Implantable Venous Port Research Articles

Evaluation of the Necessity of Port Fixation in Central Venous Port Implantation

Purpose: The technical success and complications were especially focused on and evaluated the need for fixation of a port under fluoroscopic guidance placement of the totally implantable central venous access ports for long term central venous access. Materials and Methods: Two hundred eighty nine consecutive patients (170 men, 119 women, mean age: 52-year-old) who underwent venous port implantation for the administration of chemotherapy were followed over a 1-month period. The procedures were performed in the angiographic suite by an interventional radiologist and all access was through the right jugular vein, except for the patients who had undergone a right mastectomy. The procedures were performed in the following order: 1) venous puncture, 2) making a pocket, 3) catheter tunneling, 4) port insertion, 5) catheter sizing, and 6) insertion. A port which was connected to the tunneled catheter was inserted into the minimally sized subcutaneous pocket with the aid of a small retractor. A follow-up was performed with medical records and chest radiographs. The follow-up period for evaluating the venous port ranged from 59 to 329 days (mean: 175 days) Results: The procedures performed to gain right jugular vein access were successful without difficulty in all cases. The 18 patients that underwent procedures to gain left jugular vein access encountered some difficulty upon insertion of a catheter into the SVC due to encountering the tortuous left brachiocephalic vein. No complications occurred during and immediately after the procedure. In one case the port chamber rotated within the subcutaneous pocket; however, no catheter migration or malfunction occurred. Conclusion: If port insertion was followed by catheter insertion, the port chamber can be tightly implanted in the minimally sized pocket. This would avoid the need for fixation of the catheter to the port chamber leading into the pocket.

Technical benefits and outcomes of modified upwardly created subcutaneous chest pockets for placing central venous ports: Single-center experience

Traditionally, port pockets are created in a surgical fashion, with the chest pocket dissection performed by moving in the caudal direction from the incision site. However, most right-handed operators can more easily make the port pocket by dissecting upward. To evaluate the technical benefits and outcomes of modified upwardly created subcutaneous chest pockets to allow for placement of central venous ports. We retrospectively reviewed the clinical and radiological records of 756 insertion procedures in 750 patients who were referred for image-guided implantation of chest ports. Of the 121 removal procedures reviewed, a modified chest pocket was created in 104 of them. The technical benefits and outcomes of the modified procedures were evaluated. The technical success rate of the modified method was 99% for implantation and 100% for removal procedures. No patients had major immediate complications related to the procedure. Early mechanical complications were observed in two patients: one was due to a port that turned over following implantation, and the other was due to separation of the catheter and hub-port. Late mechanical complications were observed in six patients: catheter malfunction occurred in three patients due to fibrin sheath formation, and three patients experienced catheter fracture. The rate of early and late infectious complications was 0.10 and 0.09 per 100 catheter days, respectively. There were five patients with symptomatic central venous thrombosis (range 34-167 days). Modified upwardly created chest pockets are useful for implantable central venous port systems, and may be easier to implant and remove than conventional downward pocket methods.

Comparison of implantable central venous ports with catheter insertion via external jugular cut down and subclavian puncture in children: single center experience

The purpose of this study is to demonstrate the efficacy, safety and long-term advantages of catheter insertion via external jugular vein (EJV) cut down for implantable central venous port in children. Thirty-nine central venous ports were implanted with catheter insertion via subclavian puncture in the children (group 1) with average age of 4.2 years. Forty-three were done by inserting the catheter via EJV cut down in the children (group 2) with average age of 4.8 years. Ports remained functional for a total of 11,890 patient days in group 1 and 15,743 patient days in group 2. The ports were unplanned removed in 28.2% of patients (11/39) in group 1 with comparison of 7.0% of patients (3/43; p < 0.01) in group 2. Five patients (12.8% of ports implanted) suffered an infectious complication in group 1 and just one patient (2.3% of ports implanted; p < 0.01) occurred in group 2. Permanent aspiration occlusion occurred in every two patients for each group with incidence of 5.1% in group 1 and 4.7% in group 2. Catheter fracture occurred in three patients in group 1 (7.7%). One case with catheter disconnected to the port was found in group 1 (2.6%). The disconnected catheter was removed from right ventricle by interventional therapy. Insertion of the catheter via the EJV cut down for implantable central venous port is significant better than insertion of the catheter via subclavian puncture in children.

Pulmonary Artery Pseudoaneurysm After a Vascular Access Port Catheter Implantation

Pulmonary artery pseudoaneurysm is an unusual complication of surgically implantable central venous port catheters. We experienced a case of a 57-year-old man with gastric malignancy, in which a port catheter had been previously implanted for chemotherapy. Because of a puncture site that was also medial for the subclavian vein, the catheter tip fractured between the first rib and the clavicle, and embolized in the left pulmonary artery, which caused a 5 x 4 cm pseudoaneurysm that mandated surgical resection with a lobectomy. The diagnostic work-up and a review of the literature are presented.

The Usefulness of Cephalic Vein Cut-Down for Totally Implantable Central Venous Port in Children

The Usefulness of Cephalic Vein Cut-Down for Totally Implantable Central Venous Port in Children

Administration of cancer chemotherapeutic drugs through the enhanced peripheral veins by creating a radiocephalic fistula

Background Administration of chemotherapy through peripheral veins is a morbid procedure. The alternatives include implantable venous ports with associated cost and complication of buried foreign body. Methods In this pilot study, we created an arteriovenous fistula (AVF) at the wrist of cancer patients due for chemotherapy and then used the resultant enhancement of the peripheral veins of the hand and forearm for administering chemotherapy. The complications of this novel method are compared with our historical controls receiving chemotherapy through the peripheral veins without AVF. Results and Conclusions Ten patients were offered this new technique after prior informed consent and were followed prospectively for 1 year. Venous accessibility was excellent in the experimental arm with no incident of erythema, thrombophlebitis, or skin necrosis. No significant alteration was found in cardiac parameters at 1, 6, and 12 months post AVF surgery. The procedure proved economical and affordable for a majority of our patients.

Subcutaneous Venous Port Implantation in Patients with Bilateral Breast Surgery

The purpose of this study was to evaluate the long-term follow-up results of subcutaneous venous ports implanted in patients with bilateral mastectomies. We retrospectively reviewed the hospital charts and the electronic database of 17 patients with bilateral mastectomies whom had venous port implantation in our interventional radiology suit. A total of 17 ports were implanted to the paramedian (n = 3) and anterolateral (standard; n = 12) chest wall, on the trapezius muscle (n = 1), and to the antecubital fossa (n = 1). The mean age was 48.29 years (range: 35-60 years). The mean time interval from time of surgery to port implantation was 34 months (range: 1-84 months). The mean follow-up time was 15 months (range: 7-39 months). Follow-up parameters and classification of the complications was defined according to the SIR guidelines. No procedure-related complication occurred. A single case of mild late infection was noted and the infection rate was 0.19/1000 catheter days. Infusion chemotherapy administration was still going on in eight patients. Two patients died during the follow-up and four patients were lost after 6 months. Port removal was performed in three patients at follow-up because of the end of treatment. One trapezius port and one paramedian port weres among the removed ports without any problem. Although we have a limited number of patients, port placement to the anterior chest wall, either paramedian or anterolateral, on the trapezius muscle or to the antecubital fossa depending on the extent of the bilateral breast surgeries that can be performed with low complication rates by a careful patient and anatomical location selection by involving the patients in the decision-making process. We believe that patient education and knowledge of possible complications have high importance in follow-up.

Flailed tricuspid valve as a complication of retrieving fractured catheter

The implantable venous port system has gained popularity as venous access when prolonged chemotherapy is needed in cancer patients. Intravascular fracture and embolization of catheter fragments from port-catheter systems is rare. Here we report a 49-year-old lady who was found having a fractured port-catheter located over the right ventricular outflow tract (RVOT). Percutaneous transfemoral transcatheter retrieval of the fractured catheter was performed but complicated with flailed tricuspid valve.

Implantation of central venous ports with catheter insertion via the right internal jugular vein in oncology patients—single center experience

Evaluation of suitability and safety of venous port implantation with catheter insertion via the right internal jugular vein in oncology patients. One hundred one totally implantable venous ports were placed in 100 patients with malignancies from January 1, 2003 until March 31, 2005. Catheter of venous port was preferably inserted via the right internal jugular vein. We recorded a number of successful implantations using this venous approach and the rate of complications during the procedure and follow-up. Ninety-seven catheters (96%) of totally implantable venous ports were inserted via the right internal jugular vein in 96 patients, and only in four cases were we not able to access this vein. We had no complications related to catheter insertion via the right internal jugular vein. Follow-up was made in all 96 patients with a total access days of 41 in 151 days (mean: 407 days). Premature catheter removal was required in six (6.2%, 0.144 per 1,000 access days) due to complications: three catheter dislocations/malfunctions (3.1%, 0.072 per 1,000 access days), one port-related sepsis, one pocket port infection, and one decubitus over port (1%, 0.024 per 1,000 access days). Six venous ports were removed after completion of the treatment at the patient's request. The placement of totally implantable venous ports with catheter insertion via the right internal jugular vein has a high success rate without any early complications. Follow-up also demonstrates a low incidence of late complications requiring port removal.

Noninvasive Power Doppler-Mediated Diagnosis of Catheter Leakage in a Totally Implanted Venous Access Port

Totally implantable venous access ports (TIVAPs) provide a useful option for intravenous parenteral feeding and application of chemotherapy in patients with malignancies. 1 The use of long-term catheters was first described by Broviac et al 2 in 1973 and later modified by Hickman et al 3 in 1979. In 1982, Niederhuber et al 4 introduced totally implanted venous port systems for patients with cancer. The mean duration that catheters are left in place is about 12 months. 1 , 5 Complications after implantation of TIVAPs are rare 6 , 7 and depend on the disease, the patient's performance status and blood cell count, the technique for placement of the catheter and port reservoir, and the postoperative care.8 They can be categorized as early and late complications. Early complications include pneumothorax, infections, bleeding, wound-healing disorders, pulmonary distress, and dislocation. Late complications include infections, abscesses, sepsis, and thrombosis or secondary leakages. A TIVAP catheter leakage can be related to inadequacies in the surgical technique or faults in the material and can lead to extravasation injury. 9 The diagnosis is made clinically, radiologically, or by both means. We report a case in which noninvasive sonography in the power Doppler mode was used with 0.9% sodium chloride as a contrast medium to provide evidence of a TIVAP catheter leakage. From this experience, noninvasive sonography in the power Doppler mode and 0.9% sodium chloride as a contrast agent might be a useful tool for diagnosis of leakage in a port system.

Costs of treatment of colorectal cancer in different settings in Germany

The objective of this study was to evaluate the cost implications of different settings (inpatient, outpatient/day clinic, or office-based oncologists) for the administration of standard fluoropyrimidine therapies, i.e., Mayo Clinic and Arbeitsgemeinschaft Internistische Onkologie (AIO)/Ardalan regimen, and to compare the results with the cost of oral capecitabine in Germany. In total, 89 quarterly fee-listings from 26 patients provided by 5 office-based oncologists were analyzed. Physician's services, drug costs, pharmacy costs, and costs for implantable venous port systems and single-use pumps were considered. Findings were transferred to the hospital setting. A third-party payer perspective was applied. Quarterly treatment costs for the Mayo Clinic regimen varied between <euro> 2,036 and <euro> 10,569, and between <euro> 1,294 and <euro> 10,179 for the AIO/Ardalan regimen depending on the treatment setting. Projected costs for capecitabine were <euro> 2,338. No hospitalization was considered to be necessary for capecitabine due to its oral administration route. The most expensive treatment options were the AIO/Ardalan protocol in the office-based setting and the Mayo Clinic protocol in the hospital setting. Capecitabine emerged as the cheapest option in the office-based setting. Overall, the cheapest option was the AIO/Ardalan protocol in municipal hospitals. However, municipal hospitals are unlikely to cover their costs in this situation. Substantial cost savings without incurring losses to providers may be realized if patients are transferred from the hospital setting to the office-based setting and treated with capecitabine.

Cross-infection due to imipenem-resistant Bacteroides fragilis associated with a totally implantable venous port.

Four patients in an oncology ward developed Bacteroides fragilis bacteremia over a 12-day period. Cross-infection between two of them, due to an imipenem-resistant strain, was demonstrated by epidemiological investigation and genotypic typing methods (arbitrarily primed PCR fingerprinting and nucleotide sequencing of the cfiA genes and upstream IS1186/IS1168 elements).