Totally implante edilebilir venöz kateter (TIVAD) uygulanan kanser hastalarında erken ve geç komplikasyonlar ile port çıkarımını öngören faktörler: tek merkezli retrospektif bir çalışma

Yıl 2025, Cilt: 6 Sayı: 4, 347 - 354, 31.08.2025

Ufuk Türkmen , Kudret Atakan Tekin , Ayla Ece Celikten , Görkem Yiğit

https://doi.org/10.47582/jompac.1718028

Öz

ÖZET

Amaç:
Subkütan yerleştirilen totally implantable venöz erişim cihazları (TIVAD), kanser hastalarında uzun süreli intravenöz tedavilerin uygulanmasında yaygın olarak kullanılmaktadır. Ancak bu sistemler, cihazın çıkarılmasını gerektirebilecek erken ve geç dönem komplikasyonlarla ilişkili olabilir. Bu çalışmada, onkoloji hastalarında port kateter implantasyonuna bağlı gelişen komplikasyonların insidansı ve klinik özelliklerinin değerlendirilmesi ile port çıkarımıyla ilişkili risk faktörlerinin belirlenmesi amaçlanmıştır.

Yöntemler:
Bu retrospektif, tek merkezli çalışmaya Ocak 2022 ile Temmuz 2024 tarihleri arasında subkütan port kateteri yerleştirilen 313 erişkin kanser hastası dahil edildi. Tüm işlemler lokal anestezi altında, ultrasonografi ve floroskopi rehberliğinde çift insizyon tekniği kullanılarak gerçekleştirildi. Hastalar erken (<30 gün) ve geç (≥30 gün) komplikasyonlar açısından takip edildi. Port çıkarımıyla ilişkili faktörler univaryant ve multivaryant lojistik regresyon analizleri ile değerlendirildi.

Bulgular:
Hastaların ortalama yaşı 62,45±7,75 yıl olup, en sık görülen maligniteler kolorektal (%45,0), mide (%25,9) ve pankreas kanseri (%8,9) idi. Erken komplikasyonlar %3,2 oranında, geç komplikasyonlar ise %25,6 oranında gözlendi. En sık görülen komplikasyonlar enfeksiyon (%8,3), kateter disfonksiyonu (%4,8) ve venöz tromboz (%3,8) idi. Toplam 66 hastada (%21,1) port çıkarımı gerekli oldu; en yaygın nedenler lokal enfeksiyon (%6,1), tıkanıklık (%4,8), cilt erozyonu (%5,4) ve kateter ilişkili kan dolaşımı enfeksiyonu (CRBSI) (%2,2) idi. Univaryant analizde düşük vücut kitle indeksi, metastaz, kemoterapi ve çeşitli komplikasyonlarla port çıkarımı arasında anlamlı ilişkiler bulundu (p<0,05). Multivaryant analizde, metastatik hastalık bağımsız bir risk faktörü olarak belirlendi (OR: 10,14; p<0,001), ileri yaş ise port çıkarımı ile ters yönde ilişkiliydi (OR: 0,95; p=0,021).

Sonuç:
TIVAD ile ilişkili komplikasyonlar yaygındır ve özellikle metastatik kanser hastalarında sıklıkla port çıkarımına yol açabilir. Enfeksiyon ve mekanik disfonksiyon, çıkarımın başlıca nedenleridir. Yüksek riskli hastalarda dikkatli takip ve bireyselleştirilmiş önleyici stratejiler, portun uzun dönemli işlevselliğini artırabilir.

Anahtar Kelimeler

Kanser hastaları , Komplikasyonlar , Port çıkarımı , Tam implante edilebilir venöz erişim cihazı , Venöz port kateteri.

Early and late complications and predictors of port removal in cancer patients with totally implantable venous access devices (TIVADs): a single-center retrospective study

Öz

Aims: Totally implantable venous access devices (TIVADs), placed subcutaneously, are widely used in cancer patients for the administration of long-term intravenous therapies. However, these systems may be associated with early and late complications that can necessitate device removal. This study aimed to evaluate the incidence and clinical characteristics of complications related to port catheter implantation in oncology patients, and to identify risk factors associated with port removal.
Methods: In this retrospective, single-center study, 313 adult cancer patients who underwent subcutaneous port catheter implantation between January 2022 and July 2024 were included. All procedures were performed under local anesthesia using a dual-incision technique with ultrasound and fluoroscopy guidance. Patients were monitored for early (<30 days) and late (≥30 days) complications. Factors associated with port removal were analyzed using univariate and multivariate logistic regression models.
Results: The mean age of the patients was 62.45±7.75 years, with the most common malignancies being colorectal (45.0%), gastric (25.9%), and pancreatic cancers (8.9%). Early complications were observed in 3.2% of patients, while late complications occurred in 25.6%. The most frequent complications included infection (8.3%), catheter dysfunction (4.8%), and venous thrombosis (3.8%). Port removal was required in 66 patients (21.1%), most commonly due to local infection (6.1%), occlusion (4.8%), skin erosion (5.4%), and catheter-related bloodstream infection (CRBSI) (2.2%). Univariate analysis revealed significant associations between port removal and low body-mass index, metastasis, chemotherapy, and several complications (p<0.05). In multivariate analysis, metastatic disease was identified as an independent risk factor (OR: 10.14; p<0.001), while advanced age was inversely associated with port removal (OR: 0.95; p=0.021).
Conclusion: Complications related to TIVADs are common and may frequently lead to port removal, especially in metastatic cancer patients. Infection and mechanical dysfunction are the leading causes of removal. Careful follow-up and individualized preventive strategies in high-risk patients may improve long-term port functionality.

Anahtar Kelimeler

Cancer patients , complications , port removal , totally implantable venous access device , venous port catheter

Kaynakça

• Walser EM. Venous access ports: indications, implantation technique, follow-up, and complications. Cardiovasc Intervent Radiol. 2012;35(4): 751-764. doi:10.1007/s00270-011-0271-2
• Vescia S, Baumgärtner AK, Jacobs VR, et al. Management of venous port systems in oncology: a review of current evidence. Ann Oncol. 2008;19(1):9-15. doi:10.1093/annonc/mdm272
• Ruesch S, Walder B, Tramèr MR. Complications of central venous catheters: internal jugular versus subclavian access--a systematic review. Crit Care Med. 2002;30(2):454-460. doi:10.1097/00003246-200202000-00031
• Biffi R, Orsi F, Pozzi S, et al. Best choice of central venous insertion site for the prevention of catheter-related complications in adult patients who need cancer therapy: a randomized trial. Ann Oncol. 2009;20(5):935-940. doi:10.1093/annonc/mdn701
• Pinelli F, Cecero E, Degl'Innocenti D, et al. Infection of totally implantable venous access devices: a review of the literature. J Vasc Access. 2018;19(3):230-242. doi:10.1177/1129729818758999
• Charles HW, Miguel T, Kovacs S, Gohari A, Arampulikan J, McCann JW. Chest port placement with use of the single-incision insertion technique. J Vasc Interv Radiol. 2009;20(11):1464-1469. doi:10.1016/j.jvir.2009.07.035
• Nakamura T, Sasaki J, Asari Y, Sato T, Torii S, Watanabe M. Complications after implantation of subcutaneous central venous ports (PowerPortR). Ann Med Surg (Lond). 2017;17:1-6. doi:10.1016/j.amsu. 2017.03.014
• Seo TS, Song MG, Kim JS, et al. Long-term clinical outcomes of the single-incision technique for implantation of implantable venous access ports via the axillary vein. J Vasc Access. 2017;18(4):345-351. doi:10.5301/jva.5000751
• Hong S, Seo TS, Song MG, Seol HY, Suh SI, Ryoo IS. Clinical outcomes of totally implantable venous access port placement via the axillary vein in patients with head and neck malignancy. J Vasc Access. 2019;20(2):134-139. doi:10.1177/1129729818781270
• El-Balat A, Schmeil I, Karn T, et al. Catheter-related complications of subcutaneous implantable venous access devices in breast cancer patients. In Vivo. 2018;32(5):1275-1281. doi:10.21873/invivo.11377
• Machat S, Eisenhuber E, Pfarl G, et al. Complications of central venous port systems: a pictorial review. Insights Imaging. 2019;10(1):86. doi:10. 1186/s13244-019-0770-2
• Song X, Chen S, Dai Y, et al. A novel incision technique of a totally implanted venous access port in the upper arm for patients with breast cancer. World J Surg Oncol. 2023;21(1):162. doi:10.1186/s12957-023-03043-4
• Biffi R, Corrado F, de Braud F, et al. Long-term, totally implantable central venous access ports connected to a Groshong catheter for chemotherapy of solid tumours: experience from 178 cases using a single type of device. Eur J Cancer. 1997;33(8):1190-1194. doi:10.1016/s0959-8049(97)00039-7
• Wang S, Zong H, Tang L, Wei Y. Prediction of post-insertion infections related to totally implantable subcutaneous venous access ports in tumor patients using a nomogram. Biomol Biomed. 2025;25(7):1601-1609. doi:10.17305/bb.2024.11583
• Lebeaux D, Fernández-Hidalgo N, Chauhan A, et al. Management of infections related to totally implantable venous-access ports: challenges and perspectives. Lancet Infect Dis. 2014;14(2):146-159. doi:10.1016/S1473-3099(13)70266-4
• O'Mahony AT, Coffey A, O'Regan PW, et al. Catheter tip migration in female patients with breast cancer: a retrospective comparative study of right- and left-sided chest ports. Breast J. 2024;2024:7358397. doi:10. 1155/tbj/7358397
• Liu L, Liu Z, Wang J, et al. Exploring risk factors for totally implantable venous access devices (TIVADs)-related thrombotic occlusion in the off-treatment period. Sci Rep. 2023;13(1):10767. doi:10.1038/s41598-023-37902-7
• Elliott J, Ng L, Meredith C, Mander G, Thompson M, Reynolds L. Interventions to manage occluded central venous access devices: an umbrella review. J Vasc Access. 2025;26(3):726-734. doi:10.1177/ 11297298241246092
• Song MG, Seo TS, Kim YH, et al. Effect of catheter diameter on left innominate vein in breast cancer patients after totally implantable venous access port placement. J Vasc Access. 2018;19(6):615-619. doi:10. 1177/1129729818765062