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Hataoka T, Sanmoto Y, Kinuta S. Cephalic Vein Cut-Down Method for Totally Implantable Venous Access Ports: A Single-Institution Experience. Ann Vasc Surg 2024; 98:244-250. [PMID: 37356657 DOI: 10.1016/j.avsg.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The widespread use of chemotherapies has increased the need for totally implantable venous access ports (TIVAPs). Previously, the subclavian puncture approach with the landmark technique was the most used implantation method; however, it has been related to early complications such as pneumothorax, hemothorax, and arterial puncture. Therefore, a safer implantation method is required. This study aimed to assess the safety and efficacy of the cephalic vein cut-down method used in our institution. METHODS Patients who underwent TIVAPs implantation using the cephalic vein cut-down method as the first choice between January 1, 2018, and December 31, 2020, were included in this study. We retrospectively evaluated the technical success rates, operation times, and early complications. RESULTS This study included 221 adult patients (men, 129; women, 92), with a mean age of 68 ± 11 years. The mean body mass index (BMI) was 21 ± 4 kg/m2. A total of 213 patients (96.4%) had malignant tumors that required chemotherapy. The mean postoperative follow-up period was 659 ± 442 days (range, 5-1,698 days). A total of 127 patients (57.5%) died during the follow-up period. The technical success rate was 86.4% (191/221). There were 30 failures, 24 of which were converted to the subclavian vein puncture approach. The mean operation time was 53 ± 21 min. Early complications were observed in 4 (1.8%) patients, corresponding to an incidence of 0.028 complications/1,000 catheter days. One patient had an unintended arterial puncture; however, it was not a result of the cephalic vein cut-down method but a secondary result of the subclavian vein puncture. No complications of pneumothorax, hemothorax, or arterial puncture were observed with the cephalic vein cut-down method. CONCLUSIONS This study showed that the cephalic vein cut-down method for TIVAPs had an acceptable success rate and fewer early complications than the conventional puncture techniques.
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Affiliation(s)
- Tsutomu Hataoka
- Department of Surgery, Takeda General Hospital, Fukushima, Japan.
| | - Yohei Sanmoto
- Department of Surgery, Takeda General Hospital, Fukushima, Japan
| | - Shunji Kinuta
- Department of Surgery, Takeda General Hospital, Fukushima, Japan
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2
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Otsubo R, Yano H, Matsumoto M, Tanaka A, Nonaka T, Hidaka S, Matsumoto K, Tsuchiya T, Sato S, Nagayasu T. Comparison of Central Venous Port Procedures Between Puncture vs. Cut-down and Residents vs. Senior Surgeons. In Vivo 2021; 35:1197-1204. [PMID: 33622921 DOI: 10.21873/invivo.12369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To compare operative results between venous puncture (P) with real-time ultrasonography vs. cut-down (CD) with preoperative ultrasonography for totally implantable central vein access device (TICVAD) implantation performed by residents (R) vs. senior surgeons (S). PATIENTS AND METHODS Adult oncologic patients (n=268) undergoing TICVAD implantations were retrospectively compared between 172 Ps and 96 CDs. Then, we compared Ps performed by R (P-R, n=131) and S (P-S, n=41) and CDs performed by R (CD-R, n=59) and S (CD-S, n=37). RESULTS Median operation times were 40 min in the P group and 53.5 min in the CD group, and times were significantly shorter for P-S and CD-S. Completion rates were comparable for each method and each surgeon. Intraoperative complication rates were 3.8% (P-R), 2.4% (P-S), and 0% (CD-R and CD-S). CONCLUSION P with real-time ultrasonography did not avoid complications compared to CD with preoperative ultrasonography. The latter performed safely even by residents.
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Affiliation(s)
- Ryota Otsubo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan;
| | - Hiroshi Yano
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Megumi Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Aya Tanaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shigekazu Hidaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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3
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Hashimoto S, Otsubo R, Adachi M, Doi R, Shibata K, Sano I, Shibata Y, Nakazaki T, Taniguchi H, Nagayasu T. Cephalic Vein Cut-down for Totally Implantable Central Venous Access Devices With Preoperative Ultrasonography by Surgical Residents. In Vivo 2020; 33:2079-2085. [PMID: 31662541 DOI: 10.21873/invivo.11707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Cephalic vein (CV) cut-down for totally implantable central venous access devices (TICVADs) is not frequently used due to its low success rate. We compared the outcomes of CV cut-down using preoperative ultrasonography (US) performed by experienced surgeons versus surgical residents. PATIENTS AND METHODS From December 2015 to December 2017, 10 surgeons implanted 212 TICVADs using CV cut-down with preoperative US. The surgeons were divided into two groups of five each: surgical residents (Group A, n=124 procedures) and experienced surgeons (Group B, n=88 procedures). Duration of operation time, completion rate, and complications were retrospectively analyzed. RESULTS The completion rate was significantly higher in Group A (98.4% versus 92.0%, p=0.04). Duration of operation time (45.2±14.5 versus 42.0±13.1 minutes, p=0.22), rates of early complications (1.6% versus 1.1%, p=0.77) and late complications (3.2% versus 2.3%, p=0.68) were equivalent between the two groups. No fatal complications occurred in either group. CONCLUSION CV cut-down can be safely performed by surgical residents under the use of preoperative US.
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Affiliation(s)
- Shintaro Hashimoto
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan.,Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryota Otsubo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masahiro Adachi
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Ryoichiro Doi
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Kenichiro Shibata
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Isao Sano
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Yoshihito Shibata
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takayuki Nakazaki
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Hideki Taniguchi
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kansay R, Singhal A, Patil B, Malhotra A. Iatrogenic median nerve injury as a result of venous cut down procedure: A rare case report. Int J Surg Case Rep 2020; 73:146-149. [PMID: 32688234 PMCID: PMC7369452 DOI: 10.1016/j.ijscr.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rajeev Kansay
- Department of Orthopaedics, Government Medical College Hospital, Sector 32, Chandigarh, 160030, India.
| | - Akash Singhal
- Department of Orthopaedics, Government Medical College Hospital, Sector 32, Chandigarh, 160030, India.
| | - Bharath Patil
- Department of Orthopaedics, Government Medical College Hospital, Sector 32, Chandigarh, 160030, India.
| | - Anubhav Malhotra
- Department of Orthopaedics, Government Medical College Hospital, Sector 32, Chandigarh, 160030, India.
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Rhu J, Jun KW, Song BJ, Sung K, Cho J. Cephalic vein approach for the implantable central venous access: A retrospective review of the single institution's experiences; Cohort Study. Medicine (Baltimore) 2019; 98:e18007. [PMID: 31725671 PMCID: PMC6867776 DOI: 10.1097/md.0000000000018007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Long-term venous access is usually required in patients receiving chemotherapy. We hypothesized that, out of the various central line approach techniques, the cephalic vein cut-down technique can be a safe and simple alternative in terms of surgical safety, feasibility, cost-effectiveness, and functional outcomes.We retrospectively reviewed the medical records of 569 patients who underwent implantable central venous access between January 2012 and December 2014 at our hospital.We classified our cohort according to access routes, as follows: 230 patients underwent subclavian vein access, 134 patients underwent internal jugular vein access, 25 patients underwent external jugular vein access, and 119 patients underwent cephalic vein access. The cephalic vein group had a significantly longer operation time than the subclavian group (P < .01); however, there was no difference in operation time between the internal jugular vein and cephalic vein groups (P = .59). The procedure-related complications and functional outcomes of the implanted venous port during chemotherapy were comparable between the cephalic group and other groups. Additionally, body mass index, operation time, and age did not correlate with catheter dysfunction in the multivariate logistic regression analysis (P = .53; P = .66; P = .19, respectively).We suggest that a cut-down central venous catheter insertion through the cephalic vein can be performed easily and safely with no differences in surgical and clinical outcomes compared to those of conventional percutaneous approaches. Moreover, the cephalic vein approach requires no specialized equipment, including percutaneous vascular kits, tunneling instruments, and intraoperative ultrasonography. Therefore, this technique might incur less medical expenses than conventional approaches and would be helpful for both patients and surgeons.
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Wu CY, Fu JY, Wu CF, Hsieh MJ, Wen CT, Cheng CH, Liu YH, Ko PJ. Superior Vena Cava Port Catheter Tip Confirmation: Quantified Formula for Intravascular Catheter Length versus Anatomic Landmark Reference. Ann Vasc Surg 2019; 60:193-202. [PMID: 31075484 DOI: 10.1016/j.avsg.2019.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/05/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adequate tip location is crucial for intravenous port implantation because it can minimize catheter-related complications. Adequate tip location cannot be observed directly and needs to be confirmed by imaging tools. A quantified intravascular catheter length formula has been proposed and we attempt to compare its clinical effectiveness with anatomic landmark references. METHODS During the period from March 2012 to February 2013, 503 patients who received port implantation where implanted catheter length depended on carina level as confirmed by intraoperative fluoroscopy were assigned to Group A. From March 2013 to February 2014, 521 patients who received port implantation based on quantified intravascular catheter length formula were assigned to Group B. Clinical outcomes were compared. RESULTS Catheter tip location of Group A, as revealed by intraoperative fluoroscopy and postoperative chest film, was 1.18 ± 0.51 and 1.1 ± 1.3 cm below carina, respectively. Catheter tip location of Group B, as revealed by intraoperative fluoroscopy and postoperative chest film, was 1.25 ± 1.05 and 1.05 ± 1.32 cm below carina, respectively. Similar catheter tip location was identified in both groups. The functional period of implanted ports, complication rate (3.58% and 2.53%), and incidence (0.049 and 0.0506 episodes/1,000 catheter days) were similar in both groups. CONCLUSIONS The quantified intravascular catheter length formula can predict an adequate catheter length just as well as carina do and results in good catheter tip location. The formula could replace the clinical use of anatomic landmarks and serve as an easy tool for practitioners.
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Affiliation(s)
- Ching-Yang Wu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Jui-Ying Fu
- Chest Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Feng Wu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tsung Wen
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hui Cheng
- Cardiovascular Physiology Laboratory, Department of Medical Research and Development, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Thoracic and Cardiovascular Surgery Division, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Sun X, Zhang Y, Yang C, Zhou Y, Bai X, Zheng W, Jin Y. Ultrasound-guided totally implantable venous access device through the right innominate vein in older patients is safe and reliable. Geriatr Gerontol Int 2019; 19:218-221. [PMID: 30724007 DOI: 10.1111/ggi.13611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 11/26/2022]
Abstract
AIM Ultrasound guidance has become the routine method for catheterization, dramatically reducing failure and complication rates for totally implantable venous access devices (TIVAD) placement. The aim of the present study was to report the safety and efficacy of ultrasound-guided right innominate vein TIVAD placement in older patients. METHODS Between September 2015 and September 2017, 55 older patients underwent right innominate vein TIVAD placement under ultrasound guidance. Intraoperative fluoroscopy was always carried out. The technical success rate and complications were recorded and retrospectively analyzed. RESULTS The technical success rate was 100%. The success rate of the first puncture was 96.36% (53/55). The mean operation time was 28 ± 7 min (range 23-39 min), and the mean length of catheter introduction was 19.24 ± 2.65 cm (range 17-21 cm). The overall incidence of complications was 7.27% (4/55), including one arterial puncture with self-limiting hematoma, two cases of catheter-related infection and one case of fibrin sheath. No catheter malposition or catheter fracture was observed. At the time of this study, three TIVAD were pulled out unexpectedly, and 32 TIVAD are still in functional use. CONCLUSIONS Ultrasound-guided puncture of the right innominate vein is safe and reliable to implant TIVAD, which can provide new options for older patients. Geriatr Gerontol Int 2019; 19: 218-221.
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Affiliation(s)
- Xingwei Sun
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chuanlai Yang
- Department of Science and Education, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yubin Zhou
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuming Bai
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Weiwei Zheng
- Department of Orthopedics, Suzhou Hospital affiliated to Nanjing Medical University, Suzhou, China
| | - Yong Jin
- Department of Intervention, The Second Affiliated Hospital of Soochow University, Suzhou, China
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8
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Iorio O, Gazzanelli S, D'ermo G, Pezzolla A, Gurrado A, Testini M, Toma GD, Cavallaro G. A Prospective, Comparative Evaluation on Totally Implantable Venous Access Devices by External Jugular Vein versus Cephalic Vein Cutdown. Am Surg 2018. [DOI: 10.1177/000313481808400629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The request for totally implantable venous access devices (TIVADs) has rapidly grown up through the last decades. TIVADs are implanted by direct vein puncture or by surgical approach with vein cutdown. The authors present a comparative prospective study evaluating external jugular vein (EJV) and cephalic vein cutdown techniques. Two hundred and fifteen patients were consecutively submitted to TIVAD implantation to perform chemotherapy. Patients were divided in two groups, depending on the implantation technique. Group A patients (106) underwent implantation via EJV cutdown and group B (109) patients underwent implantation by cephalic vein cut-down. The following variables were investigated: operating time, need for conversion to other approaches, complications, and intraoperative and postoperative pain. In Group A patients, the success rate of the procedure was 100 per cent, whereas in 11 patients (10.1%) of Group B, a modification of the initial approach was needed. Mean operative time was 23.9 ± 9.2 minutes in Group A and 35.4 ± 11.9 in Group B, and this was statistically significant (P < 0.05). Complication rates at 30 days were similar. Considering intraoperative pain, a difference was found between the two groups because the mean value of pain in Group Awas lower than that in Group B (4.13 ± 0.3 vs 5.22 ± 1.24), even if not significant. External jugular vein cutdown approach is quick and safe and allows a very high success rate with very low risk of complications. For these reasons, this approach could be considered as a first choice in TIVAD placement.
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Affiliation(s)
- Olga Iorio
- General Surgery Unit, Aprilia Hospital, Aprilia, Italy
| | - Sergio Gazzanelli
- Department of Anesthesiology and Critical Care, Sapienza University, Rome, Italy
| | - Giuseppe D'ermo
- Department of Surgery “P. Valdoni”, Sapienza University, Rome, Italy
| | - Angela Pezzolla
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Angela Gurrado
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Giorgio De Toma
- Department of Surgery “P. Valdoni”, Sapienza University, Rome, Italy
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9
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Yıldırım İ, Tütüncü AÇ, Bademler S, Özgür İ, Demiray M, Karanlık H. Does the real-time ultrasound guidance provide safer venipuncture in implantable venous port implantation? J Vasc Access 2018; 19:297-302. [PMID: 29582679 DOI: 10.1177/1129729817752606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIM To examine whether the real-time ultrasound-guided venipuncture for implantable venous port placement is safer than the traditional venipuncture. METHODS The study analyzed the results of 2153 venous ports placed consecutively from January 2009 to January 2016. A total of 922 patients in group 1 and 1231 patients in group 2 were admitted with venous port placed using the traditional landmark subclavian approach and real-time ultrasound-guided axillary approach, respectively. Sociodemographic characteristics of patients, early (pneumothorax, pinch-off syndrome, arterial puncture, hematoma, and malposition arrhythmia) and late (deep vein thrombosis, obstruction, infection, erosion-dehiscence, and rotation of the port chamber) complications and the association of these complications with the implantation method were evaluated. RESULTS There were no significant differences in the sociodemographic characteristics of the patients between the two groups. The overall and early complications in group 2 were significantly lower than those in group 1. Pinch-off syndrome only developed in group 1. Seven patients and two patients had pneumothorax in groups 1 and 2, respectively. Puncture number was significantly associated with the development of the overall complications. CONCLUSION The ultrasound-guided axillary approach may be preferred as a method to reduce the risk of both early and late complications. Large, randomized, controlled prospective trials will be helpful in determining a safer implantable venous port implantation technique.
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Affiliation(s)
- İlknur Yıldırım
- 1 Department of Anesthesiology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Ayşe Çiğdem Tütüncü
- 2 Department of Anesthesiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Süleyman Bademler
- 3 Department of Surgery, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - İlker Özgür
- 4 Department of Surgery, Acibadem International Hospital, Istanbul, Turkey
| | - Mukaddes Demiray
- 5 Department of Surgery, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| | - Hasan Karanlık
- 3 Department of Surgery, Institute of Oncology, Istanbul University, Istanbul, Turkey
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10
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Nishinari K, Wolosker N, Vinicius Bernardi C, Yazbek G. Totally Implantable Ports Connected to Valved Catheters for Chemotherapy: Experience from 350 Groshong Devices. J Vasc Access 2018; 11:17-22. [PMID: 20119917 DOI: 10.1177/112972981001100104] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose There are few studies regarding the use of totally implantable valved ports for chemotherapy. The objective of this study was to analyze the results obtained from consecutive implantation of 350 devices. Methods Adult patients submitted to port insertion in veins of the superior vena cava system over a 17-month period (July 2006 to December 2007) were considered. The device used was composed of a titanium and silicone rubber port (Dome Port™; Bard Inc, Salt Lake City, UT) connected to an 8.0 Fr silastic Groshong™ catheter tube. Follow-up was conducted on outpatient data and during clinical readmissions, until the device was removed or the patient died. Results Three hundred and fifty devices, total of 74,691 days in situ, were inserted, with a median follow-up of 176 days. There were 11 early complications (3.1%) and 49 late complications (14%), 21 of these (6%) were considered major ones. Early complications comprised four instances of phlebitis of the external jugular, three of pocket infection, two of technical failure and two of ecchymosis. Late complications comprised 33 instances of withdrawal difficulty, 12 of port-related bacteremia, two of deep venous thrombosis, one of occlusion and one of catheter fracture. Out of the 350 catheters implanted, 258 (73.5%) were still being used, 73 (21%) remained in use until the patient died, five (1.5%) were removed at the end of the treatment and 14 (4%) were removed because of complications. Conclusions There was a low rate of major complications associated with this valved system justifying its use.
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Affiliation(s)
- Kenji Nishinari
- Department of Vascular Surgery, Hospital A.C. Camargo, São Paulo - Brazil
| | - Nelson Wolosker
- Department of Vascular Surgery, Hospital A.C. Camargo, São Paulo - Brazil
| | | | - Guilherme Yazbek
- Department of Vascular Surgery, Hospital A.C. Camargo, São Paulo - Brazil
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11
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Matiotti-neto M, Eskander MF, Tabatabaie O, Kasumova G, Bliss LA, Ng SC, Tawa NE, Murphy B, Critchlow JF, Tseng JF. Percutaneous versus Cut-Down Technique for Indwelling Port Placement. Am Surg 2017. [DOI: 10.1177/000313481708301214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The superiority of surgical cut-down of the cephalic vein versus percutaneous catheterization of the subclavian vein for the insertion of totally implantable venous access devices (TIVADs) is debated. To compare the safety and efficacy of surgical cut-down versus percutaneous placement of TIVADs. This is a single-institution retrospective cohort study of oncologic patients who had TIVADs implanted by 14 surgeons. Primary outcomes were inability to place TIVAD by the primary approach and postoperative complications within 30 days. Multivariate analysis was performed by logistic regression. Secondary outcomes included operative time. Two hundred and forty-seven (55.9%) percutaneous and 195 (44.1%) cephalic cut-down patients were identified. The 30-day complication rate was 5.2 per cent: 14 patients (5.7%) in the percutaneous and nine (4.6%) in the cut-down group. The technique was not a significant predictor of having a 30-day complication (odds ratio = 0.820; 95% confidence interval 0.342–1.879). Implantation failure was observed in 16 percutaneous patients (6.5%) and 28 cut-down patients (14.4%) (adjusted odds ratio for cephalic vs cut-down = 2.387; 95% confidence interval 1.275–4.606). The median operative time for percutaneous patients was 46 minutes (interquartile range = 35, 59) versus 37.5 minutes (interquartile range = 30, 49) for cut-down patients(P < 0.0001). Both the percutaneous and cut-down technique are safe and effective for TIVAD implantation. Operative times were shorter and the odds of implantation failure higher for cephalic cut-down. As implantation failure is common, surgeons should familiarize themselves with both techniques.
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Affiliation(s)
- Mario Matiotti-neto
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Mariam F. Eskander
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Omidreza Tabatabaie
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Gyulnara Kasumova
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Lindsay A. Bliss
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Sing Chau Ng
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Nicholas E. Tawa
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Blanche Murphy
- Central Line Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jonathan F. Critchlow
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Jennifer F. Tseng
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
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12
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Pneumothorax and Subclavian Vein Thrombosis in Patients With Venous Access Device Implantation. Int Surg 2017. [DOI: 10.9738/intsurg-d-15-00019.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The primary aim is to assess the length of hospitalization due to iatrogenic pneumothorax as a main complication of totally implantable venous access device (TIVAD) implantation. Secondary aim is to analyze the thrombogenic effects of different catheter diameters on the subclavian vein. Pneumothorax is a rare and may be underestimated, underdocumented, but serious complication in TIVAD of implantation using the subclavian vein puncture method. A total of 1155 consecutive patients with TIVAD implantation were assessed retrospectively over a 14-year time period. As primary outcome the length of hospitalization due to iatrogenic pneumothorax and as secondary outcome subclavian vein thrombosis (SVT) in relation to different TIVAD catheter sizes were analyzed. Pneumothoraces occurred 6 times (0.52%) and only when the subclavian vein was punctured. The median hospitalization for these patients was 8 days (5 of the 6 patients needed a chest drain). No pneumothoraces occurred when a peripheral vein was used for access (980 patients). SVTs were detected in 13 patients (1.1%) without any correlation to the diameter of the catheter. There was no significant correlation detected between the different tumor types and the complication rates. Iatrogenic pneumothorax may lead to hospitalization of 1 week or more. The costs then increase with additional chests x-rays, chest drain insertions, and hospitalization days. When making the choice for surgical venous cutdown or subclavian vein puncture to implant TIVAD, the consequences of iatrogenic pneumothorax should be considered as pneumothorax is a rare but serious complication of TIVAD implantation inherent to subclavian vein puncture.
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Ben Kridis W, Sahnoun M, Maraoui H, Amari N, Frikha M. Fracture at catheter of totally implantable venous access port with migration into the right pulmonary artery: A serious complication. Acta Clin Belg 2016; 71:349-352. [PMID: 27177614 DOI: 10.1080/17843286.2016.1153212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Totally implantable venous access port has become an essential prerequisite for many chemotherapy protocols in solid tumors and hematological malignancies. However, we should be aware of its complications such as: venous thrombosis, extravasations, dislocation, obstruction, catheter leakage, and local or systemic infections. Among those complications, a dislodged broken catheter is rare and dangerous. We report a new case with review of literature to make oncologists aware about this entity and the necessity of monitoring by chest radiography. Percutaneous endovascular retrieval of a dislodged Port-A catheter (portacath) is both safe and effective. However, there are potential risks of valve damage and fatal tachycardia during retrieval of a fractured Port-A catheter. Physicians should be aware of these complications.
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Shiono M, Takahashi S, Takahashi M, Yamaguchi T, Ishioka C. Current situation regarding central venous port implantation procedures and complications: a questionnaire-based survey of 11,693 implantations in Japan. Int J Clin Oncol 2016; 21:1172-1182. [PMID: 27324107 DOI: 10.1007/s10147-016-1003-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND We conducted a nationwide questionnaire-based survey to understand the current situation regarding central venous port implantation in order to identify the ideal procedure. METHODS Questionnaire sheets concerning the number of implantation procedures and the incidence of complications for all procedures completed in 2012 were sent to 397 nationwide designated cancer care hospitals in Japan in June 2013. Venipuncture sites were categorized as chest, neck, upper arm, forearm, and others. Methods were categorized as landmark, cut-down, ultrasound-mark, real-time ultrasound guided, venography, and other groups. RESULTS We received 374 responses (11,693 procedures) from 153 centers (38.5 %). The overall complication rates were 7.4 % for the chest (598/8,097 cases); 6.8 % for the neck (157/2325); 5.2 % for the upper arm (54/1,033); 7.3 % for the forearm (9/124); and 6.1 % for the other groups (7/114). Compared to the chest group, only the upper arm group showed a significantly lower incidence of complications (P = 0.010), and multivariate logistic regression (odds ratio 0.69; 95 % confidence interval 0.51-0.91; P = 0.008) also showed similar findings. Real-time ultrasound-guided puncture was most commonly used in the upper arm group (83.8 %), followed by the neck (69.8 %), forearm (53.2 %), chest (41.8 %), and other groups (34.2 %). CONCLUSION Upper arm venipuncture with ultrasound guidance seems the most promising technique to prevent complications of central venous port implantation.
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Affiliation(s)
- Masatoshi Shiono
- Department of Medical Oncology, Tohoku University Hospital, Tohoku University, Seiryo-machi 1-1, Aoba-ku, Sendai, 980-8574, Japan.,Department of Clinical Oncology, Institute of Development, Aging, and Cancer, Tohoku University, Seiryo-machi 4-1, Aoba-ku, Sendai, 980-8575, Japan
| | - Shin Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Tohoku University, Seiryo-machi 1-1, Aoba-ku, Sendai, 980-8574, Japan.,Department of Clinical Oncology, Institute of Development, Aging, and Cancer, Tohoku University, Seiryo-machi 4-1, Aoba-ku, Sendai, 980-8575, Japan
| | - Masanobu Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Tohoku University, Seiryo-machi 1-1, Aoba-ku, Sendai, 980-8574, Japan.,Department of Clinical Oncology, Institute of Development, Aging, and Cancer, Tohoku University, Seiryo-machi 4-1, Aoba-ku, Sendai, 980-8575, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi 1-1, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Chikashi Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Tohoku University, Seiryo-machi 1-1, Aoba-ku, Sendai, 980-8574, Japan. .,Department of Clinical Oncology, Institute of Development, Aging, and Cancer, Tohoku University, Seiryo-machi 4-1, Aoba-ku, Sendai, 980-8575, Japan.
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Almasi-Sperling V, Hieber S, Lermann J, Strahl O, Beckmann MW, Lang W, Sagban TA. Femoral Placement of Totally Implantable Venous Access Ports in Patients with Bilateral Breast Cancer. Geburtshilfe Frauenheilkd 2016; 76:53-58. [PMID: 26855441 DOI: 10.1055/s-0035-1558173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Purpose: Aim of this study was to determine the rate of complications following femoral placement of totally implantable venous access ports (f-TIVAP) in women with bilateral breast cancer, with a special focus on long-term function, deep vein thrombosis (DVT), and port infection. Methods: 73 patients with bilateral breast cancer treated between October 2000 and January 2013 with placement of an f-TIVAP using a transfemoral approach were retrospectively reviewed. All patients were followed up, and all complications of f-TIVAP were recorded. Results: The median age was 62.5 years (range: 35-86 years). Four patients received f-TIVAP under local anesthesia, and 69 underwent placement under general anesthesia. Mean follow-up was 33.7 months (SD 25.9; range: 0.2-93.5 months). Complications over the entire period of observation included infections in 21 %, DVT in 19 % and catheter occlusion in 12 %. Patients receiving chemotherapy who developed leukopenia were more likely to experience DVT at the access site (p = 0.037). There was a trend towards a higher infection rate when the device was used more often (p = 0.084). Conclusion: Although the rates of complications in the longer term, especially device infections and DVTs, appeared to be relatively high, TIVAP implantation using femoral vein access is recommended in patients with bilateral breast cancer not suitable for cephalic vein cut-down.
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Affiliation(s)
- V Almasi-Sperling
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
| | - S Hieber
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
| | - J Lermann
- Department of Obstetrics and Gynecology, Friedrich Alexander University Erlangen, Erlangen
| | - O Strahl
- Department of Obstetrics and Gynecology, Friedrich Alexander University Erlangen, Erlangen
| | - M W Beckmann
- Department of Obstetrics and Gynecology, Friedrich Alexander University Erlangen, Erlangen
| | - W Lang
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
| | - T A Sagban
- Department of Vascular Surgery, Friedrich Alexander University Erlangen, Erlangen
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Ultrasound-guided vein puncture versus surgical cut-down technique in totally implantable venous access devices (TIVADS): a prospective comparative study on safety, efficacy andcomplications. Int Surg 2015; 99:475-8. [PMID: 25058787 DOI: 10.9738/intsurg-d-14-00008.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Short-term and long-term outcome of radiological-guided insertion of central venous access port devices implanted at the forearm: a retrospective monocenter analysis in 1704 patients. Eur Radiol 2014; 25:606-16. [PMID: 25239184 DOI: 10.1007/s00330-014-3417-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/06/2014] [Accepted: 08/27/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objectives are to analyze the technical success rate as well as the short-term and long-term complications of totally implantable venous access ports (TIVAPs) at the forearm. METHODS Retrospective analysis of 1,704 consecutively implanted TIVAPs was performed. Primary endpoints were defined as technical success rate, clinical outcome, device service interval, and rates of major complications. Minor complications not requiring port explantation were defined as secondary endpoints. RESULTS The technical success rate was 99.2 % with no major complications. During follow-up, a total of 643,200 catheter-days were documented, the mean device service interval was 380.6 days/patient. A total of 243 complications (14.4 %) in 226 patients were observed (0.4/1000 catheter-days), in 140 patients (8.3 %) the port device had to be explanted. Disconnection between the port device and the catheter (1.6 %) was more frequent than fracture (0.8 %) and leakage (0.6 %) of the catheter, which occurred more frequently when the catheter was inserted via the cephalic versus the brachial vein. CONCLUSION TIVAP implantation at the forearm is a simple and safe procedure with a low rate of early and late complications.
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El Hammoumi M, El Ouazni M, Arsalane A, El Oueriachi F, Mansouri H, Kabiri EH. Incidents and complications of permanent venous central access systems: a series of 1,460 cases. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:117-23. [PMID: 24782960 PMCID: PMC4000867 DOI: 10.5090/kjtcs.2014.47.2.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 10/02/2013] [Accepted: 10/07/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Implanted venous access devices or permanent central venous access systems (PCVASs) are routinely used in oncologic patients. Complications can occur during the implantation or use of such devices. We describe such complications of the PCVAS and their management. METHODS Our retrospective study included 1,460 cases in which PCVAS was implanted in the 11 years between January 2002 and January 2013, including 810 women and 650 men with an average age of 45.2 years. We used polyurethane or silicone catheters. The site of insertion and the surgical or percutaneous procedure were selected on the basis of clinical data and disease information. The subclavian and cephalic veins were our most common sites of insertion. RESULTS About 1,100 cases (75%) underwent surgery by training surgeons and 360 patients by expert surgeons. Perioperative incidents occurred in 33% and 12% of these patients, respectively. Incidents (28%) included technical difficulties (n=64), a subcutaneous hematoma (n=37), pneumothoraces (n=15), and an intrapleural catheter (n=1). Complications in the short and medium term were present in 14.2% of the cases. Distortion and rupture of the catheter (n=5) were noted in the costoclavicular area (pinch-off syndrome). There were 5 cases of catheter migration into the jugular vein (n=1), superior vena cava (n=1), and heart cavities (n=3). No patient died of PCVAS insertion or complication. CONCLUSION PCVAS complications should be diagnosed early and treated with probable removal of this material for preventing any life-threatening outcome associated with complicated PVCAS.
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Affiliation(s)
- Massine El Hammoumi
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Morocco
| | | | - Adil Arsalane
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Morocco
| | - Fayçal El Oueriachi
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Morocco
| | - Hamid Mansouri
- Department of Radiotherapy, Mohamed V Military University Hospital, Morocco
| | - El Hassane Kabiri
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Morocco
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Wang SC, Tsai CH, Hou CP, Lee SY, Ko SF, Hsiao CC, Chen YC, Chuang JH, Sheen JM. Dislodgement of port-A catheters in pediatric oncology patients: 11 years of experience. World J Surg Oncol 2013; 11:191. [PMID: 23941644 PMCID: PMC3765137 DOI: 10.1186/1477-7819-11-191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 08/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Port-A catheters are frequently used in pediatric cancer patients. Their dislodgement is potentially seriously risky although the incidence is not high. We analyzed our 11 years of data to address this important problem. METHODS From January 2001 to December 2011, 330 port-A catheters of different brands were implanted in pediatric cancer patients. In total, eight children suffered a dislodgement of their catheter. Their ages ranged from four to thirteen years, with a median age of ten. Five patients presented with catheter dysfunction, two presented with a cough and one was identified incidentally during surgery to remove his port. RESULTS The downstream ends of the dislodged catheters were located in the right atrium (three patients), left pulmonary artery (three) and inferior vena cava (two). Six of the eight catheters were broken at the site of anastomosis to the port and the other two were broken halfway in between. All episodes of dislodgement happened after the chemotherapy regimen was completed. The dislodged catheters were successfully retrieved without complications by transcatheter retrieval using a gooseneck snare. CONCLUSIONS The dislodgment rate of port-A catheter in our series was 2.4%. Chest X-rays can rapidly detect the problem. Most of the catheters were broken at the site of anastomosis. Earlier explantation of port-A catheters after completing chemotherapy may be considered to avoid the dislodgement of catheters, but this needs to be weighed against the possibility of underlying disease recurrence. However, we should re-examine how long port-A catheters need to be retained after chemotherapy considering the improved cure rate of pediatric cancer.
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Subclavian vein puncture vs. surgical cut-down to the cephalic vein for insertion of totally implantable venous access ports. Eur Surg 2012. [DOI: 10.1007/s10353-012-0157-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Plumhans C, Ocklenburg C, Verburg FA, Günther RW, Behrendt FF. High pressure versus standard port system: Comparison of implantation and complications. J Med Imaging Radiat Oncol 2012; 56:532-7. [DOI: 10.1111/j.1754-9485.2012.02439.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/03/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Cédric Plumhans
- Departments of Radiology; University Hospital, RWTH-Aachen University; Aachen; Germany
| | - Christina Ocklenburg
- Institute of Medical Statistics; University Hospital, RWTH-Aachen University; Aachen; Germany
| | - Frederik A. Verburg
- Nuclear Medicine; University Hospital, RWTH-Aachen University; Aachen; Germany
| | - Rolf W. Günther
- Departments of Radiology; University Hospital, RWTH-Aachen University; Aachen; Germany
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Ribeiro RC, Abib SCV, Aguiar AS, Schettini ST. Long-term complications in totally implantable venous access devices: randomized study comparing subclavian and internal jugular vein puncture. Pediatr Blood Cancer 2012; 58:274-7. [PMID: 21674765 DOI: 10.1002/pbc.23220] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 05/03/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND This prospective randomized study evaluated complications related to long-term totally implantable catheters in oncologic children and adolescents by comparing venopunction performed either in the jugular or subclavian vein. METHODS A total of 83 catheters were implanted from January 2004 to April 2006 and followed-up until March 2008. Patients were randomly allocated to the subclavian or jugular vein group. The endpoint was complications that led to catheter revision or catheter removal. RESULTS Six patients were excluded, 43 had the catheter implanted in the subclavian and 34 in the jugular vein. Subclavian catheters were used for up to 12.6 months, while jugular catheters were kept in place for up to 14.8 months (P = 0.38). No statistical differences were found between the groups concerning age, sex, leukocyte count, platelet count, type of admission (in or outpatient), or previous chemotherapy regimens. When analyzed individually, long-term complications did not present statistically significant differences either. Infection occurred in 20 and 11% (P = 0.44), while catheter embolism took place in 23 and 8% (P = 0.11) of patients with subclavian and jugular catheters, respectively. A statistical difference was seen in the total number of complications, which occurred in 48 and 23% (P = 0.02) of patients in the subclavian and in the jugular groups, respectively. CONCLUSIONS Catheters implanted by puncture in the subclavian vein were more prone to late complications than those implanted in the jugular vein.
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Affiliation(s)
- Rodrigo C Ribeiro
- Pediatric Surgery Department, Federal University of São Paulo, São Paulo, Brazil.
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Goossens GA, Stas M, Jérôme M, Moons P. Systematic review: malfunction of totally implantable venous access devices in cancer patients. Support Care Cancer 2011; 19:883-98. [DOI: 10.1007/s00520-011-1171-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 04/18/2011] [Indexed: 11/25/2022]
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Use of a totally implantable access port through the external jugular vein when the cephalic vein approach is not feasible. Ann Vasc Surg 2010; 25:217-21. [PMID: 20926248 DOI: 10.1016/j.avsg.2010.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 07/04/2010] [Accepted: 07/19/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND We report our experience of using a totally implantable access port (TIAP) through the external jugular vein (EJV) when the cephalic vein (CV) approach is not feasible. METHODS We reviewed 197 cases involving TIAP implantation through the EJV in a single medical center between January 1995 and January 2009. All the ports were implanted after the CV approach was found unfeasible. Patient characteristics, operating time, and early and late complications were recorded. RESULTS The mean patient age was 50 years (range: 33-75). The mean operating time was 54.5 ± 7.5 minutes. Early complications within the first 30 postoperative days included port hematoma (2%) and catheter migration (2%). The late postoperative complications included catheter occlusion (2.5%), venous thrombosis (2%), and port infection (1.5%). There were no complications associated with TIAP disconnection. CONCLUSIONS The EJV approach is an easy and safe alternative method for TIAP implantation when the CV approach is not feasible. This method can avoid conversion to percutaneous puncture of the subclavian vein, which could result in life-threatening complications such as pneumothorax and hemothorax. In patients with breast cancer or those who are contraindicated for TIAP implantation on the opposite side, the EJV cutdown approach provides an alternative route with comfortable and satisfactory results as complications with this approach are rare.
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Koketsu S, Samesima S, Yoneyama S, Okada T, Tomozawa S, Horikoshi H, Sawada T. Outcome of cephalic vein cut-down approach: A safe and feasible approach for totally implantable venous access device placement. Oncol Lett 2010; 1:1029-1031. [PMID: 22870107 DOI: 10.3892/ol.2010.189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 09/11/2010] [Indexed: 11/06/2022] Open
Abstract
This study aimed to evaluate the safety and feasibility of the venous access via the cephalic vein cut-down (CVCD) approach for totally implantable venous access device (TIVAD) placements. A total of 79 patients who received TIVAD for the treatment of unresectable or recurrent colorectal carcinomas were recruited. The operation time and the complications were evaluated. Results showed the TIVAD placement via the CVCD approach was successful in 74 patients. A total of 5 patients required conversion to a percutaneous puncture approach. The mean operation time was 34.7 min. No intraoperative or postoperative complications were observed. Therefore, the CVCD approach is a safe and feasible method for TIVAD placement.
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Affiliation(s)
- Shinichiro Koketsu
- First Department of Surgery, Koshigaya Hospital, Dokkyo Medical University, Saitama
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Plumhans C, Mahnken AH, Ocklenburg C, Keil S, Behrendt FF, Günther RW, Schoth F. Jugular versus subclavian totally implantable access ports: catheter position, complications and intrainterventional pain perception. Eur J Radiol 2010; 79:338-42. [PMID: 20227211 DOI: 10.1016/j.ejrad.2009.12.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 12/03/2009] [Accepted: 12/04/2009] [Indexed: 01/04/2023]
Abstract
PURPOSE To determine the safest and most tolerable method for totally implantable access ports (TIAPs) particularly in regard to patient's pain perception and catheter-related complications. MATERIALS AND METHODS From January 2007 to October 2008 a subcutaneous TIAP (Bardport, Bard Access System, UT, USA) was implanted in 138 oncological patients (60 male, 78 female; 18-85 years old; mean age of 56 ± 6 years) by experienced interventional radiologists. 94 TIAP were implanted through the subclavian vein (subclavian group) and 44 TIAP were implanted through the internal jugular vein (jugular group). Intrainterventional pain perception (visual analogue scale from 1 to 10), postinterventional catheter tip migration and radiation dose were documented for each method and implantation side and differences were compared with Wilcoxon t-test. For ordinal variables, comparison of two groups was performed with the Fisher's exact test. RESULTS No severe periinterventional complication occurred. Inadvertent arterial punctures without serious consequences were reported in one case for the jugular group versus four cases in the subclavian group. Significantly (p<0.05) lower pain perception, radiation dose and tip migration rate were observed in the jugular group. Catheter occlusions occurred in 4% (n=4) of the subclavian group versus 2% (n=1) of the jugular group. The corresponding values for vein thrombosis and catheter dislocation were 3% (n=3) and 1% (n=1) in the subclavian group, while none of those complications occurred in the jugular group. CONCLUSION Both techniques, the TIAP implantation via fluoroscopy-guided subclavian vein puncture and via ultrasound-guided jugular vein puncture, are feasible and safe. Regarding intrainterventional pain perception, radiation dose, postinterventional catheter tip position and port function the jugular vein puncture under ultrasound guidance seems to be advantageous.
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Affiliation(s)
- Cédric Plumhans
- Department of Diagnostic Radiology, University Hospital, RWTH-Aachen University, Aachen, Germany.
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Di Carlo I, Pulvirenti E, Mannino M, Toro A. Increased use of percutaneous technique for totally implantable venous access devices. Is it real progress? A 27-year comprehensive review on early complications. Ann Surg Oncol 2010; 17:1649-56. [PMID: 20204533 DOI: 10.1245/s10434-010-1005-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND First implantation of a totally implantable venous access device (TIVAD) was performed in 1982 with surgical technique. Since then, these devices have permitted infusion of total parenteral nutrition, antibiotics, blood products, and, above all, they have definitively changed the quality of life of patients with cancer. However, with the increase of percutaneous procedures, we have assisted with a concomitant raise of immediate postprocedural life-threatening complications. The aim of this study was to review the literature during a 27-year period, with regard to the changes of incidence of immediate complications after percutaneous or surgical cutdown for TIVAD's implant. MATERIALS AND METHODS An extensive search of relevant literature was carried out by using MEDLINE (PubMed) and Google Scholar. We gathered articles from 1982 to 2009 that quoted patient's number, type of pathology, specialist involved, number of devices implanted, site and technique of implantation (surgical cutdown or percutaneous technique), and immediate complications occurrence. RESULTS A total of 952 reports were screened, and finally only 45 articles addressing all inclusion criteria were used for the present study. A total of 11,430 TIVADs implanted in 11,381 patients were analyzed. Pneumothorax, hemothorax, arterial puncture, and hemoptysis developed only after percutaneous procedures. Atrial fibrillation, hematomas, and malpositioning were more frequent after percutaneous approach. The total amount of immediate complications in patients submitted to percutaneous implant was 4.5%, compared with 0.9% subsequent to cutdown technique. CONCLUSIONS Despite the increased use of percutaneous technique for TIVADs' implantation, surgical cutdown, because of its safety, remains the best approach to avoid possible fatal immediate complications.
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Affiliation(s)
- Isidoro Di Carlo
- Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies, University of Catania, Catania, Italy,
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Lin C, Wu H, Chan D, Hsieh C, Huang M, Yu J. The mechanisms of failure of totally implantable central venous access system: Analysis of 73 cases with fracture of catheter. Eur J Surg Oncol 2010; 36:100-3. [DOI: 10.1016/j.ejso.2009.07.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Revised: 06/20/2009] [Accepted: 07/09/2009] [Indexed: 10/20/2022] Open
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Sonobe M, Chen F, Fujinaga T, Sato K, Shoji T, Sakai H, Miyahara R, Bando T, Okubo K, Hirata T, Date H. Use of totally implantable central venous access port via the basilic vein in patients with thoracic malignancies. Int J Clin Oncol 2009; 14:208-12. [PMID: 19593611 DOI: 10.1007/s10147-008-0835-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 09/03/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND For patients with a thoracic malignancy whose peripheral veins are not suitable for blood access for chemotherapy, we evaluated a totally implantable central venous access port, in which the port is implanted in the ulnar side of the arm and the catheter is introduced via the basilic vein into the superior vena cava (TIAP-BV). METHODS Twenty-five patients (21 with lung cancer, 2 with malignant pleural mesothelioma, and 2 with thymoma) receiving TIAP-BV were included. Indications, surgical complications, and long-term complications were analyzed. RESULTS Indications for TIAP-BV were: chemotherapy (17 patients) and chemotherapy with parenteral nutrition (8 patients). The following surgical complications occurred: arrhythmia due to misplacement of the tip of catheter (1 patient); intraoperative conversion from the left to right arm (2 patients); and hematoma at the implantation site (1 patient). Short-term problems were: death 1 week after implantation without the use of TIAP-BV (2 patients). Long-term complications were: skin ulcer at the port site (1 patient); early removal of TIAP-BV because of port site infection (1 patient); catheter occlusion (1 patient); and venous thrombosis of basilic vein (2 patients). In the 22 patients who did not die early or have the device withdrawn early, the median duration of TIAP-BV use was 7 months (range, 1 to 20 months) without any break to the port system, leakage of drugs, or catheter-related infections. CONCLUSION TIAP-BV can be employed for long-term use for chemotherapy and parenteral nutrition. However, a patient's expected prognosis and infectious disease status at the time of implantation surgery should be considered before the surgery proceeds.
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Affiliation(s)
- Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Shogoin-kawaracho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Karanlik H, Kurul S. Modification of approach for totally implantable venous access device decreases rate of complications. J Surg Oncol 2009; 100:279-83. [DOI: 10.1002/jso.21341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Crisinel M, Mahy S, Ortega-Debalon P, Buisson M, Favre JP, Chavanet P, Piroth L. Incidence, prévalence et facteurs de risque de survenue d’une première complication infectieuse sur chambres à cathéter implantables. Med Mal Infect 2009; 39:252-8. [DOI: 10.1016/j.medmal.2008.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 10/02/2008] [Accepted: 11/14/2008] [Indexed: 10/21/2022]
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Royle TJ, Davies RE, Gannon MX. Totally implantable venous access devices - 20 years' experience of implantation in cystic fibrosis patients. Ann R Coll Surg Engl 2009; 90:679-84. [PMID: 18990281 DOI: 10.1308/003588408x321684] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Totally implantable venous access devices (TIVADs) are widely used to provide long-term, central venous access for antibiotic delivery in cystic fibrosis patients. However, few studies have demonstrated long-term follow-up with large cohorts. PATIENTS AND METHODS This is a retrospective review of TIVADs implanted in cystic fibrosis patients by vascular surgeons at a tertiary referral centre, using an open venous cut-down technique, from March 1986 to July 2006. The cephalic vein was preferentially chosen for line placement, in the deltopectoral groove, under fluoroscopic control. TIVAD performance (life-span or survival) and complications were evaluated. Data were extracted by review of a local database (data collated prospectively since 1986), with supplementation from electronic patient records and medical notes. RESULTS In total 165 TIVADs in 109 patients (34 males, 75 females) were reviewed. Median survival was 1441 days (range, 6-4440 days). Cumulative patency was 146,072 catheter-days. No immediate intrathoracic complications (pneumothorax, haemothorax, nerve injury) occurred. There were 3 early and 82 late complications, namely: occlusion (33 TIVADs; median age 510 days), infection (23 TIVADs; median 376 days), leakage (16; median 283 days), pain or discomfort (6), venous thrombosis (5), extravasation/skin necrosis (1), vegetation in right atrium (1). Overall incidence of complications was 0.58 per 1000 catheter-days. CONCLUSIONS This study concurs with others that TIVADs are safe and effective, with a favourable life-span in cystic fibrosis patients if well looked after in a specialist centre. Complications of infection, leakage and occlusion do occur. Using an open, venous cut-down technique with fluoroscopic control avoids any immediate intrathoracic complications.
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Affiliation(s)
- T James Royle
- Department of Vascular Surgery, Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
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A Comparison of Clinical Outcomes with Regular- and Low-Profile Totally Implanted Central Venous Port Systems. Cardiovasc Intervent Radiol 2008; 32:975-9. [DOI: 10.1007/s00270-008-9477-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 10/29/2008] [Accepted: 11/05/2008] [Indexed: 11/26/2022]
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Miranda RBD, Lopes JRA, Cavalcante RN, Kafejian O. Perviedade e complicações no seguimento de cateteres venosos totalmente implantáveis para quimioterapia. J Vasc Bras 2008. [DOI: 10.1590/s1677-54492008000400005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTO: A disponibilidade de acesso venoso nos pacientes que recebem cursos prolongados de terapia citotóxica é de grande importância para o sucesso do tratamento. Os cateteres totalmente implantáveis vêm sendo cada vez mais utilizados para a referida terapia, proporcionando melhoria na qualidade de vida dos doentes. OBJETIVO: Avaliar a perviedade e complicações dos cateteres venosos totalmente implantáveis instalados nos pacientes oncológicos. MÉTODOS: Estudo longitudinal retrospectivo com 74 pacientes submetidos a colocação de cateter totalmente implantável de janeiro de 2004 a fevereiro de 2007. RESULTADOS: Foram inseridos cateteres venosos totalmente implantáveis em 74 pacientes com idade média 48,9 anos, predominando o sexo feminino. As neoplasias mais prevalentes foram mama (40,5%), cólon (20,8%) e linfoma (18,9%). Houve predomínio do acesso venoso pela via cervical (74,3%), com utilização da veia jugular interna em 45,9% dos casos. Somente 13,5% dos acessos ocorreram por punção da veia subclávia. A duração média de uso dos cateteres foi de 335,33 dias. Trinta e seis doentes (48,6%) mantiveram-se com o cateter após o término da quimioterapia. Sessenta e sete doentes (90,5%) não apresentaram complicações. Entre as complicações precoces, houve um (1,4%) pneumotórax e um (1,4%) hematoma na loja de implantação. Entre as complicações tardias, ocorreram cinco (6,7%) infecções. Foram retirados 10 (13,5%) cateteres, cinco devido às complicações e cinco por término do tratamento. Houve 11 (14,9%) óbitos de pacientes em decorrência do câncer, com o cateter funcionante. CONCLUSÃO: Os resultados obtidos demonstram baixa taxa de complicações, confirmando a segurança e conveniência do uso dos acessos totalmente implantáveis em paciente em regime de quimioterapia.
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Chen SY, Lin CH, Chang HM, Hsu HM, Yu JC. A safe and effective method to implant a totally implantable access port in patients with synchronous bilateral mastectomies: modified femoral vein approach. J Surg Oncol 2008; 98:197-9. [PMID: 18704915 DOI: 10.1002/jso.21048] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study was to develop a modified method to implant a totally implantable access port (TIAP) using the femoral vein approach. METHODS We designed a modified method using the femoral vein approach to implant a TIAP in patients with synchronous bilateral breast cancer requiring bilateral mastectomy and postoperative chemotherapy. TIAP implantation was performed with parenteral sedation and local anesthesia in the operating room. All patients were followed for at least 12 months and the complications of TIAP were recorded. RESULTS In this retrospective study, 86 patients received the TIAP using the modified femoral vein approach. All patients had a history of bilateral breast cancer and underwent bilateral mastectomy. The early complication rate within the first 30 postoperative days was 2.3% and involved groin hematoma caused by missed puncture to the femoral artery during the operation. The late postoperative complication rates were 2.3% caused by local port infection, 1.2% by groin wound infection, and 3.5% by catheter occlusion. There were no complications associated with TIAP disconnection or systemic infection. CONCLUSION Traditional implantation of TIAP through the subclavian vein or cephalic vein is simple and is used worldwide. However, both the percutaneous puncture and cutdown methods have limitations and risks. We describe a safe and effective method using the modified femoral vein approach for specific patients.
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Affiliation(s)
- Shih-Yi Chen
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Central venous access: techniques and indications in oncology. Eur Radiol 2008; 18:2333-44. [PMID: 18458909 DOI: 10.1007/s00330-008-0981-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 03/21/2008] [Indexed: 10/22/2022]
Abstract
Long lines can be inserted centrally or peripherally through patent veins into the central venous system down to the atrial caval junction. Traditionally surgeons, anesthetists, cardiologists and more recently interventional radiologists have been placing them using vein cutdown or percutaneous needle puncture techniques. Typical candidates for implanted venous catheters are cancer patients undergoing long-term chemotherapy. The most important issues, in addition to the patency of central veins and the history of previous indwelling catheters, pacewires or venous thrombosis, are the patient's performance status, body mass index, medical history and respiratory status, and the relevant technique. The present article will give an overview of the radiological and surgical implantation techniques and will highlight the impact of imaging means on the technical feasibility, assessment and treatment of device-related complications.
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Marcy PY. Quality of life in female and breast cancer patients. Eur J Surg Oncol 2008; 34:252. [PMID: 17640845 DOI: 10.1016/j.ejso.2007.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 05/05/2007] [Indexed: 11/29/2022] Open
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Huang WH, Chuang CH, Yu JC, Wu HS, Lin CH. Totally Implantable Access Ports: Approach via Femoral Vein. Visc Med 2007. [DOI: 10.1159/000099462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Araújo C, Silva JP, Antunes P, Fernandes JM, Dias C, Pereira H, Dias T, Fougo JL. A comparative study between two central veins for the introduction of totally implantable venous access devices in 1201 cancer patients. Eur J Surg Oncol 2007; 34:222-6. [PMID: 17566692 DOI: 10.1016/j.ejso.2007.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Accepted: 04/10/2007] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION AND AIMS The Subclavian vein has been traditionally the vein of choice for central venous catheterization by general surgeons. Alternative settings for the introduction of totally implantable venous access devices (TIVAD) and the search for lower rates of morbidity led to the choice of other central veins. This study compares two different venous accesses, the subclavian (SC) versus the internal jugular (IJ), in terms of early and late morbidity. PATIENTS AND METHODS This is a prospective, non-randomized, observational, uni-institutional (tertiary cancer centre) study. From March 2003 to March 2006, 1231 TIVADs were placed (1201 patients), in an ambulatory operating room, under vital signs and EKG monitoring, using local anaesthesia and without perioperative radiological control. RESULTS Of the 1231 TIVAD, 617 were inserted via the SC and 614 via the IJ vein. The two groups (SC vs. IJ) were comparable as to general patient characteristics. Immediate complications were more frequent in the SC than in the IJ approach (respectively, 5.0% vs. 1.5%; p<0.001); Catheter malposition occurred in 2.3% when using the SC vein and in 0.2% for the IJ (p=0.001). Long term morbidity was also more frequent in the SC than in the IJ group (respectively, 15.8%, 87/551, vs. 7.6%, 39/512; p<0.001). Venous thrombosis developed in 2.0% of patients with an SC TIVAD as compared to 0.6% with an IJ TIVAD (p=0.044). Catheter malfunction was significantly dependent on the vein used: SC - 9.4% vs. IJ - 4.3% (p=0.001). CONCLUSIONS Our results support the preferential use of the Internal Jugular vein for the insertion of TIVAD.
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Affiliation(s)
- C Araújo
- Department of Surgical Oncology, Portuguese Institute of Oncology Francisco Gentil, Porto Centre, Portugal
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