Image-Guided Subcutaneous Port Implantation in Patients with Malignant Diseases

Abstract

To present the results of our retrospective study on 49 totally implantable subcutaneous venous ports inserted in angiography unit under ultrasound and fluoroscopic guidance. Between January 2010 and November 2011, 49 subcutaneous venous chest ports were placed in 48 patients (mean age, 49.3±16.7 years). One patient underwent port implantation twice. All the ports had single lumen catheters. The procedures were performed under ultrasound and fluoroscopic guidance in angiography unit. All ports were placed on the anterior chest wall. The technical success rate was 100%. There was no procedure-related minor or major complication. Mean duration of catheter usage was 220 days (total, 100.180 catheter days; range, 15 to 420 catheter days). There was no early complication(in the first month). Late complications occurred at a rate of 8.3% (n=4). Among those four cases, two ports (4.1%) had to be removed due to thrombosis. One port was explanted due to treatment-resistant bacteremia and sepsis, the other due to catheter malposition. In patients with malignant diseases, radiological implantation of subcutaneous venous ports can be performed with similar or lower complication rates, as compared to the surgical literature, due to the obvious advantage of imaging guidance. Hence, port implantation with imaging guidance may become a more preferred implantation method in the future.

Keywords

• Ultrasound, subcutaneous venous port, malignancy

Image-Guided Subcutaneous Port Implantation in Patients with Malignant Diseases

Öz

Anjiyografi ünitesinde ultrason ve floroskopi altında 49 tamamen implante edilebilen subkutan venöz port retrospektif olarak incelendi. 49 subkutan venöz göğüs portu 48 hastada (ortalama yaş 49.3 ± 16.7 yıl ) yerleştirildi . Bir hastaya iki port implantasyonu uygulandı. Tüm portlar tek lümen kateterine sahipti. Prosedürler ultrason ve anjiyografi ünitesinde floroskopi altında yapıldı. Tüm portlar göğüs ön duvarına yerleştirildi. Teknik başarı oranı %100 idi . İşleme bağlı minör veya major komplikasyon gözlenmemiştir . Erken komplikasyon (birinci ay ) olmadı. Geç komplikasyonlar % 8.3 oranında oluştu (n: 4) . Cerrahi literatürde malign hastalıklarda, subkutan venöz portların radyolojik implantasyonu benzer veya daha düşük komplikasyon oranları ile tercihedilebilir. Bu nedenle, görüntüleme kılavuzluğunda port implantasyonu gelecekte daha çok tercih edilen implantasyon yöntemi olabilir

Anahtar Kelimeler

• Ultrasound, deri altı venöz port, malignite

Kaynakça

1. Krupski G, Froschle GW, Weh FJ, Schlosser GA. Central venous access devices in treatment of patients with ma- lignant tumors: Venous port, central venous catheter and Hickman catheter. Cost-benefit analysis based on a criti- cal review of the literature, personal experiences with 135 port implantations and patient attitude. Chirurgie 1995;66: 202-7.
2. Morris SL, Jacques PF, Mauro MA. Radiology assisted placement of implantable subcutaneous infusion ports for long term venous access. Radiology 1992;184:149-51.
3. Ryder MA. Peripheral Access options. Surg Oncol Clin North Am 1995;4: 395–427.
4. Dede D, Akmangit I, Yildirim ZN, Sanverdi E, Sayin B. Ultrasonography and fluoroscopy-guided insertion of chest ports. EJSO 2008;34: 1340-3.
5. Beheshti MV, Protzer WR, Tomlinson TL, Martinek E, Baatz LA, Collins MS. Long-term results of radiologic placement of a central vein access device. AJR 1998;170:731–4.
6. Funaki B. Central venousaccess: a primer for the diagnos- tic radiologist. AJR 2002;179:309–18.
7. Funaki B, Szymski GX, Hackworth CA, Rosenblum JD. Radiologic placement of subcutaneous infusion chest ports for long-term central venous access. AJR 1997;169:1431–4.
8. Yerdel MA, Karayalcin K, Aras N, Bozatli L, Yildirim E, Anadol E. Mechanical complications of subclavian vein catheterization: a prospective study. Int Surg1991;76:18– 22.

9. Kusminsky RE. Complication of central venous catheter- ization. J Am Coll Surg 2007;204:681–96.
10. Onders RP, Shenk RR, Stellato TA. Long-term central ve- nous catheters:size and location do matter. Am J Surg 2006;191:396–9.
11. Biffi R, Corrado F, Braud F, et al. Long term, totally im- plantable central venous Access ports connected to a gro- shong catheter for chemotherapy of solid tumours: expe- rience from 178 cases using a single type of device. Eur J Cancer 1997;33:1190-4.
12. Schwartz RE, Groeger J, Coit DG. Subcutaneously im- planted central venous access devices in cancer patients: a retrospective analysis. Cancer 1997;79:1635-50.
13. Kurul S, Saip P, Aydin T. Totally implantable venous-access ports: local problems and extravasation injury. Lancet Onco 2002;13:684-92.
14. Lorch H, Zwaan M, Kagel C, Weiss HD. Central venous ac- cess ports placed by interventional radiologists: experi- ence with 125 consecutive patients. Cardiovasc Intervent Radiol 2001;24: 180-4.
15. Cil BE, Canyigit M, Peynircioglu B, et al. Subcutaneous ve- nous port implantation in adult patients: a single center experience. Diagn Interv Radiol 2006;12:93-8.
16. Kock HJ, Pietsch M, Krause U, Wilke H, Eigler FW. Implantable vascular Access systems: Experience in 1500 patients with totally implanted central venous port sys- tems. World J Surg 1998;22:12-6.
17. Mcdonald S, Watt AJB, Edwards RD, Moss JG. Comparison of the internal jugular and subclavian venous routes in ra- diological placed tunneled venous accesslines. Cardiovasc Intervent Radiol 1998;21: 81.
18. Damascelli B, Patelli G, Frigerio LF, et al. Placement of long-term central venous catheters in outpatients: study of 134 patients over 24 596 catheter days. AJR 1997;168:1235–9.
19. Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in criti- cally ill patients: a randomized controlled trial. JAMA 2001; 286(6):700–7.
20. Hamilton HC, Foxcroft DR. Central venous access sites for the prevention of venous thrombosis, stenosis and infec- tion in patients requiring long-term intravenous therapy. Cochrane Data base Syst Rev 2007;3:CD 004084.
21. Denys GB, Uretsky BF, Reddy PS. Ultrasound-assisted cannulation of the internal jugular vein: a prospective comparison to the external landmark-guided technique. Circulation 1993;87:1557–62.
22. Yildizeli B, Lacin T, Batirel HF, Yüksel M. Complications and management of long-term central venous access catheters and ports. J Vasc Access 2004;5(4):174–8.