliminary clinical or radiologic signs of pinching existed in 50% of POS: difficult insertion radiologic compression aspect, arm or shoulder pain, infusion rate and/or reflow depending on arm position. Conclusions: POS was the first cause of catheter embolism and should suggest the use of an alternative way for insertion instead of the subclavian access. When a catheter is inserted via a subclavian route, clinical and/or radiologic signs of POS require its removal.