Complications associated with the removal of totally implantable venous access devices (TIVADs): a retrospective analysis of 4,954 breast cancer patients in a single institution

Abstract

BackgroundTotally implantable venous access devices (TIVADs) have been widely used for many years in the management of cancer patients. However, previous studies have rarely focused on the period surrounding TIVAD removal, which is a critically important phase for these devices. This study aims to address this gap by investigating the surgical approaches, timing, and associated complications related to the removal of TIVADs, thereby enhancing the management of these devices.MethodA retrospective analysis was conducted on a cohort of 4,954 TIVAD extraction procedures performed at the Breast Center of the Fourth Hospital of Hebei Medical University between January 1, 2016, and August 1, 2023.ResultsAmong 4,954 cases, the indwelling time of TIVADs for included patients ranged from 2 to 60 months. 4,882(98.5%) cases removed their TIVADs after completion of cancer treatment, while 72 cases (1.5%) were unplanned removal due to TIVADs related complications. Two surgical techniques were observed for port removal: in 20% of cases, the injection port was removed first, followed by the catheter; in 80% of cases, the catheter was removed first, followed by the injection port. Complications during TIVADs removal were observed in 13 cases (0.3%) including 2 cases of bleeding, 5 cases difficulty in removal of the port and catheter, and 6 cases representing of delayed wound healing. Longer indwelling time tended to have higher risk of developing catheter rupture and fracture.ConclusionThis study provides valuable insights into the removal of TIVADs in cancer patients. Complications during removal were uncommon but included bleeding, difficulty in removing the port and catheter, and delayed wound healing. Additionally, longer indwelling times were associated with an increased risk of catheter rupture and fracture, highlighting the need for careful monitoring and timely removal of TIVADs to minimize potential complications. The findings of the study underscore the importance of optimizing TIVAD management, particularly during the removal phase, to improve patient outcomes.