Totally Implantable Venous Access Ports Research Articles

Outcome analysis in 270 radiologically guided implantations of totally implantable venous access ports via basilic vein.

Totally implantable venous access ports (TIVAPs) are widely applied in patients who require chemotherapy, parenteral nutrition, or frequent intravenous drug infusion. Although various venous access routes are possible for TIVAP insertion, the best method remains a topic of controversy. We present a single-center retrospective study of radiologically guided placement of TIVAPs through the basilic vein, with analysis of technical feasibility, patient safety, and device-related complications. We retrospectively reviewed 270 patients who received TIVAP implantation through the basilic vein from November 2013 to July 2016, under imaging guidance by an interventional radiology team at our institution. Fluoroscopic images, chest radiographs, computed tomography scans, and medical records were reviewed after port implantation. Catheter maintenance days were calculated and catheter-related complications were recorded. The procedural success rate was 99.3%. In total, 270 TIVAPs were implanted in 270 patients, of which 150 remained functional at the end of the study period. The total catheter maintenance days was 77 543 days, and the mean catheter indwelling duration was 287 ± 207 days. In 20 (7.4%) patients, TIVAP-related complications occurred during the follow-up period, resulting in a postprocedural complication rate of 0.26 incidences per 1000 catheter days. No significant relationship was observed between complications and gender (p = 0.188), age (p = 0.528), body mass index (p = 0.547), the type of primary malignancy (p = 0.914), or between the left and right basilic veins (p = 0.319). Real-time ultrasound and fluoroscopic guidance provides a safe method for TIVAP implantation through the basilic vein, with a high technical success rate and few device-related complications.

Femoral placement of a totally implantable venous access port with spontaneous catheter fracture: case report

BackgroundThe incidence of catheter fracture after standard positioning of a totally implantable venous access port (TIVAP) is reported to be 1.1%–5.0%; however, the incidence of catheter fracture after TIVAP implantation at a femoral site remains unclear.Case presentationIn a 30-year-old man with angiosarcoma of the right atrium, tumor embolism was observed from the left brachiocephalic vein to the superior vena cava. A TIVAP was implanted in the right femur. A catheter fracture was spontaneously observed after 7 months.ConclusionsTo the best of our knowledge, this is the first case of catheter fracture in a TIVAP implantation at a femoral site.

Modified Totally Implantable Venous Access Ports through Cephalic Vein Cutdown

Introduction: totally implantable venous access ports (TIVAPs) offered advantage of preventing venous toxicity when administering chemotherapy drugs and low risk of toxicity. Modified techniques were introduced to improve the outcome and safety of the port implantation. In this modified technique, the prioritization were the safety and stability of catheter and port placement. Case Presentation: a female, 57 years old with stage 4 breast cancer will undergo chemotherapy. She needs to do TIVAPs because her vessel was fragile and small. The author used cephalic vein cutdown to do TIVAPs. The catheter was inserted to the cephalic vein in the deltopectoral groove, in which connected to the port pocket implanted in the anteromedial thorax. This modified technique had more stable location of port, more fixed area if compared with deltopectoral groove, and easily access for non-coring needle insertion. By connecting both sides, the position of catheter would be horizontal and easily palpable, which minimalizing the risk of catheter being twisted and kinked. Conclusion: this modification technique was safe and useful. The long-term outcome was satisfactorily good by this technique without any major and minor events.

An unusual catheter malposition following totally implantable venous access port insertion: The catheter tip located into the right axillary vein

Totally implantable venous access port (TIVAP) devices have been used increasingly for repetitive chemotherapy administration, long-term parenteral nutrition, blood sampling and blood transfusion for last years. Several potential complications including catheter malposition can occur during the insertion of TIVAP devices. Catheter malposition is a less commonly reported and an important complication of TIVAP insertion. In this article, we presented an uncommon case report of catheter malposition following TIVAP insertion in a 47-year-old woman. To the best of our knowledge, this is the first reported case of mispositioned TIVAP where the tip of the catheter is in the right axillary vein.

Surface measurement, intracardiac electrocardiogram and tracheal bifurcation techniques for locating the catheter tips of totally implantable venous access port

BackgroundThe purpose of our study is to compare the reliability and consistency of three commonly used techniques, which are surface measurement, intracardiac electrocardiogram (IECG) and tracheal bifurcation methods in measuring the tip location of totally implantable venous access port (TIVAP) in the same patient. MethodsThe thirty-five patients scheduled for implantation of TIVAP were included and right subclavian vein was selected for venous access. We used surface measurement method (Group L) to estimate the length and position of catheter before catheterization, and then we used IECG method (Group E) to confirm the position of catheter during catheterization and after catheterization used tracheal bifurcation method by CT (Group T) for measurement. The differences of catheter length measured by three methods were compared by non-parametric Kruskal–Wallis test. Intraclass correlation coefficient (ICC) was used to evaluate the reliability of three methods and Bland-Altman chart was used to evaluate consistency. ResultsThere are no difference in the length of TIVAP catheter between L and T groups (P > 0.05), but they have significant differences comparing with E group (P < 0.05). The three positioning methods have a good consistency (ICC = 0.886, P < 0.05).Through linear regression analysis, the regression equation are: catheter length (mm) = 77.32 + 0.66 × height (cm), 36.25 + 0.81 × height (cm) and 68.82 + 0.70 × height (cm). The distances from catheter tip to the junction of superior vena cava and right atrium measured by IECG (Group E) was closer to the target value. ConclusionsAll three methods can be used to measure the length of TIVAP catheter, and IECG method is the most accurate. And similar to most studies, returning the catheter 20 mm after positioning can avoid catheter entering the right atrium, but we found that 10 mm is a sufficient length to achieve this.

Ultrasound-guided totally implantable venous access ports via the right innominate vein: a new approach for patients with breast cancer

BackgroundTo evaluate the feasibility and safety of ultrasound-guided totally implantable venous access port (TIVAP) implantation via the right innominate vein in patients with breast cancer.MethodsSixty-seven breast cancer patients underwent ultrasound-guided implantation of TIVAPs via the right innominate vein for administration of chemotherapy. Clinical data including technical success, success rate for the first attempt, periprocedural, and postoperative complications were recorded and retrospectively studied.ResultsAll patients underwent successful surgery. The success rate of the first attempt was 95.52% (64/67). The operation time was 28 to 45 min, with an average of 36 ± 6 min. Periprocedural complications included artery punctures in 1 (1.50%, 1/67) patient. Prior to this study, the mean TIVAP time was 257 ± 3 days (range 41 to 705 days). The rate of postoperative complications was 4.48% (3/67), including catheter-related infections in 1 case and fibrin sheath formation in 2 cases. Up to the present study, three people had unplanned port withdrawal due to complications, and the TIVAPs for 25 patients were still in normal use.ConclusionsThe success rate of ultrasound-guided TIVAPs via the right innominate vein is high with low complications, thus safe and feasible. This technique can provide a new option for chemotherapy of breast cancer patients.

Late complications associated with totally implantable venous access port implantation via the internal jugular vein.

Several studies have analyzed late complications associated with totally implantable venous access ports (TIVAP) implantation via the internal jugular vein (IJV); however, the reported results are inconclusive. The aim of the study is to elucidate the characteristics and risk factors of late complications associated with TIVAP implantation via the IJV. The study included 482 patients who underwent TIVAP implantation for long-term chemotherapy and/or nutritional support between April 2012 and December 2017. Most patients (95.2%) had malignant diseases. Events requiring TIVAP removal were defined as TIVAP-related complications. The median TIVAP and global follow-ups were 319 days (IQR 152-661) and 218,971 catheter days, respectively. The 3-year cumulative TIVAP availability rate was 70%. There were 44 complications (incidence of 9.1%; 0.201 complications/1000 catheter days). Infectious, catheter-related, and port-related complications occurred in 21, 14, and 9 patients, respectively with infectious complications occurring earlier and more frequently than catheter- and port-related complications. Multivariate analysis revealed that age < 65 years and presence of non-gastrointestinal diseases were significant unfavorable factors for TIVAP-related complications. Patients with 1 and 2 of these factors had an elevated risk (2.2 and 5.4 times, respectively) compared with those without. Among the late complications associated with TIVAP implantation via the IJV, infectious complications occur earlier and more frequently than catheter- and port-related complications. Patients with an age < 65 years and having non-gastrointestinal diseases have a significantly high risk of TIVAP-related complications.

Risk Factors of Infection and Role of Antibiotic Prophylaxis in Totally Implantable Venous Access Port Placement: Propensity Score Matching.

To evaluate risk factors of infection and effectiveness of preprocedural single-dose intravenous prophylactic antibiotic (PABX) during totally implantable venous access port (TIVAP) placement in preventing procedure-related infections. This was a retrospective single-institution multicenter study evaluating short-term (30-day) infection outcomes after TIVAP placement. Correlation between infection rates and clinical factors, including hematologic versus non-hematologic malignancy, inpatient versus outpatient status, single versus double lumen and PABX, was investigated using univariate and multivariable analysis in the overall study population as well as the propensity-score-matched cohort. Overall, 5967 patients underwent TIVAP placement from 2005 to 2016, of which 3978 (67%) patients received PABX. On propensity score matching, 1952 patients with PABX were matched to the same number of patients without PABX. TIVAP was removed due to infection concern in 48 patients in unmatched and 30 patients in matched population. There was no difference in the rate of infection between those who received PABX and those who did not in both unmatched and matched population (p = 0.5387 and 0.9999). Although infection rate was significantly higher in patients who had TIVAP placement in inpatient setting (p < 0.0001), who received a double-lumen TIVAP (p < 0.0001), or who had hematologic malignancy (p = 0.0004) on univariate analysis, inpatient status was the sole factor associated with higher rate of TIVAP infection on multivariable analysis of both overall (odds ratio 2.31, p < 0.0001) and matched populations (odds ratio 4.36, p = 0.0004). Placement of TIVAP in inpatient setting increases the risk of TIVAP infection. PABX before TIVAP placement does not prevent short-term procedure-related infections.

The risk of bloodstream infection associated with totally implantable venous access ports in cancer patient: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to provide evidence-based guidance to better understand the risk of central line-associated bloodstream infection (CLABSI) in cancer patients who received totally implantable venous access ports (TIVAPs) compared with those who received external central venous catheters (CVCs). A systematic search of PubMed, Web of science, Embase, and the Cochrane Library was carried out from inception through Oct 2018, with no language restrictions. Trials examining the risk of CLABSI in cancer patients who received TIVAPs compared with those who received external CVCs were included. Two reviewers independently reviewed, extracted data, and assessed the risk of bias of each study. A random-effect model was used to estimate relative risks (RRs) with 95% CIs. In all, 26 studies involving 27 cohorts and 5575 patients reporting the incidence of CLABSI in patients with TIVAPs compared with external CVCs were included. Pooled meta-analysis of these trials revealed that TIVAPs were associated with a significant lower risk of CLABSI than were external CVCs (relative risk [RR], 0.44; 95% confidence interval [CI], 0.31-0.62; P < 0.00001), which was confirmed by trial sequential analysis for the cumulative z curve entered the futility area. Subgroup analyses demonstrated that CLABSI reduction was greatest in adult patients (RR [95% CI], 0.35 [0.22-0.56]) compared with pediatric patients who received TIVAPs (RR [95% CI], 0.55 [0.38-0.79]). TIVAP can significantly reduce the risk of CLABSI compared with external CVCs.

Application of upper arm totally implantable venous access ports in 34 patients with tumor

Objective To investigate the safety, feasibility and clinical application effect of upper arm totally implantable venous access port (TIVAP) inserted by the combination of oncologists and nurses in patients with tumor. Methods A total of 34 patients, who needed long-term transfusion treatment, were included in this study with upper arm TIVAP from March 2017 and December 2017. There were 20 males and 14 females. The median age was 63 (35~83) years. Upper arm TIVAP was implanted by both doctors and nurses into the patients with tumor, and the TIVAP related success rate, complications and patients satisfaction were recorded. Results 34 patients all succeeded in TIVAP implantation with the operation success rate of 100%. The average operation time was about 40 minutes (30 to 60 minutes) from the disinfecting cloth to the end of the suture. The operations of all patients were successful. After the operation two patients died of cancer progression, one patient had soft tissue infection around capsular bag, None of the patients had other complications such as blocked infusion, catheter shift, port reversal, and so on, and the incidence of complication was 2.94%(1/34). Conclusions Upper arm TIVAP has the advantages of safe puncture, shorter operation time, few intra-operative and post-operative complications and higher feasibility for operation by both oncologist and nurse, which can supplement the limitations and deficiencies of the chest wall port and PICC in a certain extent, therefore is a good choice for clinical application. Key words: Upper arm; Totally implantable access port; Cancer

Evaluation of Infection Risk Factors in Adult Hematologic Malignancy Patients

IntroductionHematologic malignancies (HM) are often highly aggressive processes requiring multi-chemotherapy regimens and potentially hematopoietic stem cell transplant (HSCT) for treatment. Totally implantable venous access ports (TIVAP) are the standard access for administration of these regimens. The regimens usually involve periods of neutropenia for which infection can increase morbidity and require removal of the port. Although deemed safe for use in cancer populations, many studies have only looked at patients with TIVAP in solid tumor malignancies. Herein, we report our single institution experience identifying modulators for infection related to TIVAP in this high-risk population.ObjectivesTo identify risk factors for port infection in HM patients.MethodsWe performed an IRB-approved single institution retrospective review of HM patients who had a TIVAP removed for port infection versus completion of therapy. Medical records were evaluated for patient demographics and tumor type, details of previous therapy regimens such as chemotherapy and HSCT status, laboratory values including albumin, white blood cell, neutrophil and platelet counts, as well as characteristics of the TIVAP. Univariate and multivariate regression analyses were performed between the two cohorts to identify clinical predictors of port infection necessitating TIVAP removal.ResultsBetween March 2015 and July 2018, 104 TIVAPs were removed from HM patients, 34 (33%) for infection and 70 (67%) for completion of treatment. Median patient age was 60 years (range 22-86) and there was an even number of men and women (n=52). Most TIVAPs were double lumen (n=98, 94%) and placed in the right IJV (n=100, 96%). The median number of port days was 49 in the infection group and 414 in the completion group, with removal of 12 (35%) of the infected ports within 30 days. Multiple factors were significant predictors of port infection on univariate analysis, including diagnosis of AML or ALL (p=0.0019), no prior HSCT (p=0.0148), neutropenia within 30 days of removal (p<0.0001), ANC <1500 (p <0.0001), leukopenia the day prior to removal (p<0.0001), thrombocytopenia (p <0.0001), and hypoalbuminemia (p<0.0001). Steroid use, leukopenia or leukocytosis the day of placement, and leukocytosis the day prior to removal were not significantly different between the two groups. On multivariate analysis, no prior HSCT (OR=48.08, 95% CI 2.64-875.63, p=0.009), neutropenia within 30 days of removal (OR=67.60, 95% CI 1.68-2726.66, p=0.026), and hypoalbuminemia (OR=405.52, 95% CI 15.64-10517.89, p<0.0001) remained significant.ConclusionIn patients with HM, significant predictors of port infection requiring TIVAP removal included neutropenia within 30 days of removal and hypoalbuminemia. Interestingly, patients who underwent HSCT were less likely to a develop a port infection requiring TIVAP removal.

How do the Seldinger technique and venous cutdown implantation techniques compare for people requiring a totally implantable venous access port (TIVAP)?

How do the Seldinger technique and venous cutdown implantation techniques compare for people requiring a totally implantable venous access port (TIVAP)?

Incidence, severity and outcome of central line related complications in pediatric oncology patients; A single center study

BackgroundCentral venous access device (CVAD)-related complications are associated with high morbidity rates. This study was performed to underline the importance of CVAD-complication prevention and treatment. MethodsAn audit of practice of CVAD-related complications in pediatric oncology patients receiving a CVAD between January 2015 and June 2017 was performed. CVADs included were totally implantable venous access ports (TIVAPs), Hickman–Broviac® (HB), nontunneled, and peripherally inserted CVADs. ResultsA total of 201 children, with 307 CVADs, were analyzed. The incidence rates per 1000 CVAD-days for the most common complications were 1.66 for malfunctions, and 1.51 for central line-associated bloodstream infections (CLABSIs). Of all CVADs inserted, 37.1% were removed owing to complications, of which 45.6% were owing to CLABSIs. In 42% of the CLABSIs, the CLABSI could be successfully cured with systemic antibiotic treatment only. Of all included patients, 5.0% were admitted to the intensive care unit owing to CLABSI. The HB-CVAD compared to the TIVAP was a risk factor for CVAD-related complications, CLABSIs and dislocations in particular. ConclusionsThe incidence of CVAD-related complications is high. Research on the prevention and treatment of CVAD-related complications in pediatric oncology patients should be a high priority for all health care professionals. Type of studyPrognosis study (retrospective). Level of evidenceLevel II.

The Safety Level of Total Central Venous Access Port Implantation Performed by Residents

The implantation of totally implantable venous access ports (TIVAPs) is one of the first procedures surgical residents learn. Complications after implantation procedures have a major impact on patient outcomes, as it may lead to a delay of chemotherapy regimens or of parenteral nutrition. The aim of this study was to compare the outcomes after totally implantable venous access ports implantations done by resident and attending surgeons. The study was performed as a retrospective analysis. The study took place in primary care at the Department of General and Visceral Surgery at Frankfurt University Hospital. A total of 760 primary totally implantable venous access ports implantations performed between March 2008 and December 2016 were included in a database. Three groups of surgeons doing the implantations were defined: Group A (residents alone), Group B (resident with help), and Group C (attending surgeons). There was a significant difference between the surgeon groups in operation time (p<0.001). The groups differed between Group A (mean, 49; SD, 22) and Group C (mean, 39; SD, 20); p<0.001) and Group B (mean, 53; SD, 23) and Group C (mean, 39; SD, 20; p<0.001). The incidence of surgical site infections between Groups A and C (3.6% vs. 0.3%; p=0.003) and Groups B and C (2.5% vs. 0.3%; p = 0.027) differed also significantly. Based on multivariable logistic regression analysis operation time in minutes (OR, 1.04; 95%CI, 1.03-1.06; p<0.001) was an independent risk factor for any intraoperative complications. For any postoperative complications younger age of the patient (OR, 0.98; 95%CI, 0.97-0.99; p=0.004) and benign primary disease (OR, 3.25; 95%CI, 1.55-6.64; p=0.002) were independent risk factors based on multivariable regression analysis. Based on multivariable regression analysis a lower body mass index of the patient (OR, 0.93; 95%CI, 0.86-0.99; p=0.044), benign primary disease (OR, 2.89; 95%CI, 1.07-7.79; p=0.036), and no chemotherapy (OR, 3.55; 95%CI, 1.50-8.39; p=0.004) were independent risk factors for postoperative catheter infections. Surgeon group was no risk factor, neither for intraoperative and postoperative complications, nor for catheter explantation due to complications. Residents performing alone or residents performing with help can safely handle a central venous access port implantation. In patients with several risk factors, however, an attending should assist.

Comparison between Internal Jugular and Upper Arm Peripheral Veins Approach in Insertion of Totally Implantable Central Venous Ports

Objectives: To compare internal jugular vein approach and Upper arm approach through basilic or cephalic veins in insertion of total implantable central venous port regarding early post-operative complications, patency rate, compliance and patient quality of life. Patients and methods: We identified 50 patients who underwent totally implantable venous access ports (TIVAP) implantation in the arm (25 patients) or chest (25 patients) between November 2015 and November 2017. Implantation via an upper arm (cephalic or basilic) occurred through venous cut down, the internal jugular vein approach was performed using percutaneous technique.1 All approaches were Under fluoroscopic guidance. Early post-operative Complications were evaluated. During follow up, self-compliance and quality of life were assessed as well. Results: Technical success was 100%. Procedure-related arterial injury occurred in 3 patients in central approach only. Post-operative hematoma, stitch inflammation and seroma were observed. Late complications including catheter infection, occlusion, pinch off syndrome, skin dehiscence, thrombophlebitis of the vein and extravasation in both technique was documented, and quality of life was assessed during follow up. Conclusions: Totally implantable venous access ports (TIVAP) can be implanted with high technical success rates and are associated with low rates of complications. Upper arm implantation may benefit clinicians and patients with respect to safety and comfort.

Endovascular stent-based revascularization of malignant superior vena cava syndrome with concomitant implantation of a port device using a dual venous approach.

The aim of this paper is to evaluate the safety and efficacy of endovascular revascularization of malignant superior vena cava syndrome (SVCS) and simultaneous implantation of a totally implantable venous access port (TIVAP) using a dual venous approach. Retrospectively, 31 patients (mean age 67 ± 8years) with malignant CVO who had undergone revascularization by implantation of a self-expanding stent into the superior vena cava (SVC) (Sinus XL®, OptiMed, Germany; n = 11 [Group1] and Protégé ™ EverFlex, Covidien, Ireland; n = 20 [Group 2]) via a transfemoral access were identified. Simultaneously, percutaneous access via a subclavian vein was used to (a) probe the lesion from above, (b) facilitate a through-and-through maneuver, and (c) implant a TIVAP. Primary endpoints with regard to the SVC syndrome were technical (residual stenosis < 30%) and clinical (relief of symptoms) success; with regard to TIVAP implantation technical success was defined as positioning of the functional catheter within the SVC. Secondary endpoints were complications as well as stent and TIVAP patency. Technical and clinical success rate were 100% for revascularization of the SVS and 100% for implantation of the TIVAP. One access site hematoma (minor complication, day 2) and one port-catheter-associated sepsis (major complication, day 18) were identified. Mean catheter days were 313 ± 370days. Mean imaging follow-up was 184 ± 172days. Estimated patency rates at 3, 6, and 12months were 100% in Group 1 and 84, 84, and 56% in Group 2 (p = 0.338). Stent-based revascularization of malignant SVCS with concomitant implantation of a port device using a dual venous approach appears to be safe and effective.

Long-term stability of gentamicin sulfate-ethylenediaminetetraacetic acid disodium salt (EDTA-Na2) solution for catheter locks

A lock solution composed of gentamicin sulfate (5mg/mL) and ethylenediaminetetraacetic acid disodium salt (EDTA-Na2, 30mg/mL) could fully eradicate in vivo bacterial biofilms in totally implantable venous access ports (TIVAP). In this study, fabrication, conditioning and sterilization processes of antimicrobial lock solution (ALS) were detailed and completed by a stability study. Stability of ALS was conducted for 12 months in vial (25°C ± 2°C, 60% ± 5% relative humidity (RH), and at 40°C ± 2°C, RH 75% ± 5%) and for 24h and 72h in TIVAP (40°C ± 2°C, RH 75% ± 5%). A stability indicating HPLC assay with UV detection for simultaneous quantification of gentamicin sulfate and EDTA-Na2 was developed. ALS was assayed by ion-pairing high performance liquid chromatography (HPLC) needing gentamicin derivatization, EDTA-Na2 metallocomplexation of samples and gradient mobile phase. HPLC methods to separate four gentamicin components and EDTA-Na2 were validated. Efficiency of sterility procedure and conditioning of ALS was confirmed by bacterial endotoxins and sterility tests. Physicochemical stability of ALS was determined by visual inspection, osmolality, pH, and sub-visible particle counting. Results confirmed that the stability of ALS in vials was maintained for 12 months and 24h and 72h in TIVAP.

Port Implantation in Patients with Severe Thrombocytopenia is Safe with Interventional Radiology.

Platelet counts <50/nl are often considered a contraindication for surgical and interventional radiology procedures. Yet, there are patients requiring totally implantable venous access ports (TIVAP) in whom normalization of the coagulation state is not feasible. This retrospective study evaluates the safety of interventional radiological TIVAP implantation in patients with severe thrombocytopenia. From 12/2010 to 12/2014, a total 1200 consecutive radiological TIVAP implantations were performed and retrospectively analyzed. Among those 181 patients had platelet counts (PC) below the reference value of 150-350 thrombocytes/nl: 55 patients with mild (PC: 100-150/nl), 58 patients with moderate (PC: 50-100/nl) and 68 patients with severe thrombocytopenia (PC <50/nl). All patients diagnosed with severe thrombocytopenia received platelet concentrates before or during the procedure according to a fixed preparation protocol. All patients were assessed at least 2weeks before and up to 12months after intervention. Outcome parameters were recorded with a particular focus on bleeding complications. Data were statistically analyzed with a p value <0.05 considered statistically significant. The technical success rate for TIVAP implantation was 100%. Patients were followed for a mean of 833 indwelling catheter days in patients with thrombocytopenia (total: 150.923days) and for 936 indwelling catheter days in patients with normal platelet counts (total: 953.760days). No significant differences in complication rates between patients with normal platelet counts and patients with mild to severe thrombocytopenia under platelet substitution were found (p>0.05), especially no bleeding complications occurred during acute, early or late phase. With individualized platelet substitution, patients with severe thrombocytopenia may receive radiological TIVAP implantation without an increased risk of bleeding complications. IV.

Four-dimensional CT-guided transcatheter removal of a fractured migrated catheter of a totally implantable venous access port

Patients undergoing chemotherapy usually undergo placement of a totally implantable venous access port (TIVAP), but TIVAP catheter fracture is rare. We encountered a case where flushing the TIVAP catheter became...

Totally implantable venous access ports: a prospective long-term study of early and late complications in adult patients with cancer.

Totally implantable venous access ports (TIVAP) have been widely used for many years in the management of patients suffering from cancer. The implantation and long-term use of TIVAPs are associated with mechanical, thrombotic, and infectious complications. This is the first exhaustive prospective study of all complications occurring in a whole population on long-term follow-up and therefore allows an objective assessment to be made of the safety of TIVAPs. We carried out a prospective single-center observational study. All adult patients with cancer who had a TIVAP implanted between January 1 and December 31, 2006 were registered. Early and late complications were recorded until the removal of the device, the patient's death, or until December 31, 2013. Exhaustive data concerning patients and TIVAP was recorded at time of implantation. Four hundred and ninety-three TIVAPs were implanted in 483 adult cancer patients and were followed during a period from 1 to 94months (median=18months) representing a global quantity of 367,359 catheter-days. Eighty-seven complications were recorded (0.237/1000 catheter-days), including 37 infections (0.101/1000 catheter-days), 17 thrombotic events (0.046/1000 catheter-days), and 9 extravasations. Out of the 87 events, 62 (71.3%) occurred during the first year after implantation. Events were therefore extremely rare after 1year. Thromboembolic and infectious complications were rare and no risk factors for these were found. This study demonstrates excellent tolerability, with only occasional complications. Most of these occurred during the year following implantation. A TIVAP may also be left in place for an extremely long time.