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

AbstractObjectivesThe 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.MethodsRetrospective 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.ResultsThe 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.ConclusionTIVAP implantation at the forearm is a simple and safe procedure with a low rate of early and late complications.Key Points• TIVAP implantation at the forearm is a minimally invasive and safe procedure. • Technical success rate is close to 100 %. • Short-term and long-term complication rates are low.

[1]  Vincent Vinh-Hung,et al.  Catheter tip position as a risk factor for thrombosis associated with the use of subcutaneous infusion ports , 2005, Supportive Care in Cancer.

[2]  D. Hahn,et al.  Peripherally Placed Totally Implantable Venous-access Port Systems of the Forearm: Clinical Experience in 763 Consecutive Patients , 2010, CardioVascular and Interventional Radiology.

[3]  U. Teichgräber,et al.  Periinterventionelle prophylaktische Antibiotikagabe bei der radiologischen Portkatheterimplantation , 2007 .

[4]  H. Wagner,et al.  [Periinterventional prophylactic antibiotics in radiological port catheter implantation]. , 2007, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[5]  M. Lux,et al.  Patients' attitudes to totally implantable venous access port systems for gynecological or breast malignancies. , 2007, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[6]  D. Hahn,et al.  Percutaneous image-guided implantation of totally implantable venous access ports in the forearm or the chest? A patients’ point of view , 2013, Supportive Care in Cancer.

[7]  C. Pui,et al.  Management of occlusion and thrombosis associated with long-term indwelling central venous catheters , 2009, The Lancet.

[8]  Ming-Shian Lu,et al.  Analysis of risk factors for central venous port failure in cancer patients. , 2009, World journal of gastroenterology.

[9]  A. Silas,et al.  Complication rates and outcomes of 536 implanted subcutaneous chest ports: do rates differ based on the primary operator's level of training? , 2010, Academic radiology.

[10]  M. De Cicco,et al.  Central venous thrombosis: an early and frequent complication in cancer patients bearing long-term silastic catheter. A prospective study. , 1997, Thrombosis research.

[11]  P. Szkup,et al.  Catheter Fracture and Embolization Associated with Arm Implantation of the Cook Vital Port , 2013, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[12]  J. Nosher,et al.  Peripheral venous access ports: Outcomes analysis in 109 patients , 2000, CardioVascular and Interventional Radiology.

[13]  H. Kauczor,et al.  Insertion of Totally Implantable Venous Access Devices: An Expertise-Based, Randomized, Controlled Trial (NCT00600444) , 2011, Annals of surgery.

[14]  N. Magné,et al.  Is radiologic placement of an arm port mandatory in oncology patients? , 2007, Cancer.

[15]  E. Walser,et al.  Venous Access Ports: Indications, Implantation Technique, Follow-Up, and Complications , 2012, CardioVascular and Interventional Radiology.

[16]  H. Kock,et al.  Implantable Vascular Access Systems: Experience in 1500 Patients with Totally Implanted Central Venous Port Systems , 1998, World Journal of Surgery.

[17]  T. Awatani,et al.  Peripheral insertion of a central venous access device under fluoroscopic guidance using a Peripherally Accessed System (PAS) port in the forearm , 1998, CardioVascular and Interventional Radiology.

[18]  V. Nicolas,et al.  [Phlebography of the upper extremity. I. The technic and findings in 230 studies]. , 1995, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[19]  C. Bakal,et al.  Reporting standards for central venous access. , 2000, Journal of vascular and interventional radiology : JVIR.

[20]  S. Nagayama,et al.  Long-term outcomes of peripheral arm ports implanted in patients with colorectal cancer , 2008, International Journal of Clinical Oncology.

[21]  S. Feuerbach,et al.  [Radiologic implantation of central venous portal systems in the forearm]. , 1998, RöFo. Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren (Print).

[22]  Donald L. Miller,et al.  Society of Interventional Radiology clinical practice guidelines. , 2009, Journal of vascular and interventional radiology : JVIR.

[23]  M. Hellmich,et al.  [Experiences with ultrasound-guided port implantations via the lateral subclavian vein: a retrospective analysis of 1532 patients]. , 2012, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[24]  D. Chan,et al.  An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases. , 2006, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[25]  U. Teichgräber,et al.  Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems , 2011, European Radiology.

[26]  J. Seitz,et al.  Radiologische Implantation zentralvenöser Portsysteme am Unterarm , 1998, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[27]  T. Derlin,et al.  Follow-up of radiologically totally implanted central venous access ports of the upper arm: long-term complications in 127,750 catheter-days. , 2012, AJR. American journal of roentgenology.

[28]  R. Paz-Fumagalli,et al.  Risk of deep venous thrombosis associated with chest versus arm central venous subcutaneous port catheters: a 5-year single-institution retrospective study. , 2002, Journal of vascular and interventional radiology : JVIR.

[29]  M. Völk,et al.  [Radiological placement of peripheral central venous access ports at the forearm. Technical results and long term outcome in 391 patients]. , 2010, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.