Direct internal jugular vein incision for salvage of ‘stuck’ port catheters in pediatric leukemia: a single-center experience

Background: Totally implantable venous access ports (TIVAPs) are essential for long-term venous access in pediatric acute lymphoblastic leukemia (ALL). However, catheter-related calcified fibroblastic sheaths often make port removal difficult, and conventional traction may fail. Evidence regarding safe salvage surgery for calcified sheath-related stuck ports in children remains limited. This study aimed to investigate the etiology of difficult port removal and to evaluate the safety and feasibility of direct internal jugular vein (IJV) incision for fibroblastic sheath dissection and port extraction in pediatric patients with ALL.

Case Description: This is a retrospective analysis of five pediatric ALL patients with difficult port removals due to calcified fibroblastic sheaths between January 2022 and December 2024. All patients had indwelling 6 Fr TIVAPs for 25–44 months and failed conservative traction attempts after 3–4 weeks of therapeutic low-molecular-weight heparin (LMWH). All underwent direct internal jugular vein (IJV) incision for fibroblastic sheath dissection and port extraction. All procedures were completed with complete removal of the sheath and catheter, and no perioperative complications occurred. Operative time was 35–60 minutes (mean 45.5±8.7 minutes), blood loss was 3–10 mL (mean 6.2±2.1 mL), and hospital stay was 2–3 days (mean 2.3±0.5 days). At 1–3 months of follow-up, all patients had patent IJV flow without sheath recurrence, full neck range of motion, no pain or neurologic deficits, and excellent cosmetic outcomes.

Conclusions: Calcified adherent fibroblastic sheaths are the primary cause of difficult port removal in pediatric ALL. Direct IJV incision for fibroblastic sheath dissection appears to be a feasible and effective last-resort salvage procedure, offering a definitive solution for such complex cases.