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Karamanliev M, Yotsov T, Dimitrov D. Success rate and safety of totally implantable access ports placed by the cephalic vein cutdown technique in oncological patients - a single-center study. Folia Med (Plovdiv) 2023; 65:577-581. [PMID: 37655375 DOI: 10.3897/folmed.65.e87401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/20/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Totally implantable access ports (TIAPs) are commonly used in oncologic patients undergoing ongoing chemotherapy. The methods of choice for implantation are the subclavian vein puncture approach and the cephalic vein cutdown technique, followed by internal jugular vein access and external jugular vein access.
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Affiliation(s)
| | - Tsanko Yotsov
- Dr. Georgi Stranski University Hospital, Pleven, Bulgaria
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Won HS, Shin JO, Nam SM, Won HJ. Supraclavicular cephalic vein draining into the internal jugular vein via the external jugular vein. Surg Radiol Anat 2023; 45:487-490. [PMID: 36811688 DOI: 10.1007/s00276-023-03109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The aim of this study is to report rare anatomical variations of the cephalic vein (CV) in a 77-year-old Korean male cadaver. CASE REPORT On the right upper arm, the CV located lateral to the deltopectoral groove passed anterior to the clavicle at the lateral one-fourth of the clavicle without anastomosis to the axillary vein. It was connected to the transverse cervical and suprascapular veins by two communicating branches in the middle of its course at the neck, and opened into the external jugular vein at its junction with the internal jugular veins. The suprascapular and anterior jugular veins were flowed into the subclavian vein at the jugulo-subclavian venous confluence, and were connected by a short communicating branch. CONCLUSION Detailed knowledge of the variations in the CV is expected to be helpful in decreasing unpredicted injuries and possible postoperative complications when invasive venous access is performed through the CV.
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Affiliation(s)
- Hyung-Sun Won
- Department of Anatomy and Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, South Korea
| | - Jeong-Oh Shin
- Department of Anatomy, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Sung Min Nam
- Department of Anatomy and Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, South Korea
| | - Hyung-Jin Won
- Department of Anatomy, School of Medicine, Kangwon National University, Chuncheon, South Korea.
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Retrospective analysis: 5509 cases of "totally implantable venous access port systems implantation (TIVAPS) depth" assisted by digital radiography. Langenbecks Arch Surg 2022; 407:3123-3132. [PMID: 35660962 DOI: 10.1007/s00423-022-02573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Modern oncological treatment in breast cancer patients requires the precise delivery of chemotherapy infusion into the central venous systems without toxicity. TIVAPS is the significant method of chemotherapy delivery although certain internal or external complications associated with their placement. However, the long-term use of TIVAPS is still a concern to minimize the complications such as venous thrombosis syndrome (VTS) and cardiac defects. The aim of this study is to investigate the potential disadvantages that may be avoided by digital radiography (DR)-assisted measurement of catheter depth pertinent to TIVAPS implanted system. METHODS Retrospective analysis related to 5509 TIVAPS recipients of 99% female breast cancer patients and 1% male blood disorder patients registered from April 2013 to November 2017 were included in the study. Patients with TIVAPS catheter tip depth into superior vena cava into upper (group A), middle (group B), and lower (group C) parts were stratified for evaluation during implantation; DR-assisted measurement of TIVAPS was performed to decipher "tip depth of catheter" and determined the relevance of tip depth to complications such as VTS and cardiac defects. RESULTS Incidence of VTS complications were significantly higher in TIVAPS recipients of group A (82.7%) than group B (16%) and group C (0.12%) in which the "tip depth of TIVAPS was deeper" (P < 0.01). Defects in heart function are higher in group C (59.6%) than group A (15.8%) and group B (24.6%) in which the "tip depth of TIVAPS was deeper" (P < 0.01). CONCLUSION DR-assisted measurement can more accurately determine the depth of TIVAPS catheter implantation, and avoid the incidence of related complications, and provide a better method for surgeons.
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Thiel K, Kalmbach S, Maier G, Wichmann D, Schenk M, Königsrainer A, Thiel C. Standardized procedure prevents perioperative and early complications in totally implantable venous-access ports-a complication analysis of more than 1000 TIVAP implantations. Langenbecks Arch Surg 2022; 407:3755-3762. [PMID: 36070032 PMCID: PMC9722872 DOI: 10.1007/s00423-022-02656-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/13/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Since their invention 40 years ago, totally implantable venous-access ports (TIVAPs) have become indispensable in cancer treatment. The aim of our study was to analyze complications under standardized operative and perioperative procedures and to identify risk factors for premature port catheter explantation. METHODS A total of 1008 consecutive TIVAP implantations were studied for success rate, perioperative, early, and late complications. Surgical, clinical, and demographic factors were analyzed as potential risk factors for emergency port catheter explantation. RESULTS Successful surgical TIVAP implantation was achieved in 1005/1008 (99.7%) cases. No intraoperative or perioperative complications occurred. A total of 32 early complications and 88 late complications were observed leading to explantation in 11/32 (34.4%) and 34/88 (38.6%) cases, respectively. The most common complications were infections in 4.7% followed by thrombosis in 3.6%. Parameters that correlated with unplanned TIVAP explantation were gender (port in situ: female 95% vs. male 91%, p = 0.01), underlying disease (breast cancer 97% vs. gastrointestinal 89%, p = 0.004), indication (chemotherapy 95% vs. combination of chemotherapy and parenteral nutrition 64%, p < 0.0001), and type of complication (infection 13.4% vs. TIVAP-related complication 54% and thrombosis 95%, p < 0.0001). CONCLUSION Standardized operative and perioperative TIVAP implantation procedures provide excellent results and low explantation rate.
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Affiliation(s)
- Karolin Thiel
- Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
| | - Sarah Kalmbach
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Gerhard Maier
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Dörte Wichmann
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Martin Schenk
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Alfred Königsrainer
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Christian Thiel
- grid.411544.10000 0001 0196 8249Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
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Long-Term Results of a Standard Algorithm for Intravenous Port Implantation. J Pers Med 2021; 11:jpm11050344. [PMID: 33923312 PMCID: PMC8146737 DOI: 10.3390/jpm11050344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 01/15/2023] Open
Abstract
Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients (p < 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% (p = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.
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Mehta N, Desai SM, Dhakad V, Patel D, Saldanha E. External Jugular Cutdown Technique for Totally Implantable Venous Access Devices: a Single-Centre Study. Indian J Surg Oncol 2020; 11:418-422. [PMID: 33013121 DOI: 10.1007/s13193-020-01103-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022] Open
Abstract
Chemotherapy drugs are the integral part of cancer treatment. Their administration is optimized by central venous access devices. We present our prospective study of chemoport implantation by external jugular vein cutdown technique. We studied 100 patients who underwent chemoport insertion over a span of 3 years for various solid and haematological malignancies via external jugular vein cutdown method. Outcomes such as type of disease, anaesthesia, choice of venous access, catheter tip position, length of the procedure, time to start chemotherapy and morbidity data were analysed. The Hundred /100 intravenous devices were implanted in 66% females and 33% males. Most common indication was breast cancer (64% of patients). A total of 80% of patients underwent procedure under local anaesthesia. Chemoports were inserted on the right side in 84 and left side in the remaining 16. The average surgical time was 32 min. The overall success rate was 97% with no intraoperative complications. Three postoperative complications were encountered due to displacement of catheter or wound infection. External jugular vein cutdown approach is a safe, reliable method for venous access device implantation. This approach has a high success rate and has minimal complications and can be easily learnt.
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Affiliation(s)
- Nikhil Mehta
- Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore, 453555 India
| | - Sanjay M Desai
- Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore, 453555 India
| | - Vinod Dhakad
- Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore, 453555 India
| | - Dhruv Patel
- Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore, 453555 India
| | - Elroy Saldanha
- Department of surgical Onology, Sri Aurobindo Institute of Medical Sciences, Bhanwarsala, Indore, 453555 India
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Hashimoto S, Otsubo R, Adachi M, Doi R, Shibata K, Sano I, Shibata Y, Nakazaki T, Taniguchi H, Nagayasu T. Cephalic Vein Cut-down for Totally Implantable Central Venous Access Devices With Preoperative Ultrasonography by Surgical Residents. In Vivo 2020; 33:2079-2085. [PMID: 31662541 DOI: 10.21873/invivo.11707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Cephalic vein (CV) cut-down for totally implantable central venous access devices (TICVADs) is not frequently used due to its low success rate. We compared the outcomes of CV cut-down using preoperative ultrasonography (US) performed by experienced surgeons versus surgical residents. PATIENTS AND METHODS From December 2015 to December 2017, 10 surgeons implanted 212 TICVADs using CV cut-down with preoperative US. The surgeons were divided into two groups of five each: surgical residents (Group A, n=124 procedures) and experienced surgeons (Group B, n=88 procedures). Duration of operation time, completion rate, and complications were retrospectively analyzed. RESULTS The completion rate was significantly higher in Group A (98.4% versus 92.0%, p=0.04). Duration of operation time (45.2±14.5 versus 42.0±13.1 minutes, p=0.22), rates of early complications (1.6% versus 1.1%, p=0.77) and late complications (3.2% versus 2.3%, p=0.68) were equivalent between the two groups. No fatal complications occurred in either group. CONCLUSION CV cut-down can be safely performed by surgical residents under the use of preoperative US.
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Affiliation(s)
- Shintaro Hashimoto
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan.,Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryota Otsubo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masahiro Adachi
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Ryoichiro Doi
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Kenichiro Shibata
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Isao Sano
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Yoshihito Shibata
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takayuki Nakazaki
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Hideki Taniguchi
- Department of Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Rhu J, Jun KW, Song BJ, Sung K, Cho J. Cephalic vein approach for the implantable central venous access: A retrospective review of the single institution's experiences; Cohort Study. Medicine (Baltimore) 2019; 98:e18007. [PMID: 31725671 PMCID: PMC6867776 DOI: 10.1097/md.0000000000018007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Long-term venous access is usually required in patients receiving chemotherapy. We hypothesized that, out of the various central line approach techniques, the cephalic vein cut-down technique can be a safe and simple alternative in terms of surgical safety, feasibility, cost-effectiveness, and functional outcomes.We retrospectively reviewed the medical records of 569 patients who underwent implantable central venous access between January 2012 and December 2014 at our hospital.We classified our cohort according to access routes, as follows: 230 patients underwent subclavian vein access, 134 patients underwent internal jugular vein access, 25 patients underwent external jugular vein access, and 119 patients underwent cephalic vein access. The cephalic vein group had a significantly longer operation time than the subclavian group (P < .01); however, there was no difference in operation time between the internal jugular vein and cephalic vein groups (P = .59). The procedure-related complications and functional outcomes of the implanted venous port during chemotherapy were comparable between the cephalic group and other groups. Additionally, body mass index, operation time, and age did not correlate with catheter dysfunction in the multivariate logistic regression analysis (P = .53; P = .66; P = .19, respectively).We suggest that a cut-down central venous catheter insertion through the cephalic vein can be performed easily and safely with no differences in surgical and clinical outcomes compared to those of conventional percutaneous approaches. Moreover, the cephalic vein approach requires no specialized equipment, including percutaneous vascular kits, tunneling instruments, and intraoperative ultrasonography. Therefore, this technique might incur less medical expenses than conventional approaches and would be helpful for both patients and surgeons.
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Retrospective outcome analysis of rates and types of complications after 8654 minimally invasive radiological port implantations via the subclavian vein without ultrasound guidance. Radiol Med 2019; 124:926-933. [DOI: 10.1007/s11547-019-01048-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
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10
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The axillary vein and its tributaries are not in the mirror image of the axillary artery and its branches. PLoS One 2019; 14:e0210464. [PMID: 30629680 PMCID: PMC6328140 DOI: 10.1371/journal.pone.0210464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/25/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The axillary and cephalic veins are used for various clinical purposes but their anatomy is not fully understood. Increased knowledge and information about them as well as superficial veins in the upper arm would be useful. OBJECTIVE The aim of this study is to contribute to the literature regarding the anatomy of the venous drainage of the upper extremity. METHODS The veins of forty upper extremities from twenty one adult cadavers were injected and their axillary regions dissected. The course and pattern of drainage of the venous tributaries in the axillary region were identified and recorded. RESULTS The basilic, brachial, subscapular, lateral thoracic and superior thoracic veins drained mainly into the axillary vein, in common with most textbook descriptions. However, the thoracoacromial veins were observed to drain into the cephalic vein in 70.0% of upper limbs. In addition, a venous channel connecting the distal part and proximal part of the axilla was found along the posterolateral wall of the axilla in 77.5% of the upper limbs. In 95.0% of upper limbs, we discovered a superficial vein which ran from the axillary base and drained directly into the axillary vein. CONCLUSION The veins from the inferomedial part of the axilla drain into the axillary vein, whereas the veins from the superolateral part of the axilla drain into the cephalic vein. The venous drainage of the axilla is variable and in common with venous drainage elsewhere, does not necessarily follow the pattern of the arterial supply.
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Yıldırım İ, Tütüncü AÇ, Bademler S, Özgür İ, Demiray M, Karanlık H. Does the real-time ultrasound guidance provide safer venipuncture in implantable venous port implantation? J Vasc Access 2018; 19:297-302. [PMID: 29582679 DOI: 10.1177/1129729817752606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIM To examine whether the real-time ultrasound-guided venipuncture for implantable venous port placement is safer than the traditional venipuncture. METHODS The study analyzed the results of 2153 venous ports placed consecutively from January 2009 to January 2016. A total of 922 patients in group 1 and 1231 patients in group 2 were admitted with venous port placed using the traditional landmark subclavian approach and real-time ultrasound-guided axillary approach, respectively. Sociodemographic characteristics of patients, early (pneumothorax, pinch-off syndrome, arterial puncture, hematoma, and malposition arrhythmia) and late (deep vein thrombosis, obstruction, infection, erosion-dehiscence, and rotation of the port chamber) complications and the association of these complications with the implantation method were evaluated. RESULTS There were no significant differences in the sociodemographic characteristics of the patients between the two groups. The overall and early complications in group 2 were significantly lower than those in group 1. Pinch-off syndrome only developed in group 1. Seven patients and two patients had pneumothorax in groups 1 and 2, respectively. Puncture number was significantly associated with the development of the overall complications. CONCLUSION The ultrasound-guided axillary approach may be preferred as a method to reduce the risk of both early and late complications. Large, randomized, controlled prospective trials will be helpful in determining a safer implantable venous port implantation technique.
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Affiliation(s)
- İlknur Yıldırım
- 1 Department of Anesthesiology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Ayşe Çiğdem Tütüncü
- 2 Department of Anesthesiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Süleyman Bademler
- 3 Department of Surgery, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - İlker Özgür
- 4 Department of Surgery, Acibadem International Hospital, Istanbul, Turkey
| | - Mukaddes Demiray
- 5 Department of Surgery, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| | - Hasan Karanlık
- 3 Department of Surgery, Institute of Oncology, Istanbul University, Istanbul, Turkey
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Polychronidis G, Hennes R, Engerer C, Knebel P, Schultze D, Bruckner T, Müller-Stich BP, Fischer L. Use of a hydrophilic coating wire reduces significantly the rate of central vein punctures and the incidence of pneumothorax in totally implantable access port (TIAP) surgery. BMC Surg 2017; 17:131. [PMID: 29216858 PMCID: PMC5721482 DOI: 10.1186/s12893-017-0329-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 11/27/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
| | | | - Cosima Engerer
- Department of Surgery, University of Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - Phillip Knebel
- Department of Surgery, University of Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - Daniel Schultze
- Department of Surgery, University of Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry, Institute of Medical Biometry and Informatics (IMBI), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of Surgery, University of Heidelberg, INF 110, 69120, Heidelberg, Germany
| | - Lars Fischer
- Department of Surgery, University of Heidelberg, INF 110, 69120, Heidelberg, Germany. .,Department of Surgery, Klinikum Mittelbaden Baden-Baden Bühl, Balger Str. 50, 76532, Baden-Baden, Germany.
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Go JY, Han DJ, Kim J, Yoon SP. A supraclavicular cephalic vein drained into the subclavian vein. Surg Radiol Anat 2017; 39:1413-1415. [PMID: 28547035 DOI: 10.1007/s00276-017-1878-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
Although the cephalic vein follows a fairly consistent course, numerous variants have been reported. We found a rare anatomical presentation of the cephalic vein in a 75-year-old Korean male cadaver. The left cephalic vein was identified in the deltopectoral groove, ascended over the clavicle, and terminated into the left subclavian vein just before its union with the left internal jugular vein. The detailed knowledge on the variations of the cephalic vein is important for clinicians as well as anatomists since the approach through the axillary base is favored in many invasive clinical procedures.
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Affiliation(s)
- Jun-Yong Go
- Medical Course, Medical School, Jeju National University, Jeju-si, Jeju-do, 63243, Republic of Korea
| | - Dong-Jae Han
- Medical Course, Medical School, Jeju National University, Jeju-si, Jeju-do, 63243, Republic of Korea
| | - Jinu Kim
- Department of Anatomy, School of Medicine, Jeju National University, 102 Jejudaehak-ro, Jeju-si, Jeju-do, 63243, Republic of Korea
| | - Sang-Pil Yoon
- Department of Anatomy, School of Medicine, Jeju National University, 102 Jejudaehak-ro, Jeju-si, Jeju-do, 63243, Republic of Korea. .,Institute of Medical Science, Jeju National University, Jeju-si, Jeju-do, 63243, Republic of Korea.
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Tyrak KW, Holda J, Holda MK, Koziej M, Piatek K, Klimek-Piotrowska W. Persistent left superior vena cava. Cardiovasc J Afr 2017; 28:e1-e4. [PMID: 28759082 PMCID: PMC5558145 DOI: 10.5830/cvja-2016-084] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 09/15/2016] [Indexed: 11/06/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is the most common congenital malformation of thoracic venous return and is present in 0.3 to 0.5% of individuals in the general population. This heart specimen was dissected from a 35-year-old male cadaver whose cause of death was determined as non-cardiac. The heart was examined and we found a PLSVC draining into the coronary sinus. The right superior vena cava was present with a small-diameter ostium. An anomalous pulmonary vein pattern was observed; there was a common trunk to the left superior and left inferior pulmonary veins (diameter 17.8 mm) and an additional middle right pulmonary vein (diameter 2.7 mm) with two classic right pulmonary veins. The PLSVC draining into the coronary sinus had led to its enlargement, which could have altered the cardiac haemodynamics by significantly reducing the size of the left atrium and impeding its outflow via the mitral valve.
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Affiliation(s)
- Kamil W Tyrak
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.
| | - Jakub Holda
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz K Holda
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Piatek
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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Otsubo R, Hatachi T, Shibata K, Yoshida T, Watanabe H, Oikawa M, Matsumoto M, Yano H, Taniguchi H, Nagayasu T. Evaluation of totally implantable central venous access devices with the cephalic vein cut-down approach: Usefulness of preoperative ultrasonography. J Surg Oncol 2015; 113:114-9. [DOI: 10.1002/jso.24100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 11/07/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Ryota Otsubo
- Department of Surgical Oncology; Nagasaki University Hospital; Nagasaki Japan
- Department of Surgery; The Japanese Red Cross Nagasaki Genbaku Hospital; Nagasaki Japan
| | - Toshiko Hatachi
- Department of Surgery; The Japanese Red Cross Nagasaki Genbaku Hospital; Nagasaki Japan
| | - Kenichiro Shibata
- Department of Surgery; The Japanese Red Cross Nagasaki Genbaku Hospital; Nagasaki Japan
| | - Takuya Yoshida
- Department of Surgical Oncology; Nagasaki University Hospital; Nagasaki Japan
- Department of Surgery; The Japanese Red Cross Nagasaki Genbaku Hospital; Nagasaki Japan
| | - Hironosuke Watanabe
- Department of Surgical Oncology; Nagasaki University Hospital; Nagasaki Japan
- Department of Surgery; The Japanese Red Cross Nagasaki Genbaku Hospital; Nagasaki Japan
| | - Masahiro Oikawa
- Department of Surgical Oncology; Nagasaki University Hospital; Nagasaki Japan
- Department of Surgery; Nyuuwakai Oikawa Hospital; Fukuoka Japan
| | - Megumi Matsumoto
- Department of Surgical Oncology; Nagasaki University Hospital; Nagasaki Japan
| | - Hiroshi Yano
- Department of Surgical Oncology; Nagasaki University Hospital; Nagasaki Japan
| | - Hideki Taniguchi
- Department of Surgery; The Japanese Red Cross Nagasaki Genbaku Hospital; Nagasaki Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology; Nagasaki University Hospital; Nagasaki Japan
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Ultrasound-guided vein puncture versus surgical cut-down technique in totally implantable venous access devices (TIVADS): a prospective comparative study on safety, efficacy andcomplications. Int Surg 2015; 99:475-8. [PMID: 25058787 DOI: 10.9738/intsurg-d-14-00008.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Biacchi D, Sammartino P, Sibio S, Accarpio F, Cardi M, Sapienza P, De Cesare A, Maher Fouad Atta J, Impagnatiello A, Di Giorgio A. Does the Implantation Technique for Totally Implantable Venous Access Ports (TIVAPs) Influence Long-Term Outcome? World J Surg 2015; 40:284-90. [DOI: 10.1007/s00268-015-3233-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cavallaro G, Iorio O, Iossa A, De Angelis F, Avallone M, Massaro M, Mattia C, Silecchia G. A prospective evaluation on external jugular vein cut-down approach for TIVAD implantation. World J Surg Oncol 2015; 13:243. [PMID: 26264364 PMCID: PMC4534022 DOI: 10.1186/s12957-015-0663-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/28/2015] [Indexed: 11/21/2022] Open
Abstract
Background Totally implantable venous access devices can be implanted both by percutaneous approaches and by surgical approaches with cephalic vein or external jugular vein cut-down techniques that are related to low intraoperative complication rates. The authors report a prospective evaluation of 83 consecutive external jugular vein cut-down approaches for totally implantable venous access devices implantation. Methods Eighty three consecutive patients (28 M, 55 F, mean age 54.2) suffering from solid tumors (58) or hematologic diseases (25) were consecutively submitted to totally implantable venous access devices insertion through external jugular vein cut-down approach (75 on right side, 8 on left side). Results All devices were surgically implanted; no instances of intraoperative complications were detected. After a minimum follow-up of 150 days, only one case of wound hematoma and one case of device malfunction due to incorrect catheter angulation were noted. Postoperative patient satisfaction was evaluated by the use of specific questionnaire that demonstrated a good satisfaction and compliance (92.8 %) of patients with implanted devices. Conclusions Despite the lack of controlled studies comparing external jugular vein cut-down approach vs other approaches, this approach should be considered as a tool for long-term central vein catheters positioning, both as an alternative and for primary approach.
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Affiliation(s)
- Giuseppe Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy.
| | - Olga Iorio
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Francesco De Angelis
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Marcello Avallone
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Matteo Massaro
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Consalvo Mattia
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
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Wei WC, Wu CY, Wu CF, Fu JY, Su TW, Yu SY, Kao TC, Ko PJ. The Treatment Results of a Standard Algorithm for Choosing the Best Entry Vessel for Intravenous Port Implantation. Medicine (Baltimore) 2015; 94:e1381. [PMID: 26287429 PMCID: PMC4616437 DOI: 10.1097/md.0000000000001381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Vascular cutdown and echo guide puncture methods have its own limitations under certain conditions. There was no available algorithm for choosing entry vessel. A standard algorithm was introduced to help choose the entry vessel location according to our clinical experience and review of the literature. The goal of this study is to analyze the treatment results of the standard algorithm used to choose the entry vessel for intravenous port implantation.During the period between March 2012 and March 2013, 507 patients who received intravenous port implantation due to advanced chemotherapy were included into this study. Choice of entry vessel was according to standard algorithm. All clinical characteristic factors were collected and complication rate and incidence were further analyzed.Compared with our clinical experience in 2006, procedure-related complication rate declined from 1.09% to 0.4%, whereas the late complication rate decreased from 19.97% to 3.55%. No more pneumothorax, hematoma, catheter kinking, fractures, and pocket erosion were identified after using the standard algorithm. In alive oncology patients, 98% implanted port could serve a functional vascular access to fit therapeutic needs.This standard algorithm for choosing the best entry vessel is a simple guideline that is easy to follow. The algorithm has excellent efficiency and can minimize complication rates and incidence.
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Affiliation(s)
- Wen-Cheng Wei
- From the Department of Surgery, Division of Thoracic and Cardiovascular Surgery (W-CW, C-YW, C-FW, T-WS, S-YY, T-CK, P-JK); and Department of Internal Medicine, Division of Chest and Critical Care, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan (J-YF)
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20
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Abstract
The implantation of Long-Term Central Venous Catheters (LTCVC) in cancer patients has been essential to conduct the oncological treatments of today. The complexity of the protocols requires accuracy on the management of such devices in order to keep them long-functioning. The article focuses on such subject from an oncological perspective, pointing out threats of the disease to the central venous system (CVS) and the ways to face them successfully. The most salient points related to surgical techniques and the insights to follow-up long-term inserted catheters are discussed. An anatomical classification is suggested to help understand occurrence of malpositions and to north the necessary maneuvers of repositioning. Such matters are based on 3000 LTCVC-placements performed by the author at the Brazilian National Cancer Institute (INCA) between 1999 and 2011. As nearly 30% of the patients presented some sort of anatomical disorder at the moment of the surgery, it was judged worthy to address such experience to those young surgical oncologists willing to tackle LTCVCs in Cancer Units.
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21
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Su TW, Wu CF, Fu JY, Ko PJ, Yu SY, Kao TC, Hsieh HC, Wu CY. Deltoid branch of thoracoacromial vein: a safe alternative entry vessel for intravenous port implantation. Medicine (Baltimore) 2015; 94:e728. [PMID: 25929903 PMCID: PMC4603045 DOI: 10.1097/md.0000000000000728] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
An entry vessel is crucial for intravenous port implantation. A safe alternative entry vessel that can be easily explored is crucial for patients without feasible cephalic vein or for those who need port reimplantation because of disease relapse. In this study, we tried to analyze the safety and feasibility of catheter implantation via the deltoid branch of the thoracoacromial vein.From March 2012 to November 2013, 802 consecutive oncology patients who had received intravenous port implantation via the superior vena cava were enrolled in this study. The functional results and complications of different entry vessels were compared.The majority of patients (93.6%) could be identified as thoracoacromial vessel. The deltoid branch of the thoracoacromial vein is located on the medial aspect of the deltopectoral groove beneath the pectoralis major muscle (85.8%) and in the deep part of the deltopectoral groove (14.2%). Due to the various calibers employed and tortuous routes followed, we utilized 3 different methods for catheter implantation, including vessel cutdown (47.4%), wire assisted (17.9%), and modified puncture method (34.6%). The functional results and complication rate were similar to other entry vessels.The deltoid branch of the thoracoacromial vein is located in the neighborhood of the cephalic vein. The functional results of intravenous port implantation via the deltoid branch of the thoracoacromial vein are similar to other entry vessels. It is a safe alternative entry vessel for intravenous port implantation.
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Affiliation(s)
- Ta-Wei Su
- From the Division of Thoracic and Cardiovascular Surgery (TWS, CFW, PJK, SYY, TCK, HCH, CYW), Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University; and Division of Chest and Critical care (JYF), Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan
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Hüttner FJ, Bruckner T, Alldinger I, Hennes R, Ulrich A, Büchler MW, Diener MK, Knebel P. Frequency of pneumothorax and haemothorax after primary open versus closed implantation strategies for insertion of a totally implantable venous access port in oncological patients: study protocol for a randomised controlled trial. Trials 2015; 16:128. [PMID: 25872780 PMCID: PMC4396913 DOI: 10.1186/s13063-015-0643-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/10/2015] [Indexed: 11/29/2022] Open
Abstract
Background The insertion of central venous access devices, such as totally implantable venous access ports (TIVAPs), is routine in patients who need a safe and permanent venous access. The number of port implantations is increasing due to the development of innovative adjuvant and neo-adjuvant therapies. Currently, two different strategies are being routinely used: surgical cut-down of the cephalic vein (vena section) and direct puncture of the subclavian vein. The aim of this trial is to identify the strategy for the implantation of TIVAPs with the lowest risk of pneumothorax and haemothorax. Methods/Design The PORTAS-3 trial is designed as a multicentre, randomised controlled trial to compare two implantation strategies. A total of 1,154 patients will be randomised after giving written informed consent. Patients must be over 18 years of age and scheduled for primary implantation of a TIVAP on the designated side. The primary endpoint will be the frequency of pneumothorax and haemothorax after insertion of a TIVAP by one of two different strategies. The experimental intervention is as follows: open strategy, defined as surgical cut-down of the cephalic vein, supported by a rescue technique if necessary, and in the case of failure, direct puncture of the subclavian vein. The control intervention is as follows: direct puncture of the subclavian vein using the Seldinger technique guided by sonography, fluoroscopy or landmark technique. The trial duration is approximately 36 months, with a recruitment period of 18 months and a follow-up period of 30 days. Discussion The PORTAS-3 trial will compare two different TIVAP implantation strategies with regard to their individual risk of postoperative pneumothorax and haemothorax. Since TIVAP implantation is one of the most common procedures in general surgery, the results will be of interest for a large community of surgeons as well as oncologists and general practitioners. The pragmatic trial design ensures that the results will be generalizable to a wide range of patients. Trial registration The trial protocol was registered on 28 August 2014 with the German Clinical Trials Register (DRKS00004900). The World Health Organization’s Universal Trial Number is U1111-1142-4420. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0643-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felix J Hüttner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Tom Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany.
| | - Ingo Alldinger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Roland Hennes
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. .,Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Abstract
Background:Although many catheter-related blood-stream infections (CRBSIs) are preventable, measures to reduce these infections are not uniformly implemented.Objective:To update an existing evidenced-based guideline that promotes strategies to prevent CRBSIs.Data Sources:The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles.Studies Included:Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiologic investigations.Outcome Measures:Reduction in CRBSI, catheter colonization, or catheter-related infection.Synthesis:The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis).Conclusion:Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.
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Chang DH, Hiss S, Herich L, Becker I, Mammadov K, Franke M, Mpotsaris A, Kleinert R, Persigehl T, Maintz D, Bangard C. Implantation of venous access devices under local anesthesia: patients' satisfaction with oral lorazepam. Patient Prefer Adherence 2015; 9:943-9. [PMID: 26185424 PMCID: PMC4501160 DOI: 10.2147/ppa.s80330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The aim of the study reported here was to evaluate patients' satisfaction with implantation of venous access devices under local anesthesia (LA) with and without additional oral sedation. MATERIALS AND METHODS A total of 77 patients were enrolled in the prospective descriptive study over a period of 6 months. Subcutaneous implantable venous access devices through the subclavian vein were routinely implanted under LA. Patients were offered an additional oral sedative (lorazepam) before each procedure. The level of anxiety/tension, the intensity of pain, and patients' satisfaction were evaluated before and immediately after the procedure using a visual analog scale (ranging from 0 to 10) with a standardized questionnaire. RESULTS Patients' satisfaction with the procedure was high (mean: 1.3±2.0) with no significant difference between the group with premedication and the group with LA alone (P=0.54). However, seven out of 30 patients (23.3%) in the group that received premedication would not undergo the same procedure without general anesthesia. There was no significant influence of lorazepam on the intensity of pain (P=0.88). In 12 out of 30 patients (40%) in the premedication group, the level of tension was higher than 5 on the visual analog scale during the procedure. In 21 out of 77 patients (27.3%), the estimate of the level of tension differed between the interventionist and the patient by 3 or more points in 21 out of 77 patients (27.3%). CONCLUSION Overall patient satisfaction is high for implantation of venous access devices under LA. A combination of LA with lorazepam administered orally might not be adequate for patients with a high level of anxiety and tension. The level of tension is often underestimated by the interventionist. Pre-procedural standardized questionnaires could be used to identify patients for whom a gradual approach of individualized sedation may be more effective.
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Affiliation(s)
- De-Hua Chang
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
- Correspondence: De-Hua Chang, University Hospital of Cologne, Kerpener Str 62, 50937 Cologne, Germany, Tel +49 163 8859 534, Fax +49 478 7348, Email
| | - Sonja Hiss
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Lena Herich
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Kamal Mammadov
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - Mareike Franke
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | | | - Robert Kleinert
- Department of Surgery, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
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Powell CA, Prousskaia E, Wilson SM. Cephalic vein inconsistency in autologous breast reconstruction salvage. J Plast Reconstr Aesthet Surg 2014; 68:e39. [PMID: 25455295 DOI: 10.1016/j.bjps.2014.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022]
Affiliation(s)
- C A Powell
- Department of Plastic Surgery, Southmead Hospital, Southmead Rd., Westbury on Trym, Bristol, South Gloucestershire, BS10 5NB, United Kingdom.
| | - E Prousskaia
- Department of Plastic Surgery, Southmead Hospital, Southmead Rd., Westbury on Trym, Bristol, South Gloucestershire, BS10 5NB, United Kingdom
| | - S M Wilson
- Department of Plastic Surgery, Southmead Hospital, Southmead Rd., Westbury on Trym, Bristol, South Gloucestershire, BS10 5NB, United Kingdom
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External jugular vein approach for TIVAD implantation: first choice or only an alternative? A review of the literature. J Vasc Access 2014; 16:1-4. [PMID: 25198827 DOI: 10.5301/jva.5000287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2014] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Totally implantable venous access devices (TIVADs) can be implanted by percutaneous approach (to the subclavian or internal jugular vein) or by surgical approach, through cephalic vein or external jugular vein (EJV). The authors present a review of the literature about EJV approach for TIVAD implantation. METHODS A review of articles indexed in MEDLINE (PubMed) and Cochrane Central Register on "EJV access," "EJV cut-down," and "TIVADs" was performed, even matching the terms.We gathered articles from papers quoting patient number, specialist involved, number of devices implanted, site and technique of implantation and complications. RESULTS A total of 1,308 TIVAD implantations through EJV have been reported, with a success rate ranging from 73.7% to 100% and a complication rate up to 13%. Only in 4 on 10 series reported (with more than 15 procedures) the EJV approach was the first choice, while in the other 6 series this approach was the alternative after failure of other approaches. CONCLUSIONS Despite the lack of consistent series and prospective studies comparing EJV with other approaches, data present in the literature may support the evidence that EJV approach for TIVAD implantation is safe and effective, and may be considered as the first approach in selected patients.
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Randomized Clinical Trial Comparing Ultrasound-Guided Procedure with the Seldinger’s Technique for Placement of Implantable Venous Ports. Cell Biochem Biophys 2014; 70:559-63. [DOI: 10.1007/s12013-014-9956-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Analysis of chest X-ray plain film images of intravenous ports inserted via the superior vena cava. Surg Today 2014; 44:1513-21. [PMID: 24711121 DOI: 10.1007/s00595-014-0893-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 08/20/2013] [Indexed: 10/25/2022]
Abstract
PURPOSES The optimal tip position for an intravenous port and the angle between the locking nut and the catheter are still debatable. This study evaluates the use of chest X-ray plain films for screening patients with potential intravenous port complications. METHODS We reviewed, retrospectively, 1505 patients who had an intravenous port implanted between January 1 and December 31, 2006 at Chang Gung Memorial Hospital, and were followed up until June 30, 2010. Of the 1119 patients with an intravenous port implanted via the superior vena cava (SVC), 279 underwent re-interventions for complications. There were four different types of single lumen port, and entry vessels on the right side were utilized as the predominant entry sites through the vessel cut-down method for catheter cannulation. The anatomic catheter tip was confirmed on the postero-anterior view of plain chest X-ray films. We used the Picture Arching and Communicating System (PACS) (GE, Fairfield, CT, USA) to record the angle and distance in degrees and centimeters, respectively. RESULTS The tracheal carina was seen easily on the chest X-ray plain film and the location of the catheter tip and the angle between the locking nut and the catheter were identified. The location of the catheter tip was significantly related to migration (p < 0.0001). The cut-off value of the receiver operating characteristic (ROC) curve for location and migration was 0.68 cm below the carina. The area under the curve (AUC) was 0.8385 and had favorable predictive power. CONCLUSION The ideal position of an intravenous port to avoid migration is 0.68 cm below the carina. For surgeons, a quantified reference may minimize technical errors. Patients with shallow tip location should be followed up regularly and aggressive intervention initiated for any intravenous port malfunction.
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Jung KH, Moon SB. Cephalic vein cutdown for totally implantable central venous port in children: a retrospective analysis of prospectively collected data. Can J Surg 2014; 57:21-5. [PMID: 24461222 DOI: 10.1503/cjs.025512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The jugular vein cutdown for a totally implantable central venous port (TICVP) has 2 disadvantages: 2 separate incisions are needed and the risk for multiple vein occlusions. We sought to evaluate the feasibility of a cephalic vein (CV) cutdown in children. METHODS We prospectively followed patients who underwent a venous cutdown for implantation of a TICVP between Jan. 1, 2002, and Dec. 31, 2006. For patients younger than 8 months, an external jugular vein cutdown was initially tried without attempting a CV cutdown. For patients older than 8 months, a CV cutdown was tried initially. We recorded information on age, weight, outcome of the CV cutdown and complications. RESULTS During the study period, 143 patients underwent a venous cutdown for implantation of a TICVP: 25 younger and 118 older than 8 months. The CV cutdown was successful in 73 of 118 trials. The 25th percentile and median body weight for 73 successful cases were 15.4 kg and 28.3 kg, respectively. There was a significant difference in the success rate using the criterion of 15 kg as the cutoff. The overall complication rate was 8.2%. CONCLUSION The CV cutdown was an acceptable procedure for TICVP in children. It could be preferentially considered for patients weighing more than 15 kg who require TICVP.
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Affiliation(s)
- Kyu-Hwan Jung
- The Department of Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Suk-Bae Moon
- The Department of Surgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
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Troupis TG, Michalinos A, Manou V, Vlastos D, Johnson EO, Demesticha T, Skandalakis P. Report of an unusual combination of arterial, venous and neural variations in a cadaveric upper limb. J Brachial Plex Peripher Nerve Inj 2014; 9:2. [PMID: 24495850 PMCID: PMC4002576 DOI: 10.1186/1749-7221-9-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/31/2014] [Indexed: 11/10/2022] Open
Abstract
In this study an unusual combination of arterial, venous and neural variations discovered during dissection of cervical, axillary and brachial area of a cadaver is described. Variations are thoroughly described and literature is briefly reviewed. Lateral cord of brachial plexus was not formed; Eight Cervical root divided into anterior and posterior division before uniting with First Thoracic root and Upper Trunk was unusually short. Axillary artery gave origin to a superficial brachial artery and then continued as deep brachial artery. Multiple variations in typical axillary artery branches were present including existence of inferior pectoral artery. Cephalic vein was absent. A variety of interventions, from relative simple as central venous catheter placement to most complicated as brachial plexus injury repair demand thorough knowledge of area's regional anatomy. Familiarity with anatomic variations allows more precise and careful interventions. Research on these variations is valuable for anatomists and embryologists but also for clinicians because it may provide useful information for non - typical cases but also helps in raising a high level of suspicion.
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Affiliation(s)
- Theodore G Troupis
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Adamantios Michalinos
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Manou
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vlastos
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth O Johnson
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theano Demesticha
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Skandalakis
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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A single-center study of vascular access sites for intravenous ports. Surg Today 2013; 44:723-31. [PMID: 23670039 DOI: 10.1007/s00595-013-0610-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study evaluated the use of intravenous ports and provides a guide related to clinical decision making. METHODS This study retrospectively reviewed 1505 patients who had received intravenous ports at Chang Gung Memorial Hospital in 2006. The relationships between the complications and entry routes were assessed. The intervention-free periods were also determined and compared. The patients were followed up until June 2010. RESULTS Of the 1543 procedures performed, 412 were reinterventions to treat complications, most of which corresponded to fewer than 0.1 episodes per 1000 catheter-days; these were not associated with any particular entry route. There was a higher catheter fracture rate when the right subclavian vein was chosen as the entry vessel (p < 0.05). The intervention-free period ranged from 207 to 533 days. CONCLUSION The subclavian vein is not recommended for the use of intravenous ports. There is not only a higher risk of iatrogenic pneumothorax or hemothorax using this entry route but also a higher fracture rate, which may be caused by pinch-off syndrome. The greater saphenous vein should only be considered when the patient has superior vena cava syndrome. However, a higher incidence of infection and a lower device survival rate should be expected with this location.
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Subclavian vein puncture vs. surgical cut-down to the cephalic vein for insertion of totally implantable venous access ports. Eur Surg 2012. [DOI: 10.1007/s10353-012-0157-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ribeiro RC, Abib SCV, Aguiar AS, Schettini ST. Long-term complications in totally implantable venous access devices: randomized study comparing subclavian and internal jugular vein puncture. Pediatr Blood Cancer 2012; 58:274-7. [PMID: 21674765 DOI: 10.1002/pbc.23220] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 05/03/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND This prospective randomized study evaluated complications related to long-term totally implantable catheters in oncologic children and adolescents by comparing venopunction performed either in the jugular or subclavian vein. METHODS A total of 83 catheters were implanted from January 2004 to April 2006 and followed-up until March 2008. Patients were randomly allocated to the subclavian or jugular vein group. The endpoint was complications that led to catheter revision or catheter removal. RESULTS Six patients were excluded, 43 had the catheter implanted in the subclavian and 34 in the jugular vein. Subclavian catheters were used for up to 12.6 months, while jugular catheters were kept in place for up to 14.8 months (P = 0.38). No statistical differences were found between the groups concerning age, sex, leukocyte count, platelet count, type of admission (in or outpatient), or previous chemotherapy regimens. When analyzed individually, long-term complications did not present statistically significant differences either. Infection occurred in 20 and 11% (P = 0.44), while catheter embolism took place in 23 and 8% (P = 0.11) of patients with subclavian and jugular catheters, respectively. A statistical difference was seen in the total number of complications, which occurred in 48 and 23% (P = 0.02) of patients in the subclavian and in the jugular groups, respectively. CONCLUSIONS Catheters implanted by puncture in the subclavian vein were more prone to late complications than those implanted in the jugular vein.
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Affiliation(s)
- Rodrigo C Ribeiro
- Pediatric Surgery Department, Federal University of São Paulo, São Paulo, Brazil.
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Povoski SP, Khabiri H. Persistent left superior vena cava: review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients. World J Surg Oncol 2011; 9:173. [PMID: 22204758 PMCID: PMC3266648 DOI: 10.1186/1477-7819-9-173] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 12/28/2011] [Indexed: 12/11/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) represents the most common congenital venous anomaly of the thoracic systemic venous return, occurring in 0.3% to 0.5% of individuals in the general population, and in up to 12% of individuals with other documented congential heart abnormalities. In this regard, there is very little in the literature that specifically addresses the potential importance of the incidental finding of PLSVC to surgeons, interventional radiologists, and other physicians actively involved in central venous access device placement in cancer patients. In the current review, we have attempted to comprehensively evaluate the available literature regarding PLSVC. Additionally, we have discussed the clinical implications and relevance of such congenital aberrancies, as well as of treatment-induced or disease-induced alterations in the anatomy of the thoracic central venous system, as they pertain to the general principles of successful placement of central venous access devices in cancer patients. Specifically regarding PLSVC, it is critical to recognize its presence during attempted central venous access device placement and to fully characterize the pattern of cardiac venous return (i.e., to the right atrium or to the left atrium) in any patient suspected of PLSVC prior to initiation of use of their central venous access device.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio 43210, USA.
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Insertion of totally implantable venous access devices: an expertise-based, randomized, controlled trial (NCT00600444). Ann Surg 2011; 253:1111-7. [PMID: 21412146 DOI: 10.1097/sla.0b013e318214ba21] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Comparison of two different insertion techniques for implantation of totally implantable access ports (TIAP). BACKGROUND TIAP are introduced through different open and closed cannulation strategies and by various medical experts. The aim of this expertise-based randomized trial was to compare venous cutdown approach with puncture of subclavian vein. METHODS One hundred and ten patients scheduled for primary implantation of a TIAP were randomly assigned to either open insertion technique performed by surgeons or puncture of the subclavian vein under fluoroscopic guidance by radiologists at an outpatient single university center. The primary endpoint was the primary success rate of the cannulation strategy. A logistic regression model was used for analysis adjusting for age, Karnofsky index, body mass index and surgeons', and the radiologists' experience. RESULTS Percutaneus cannulation was not superior to surgical venous cutdown in the intention-to-treat analysis (odds ratio, 0.37; 95% CI, 0.07; 2.15) and the as-treated analysis (odds ratio, 0.16; 95% CI, 0; 1.28). The procedure was shorter with surgery (median, 21 minutes; 95% CI, 14; 30) than with radiology (median, 45 minutes; 95% CI, 43; 50) (P < 0.001), and the dose of radiation was lower with surgery (median, 37 cGy/cm(2); 95% CI, 26; 49) than with radiology (200 cGy/cm(2); 95% CI, 200; 300) (P < 0.001). CONCLUSION Central venous cannulation for insertion of TIAPs can be performed safely and effectively with both approaches. The open direct surgical access requires further strategies for successful placement of a TIAP, and percutaneous Seldinger technique requires more time and a higher dose of radiation and is associated with risk of pneumothorax.
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Saber W, Moua T, Williams EC, Verso M, Agnelli G, Couban S, Young A, De Cicco M, Biffi R, van Rooden CJ, Huisman MV, Fagnani D, Cimminiello C, Moia M, Magagnoli M, Povoski SP, Malak SF, Lee AY. Risk factors for catheter-related thrombosis (CRT) in cancer patients: a patient-level data (IPD) meta-analysis of clinical trials and prospective studies. J Thromb Haemost 2011; 9:312-9. [PMID: 21040443 PMCID: PMC4282796 DOI: 10.1111/j.1538-7836.2010.04126.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Knowledge of independent, baseline risk factors for catheter-related thrombosis (CRT) may help select adult cancer patients who are at high risk to receive thromboprophylaxis. OBJECTIVES We conducted a meta-analysis of individual patient-level data to identify these baseline risk factors. PATIENTS/METHODS MEDLINE, EMBASE, CINAHL, CENTRAL, DARE and the Grey literature databases were searched in all languages from 1995 to 2008. Prospective studies and randomized controlled trials (RCTs) were eligible. Studies were included if original patient-level data were provided by the investigators and if CRT was objectively confirmed with valid imaging. Multivariate logistic regression analysis of 17 prespecified baseline characteristics was conducted. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. RESULTS A total sample of 5636 subjects from five RCTs and seven prospective studies was included in the analysis. Among these subjects, 425 CRT events were observed. In multivariate logistic regression, the use of implanted ports as compared with peripherally implanted central venous catheters (PICCs), decreased CRT risk (OR, 0.43; 95% CI, 0.23-0.80), whereas past history of deep vein thrombosis (DVT) (OR, 2.03; 95% CI, 1.05-3.92), subclavian venipuncture insertion technique (OR, 2.16; 95% CI, 1.07-4.34) and improper catheter tip location (OR, 1.92; 95% CI, 1.22-3.02), increased CRT risk. CONCLUSIONS CRT risk is increased with use of PICCs, previous history of DVT, subclavian venipuncture insertion technique and improper positioning of the catheter tip. These factors may be useful for risk stratifying patients to select those for thromboprophylaxis. Prospective studies are needed to validate these findings.
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Affiliation(s)
- W Saber
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Teichgräber UKM, Kausche S, Nagel SN, Gebauer B. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol 2011; 21:1224-32. [PMID: 21207035 DOI: 10.1007/s00330-010-2045-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 10/22/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
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Use of a totally implantable access port through the external jugular vein when the cephalic vein approach is not feasible. Ann Vasc Surg 2010; 25:217-21. [PMID: 20926248 DOI: 10.1016/j.avsg.2010.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 07/04/2010] [Accepted: 07/19/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND We report our experience of using a totally implantable access port (TIAP) through the external jugular vein (EJV) when the cephalic vein (CV) approach is not feasible. METHODS We reviewed 197 cases involving TIAP implantation through the EJV in a single medical center between January 1995 and January 2009. All the ports were implanted after the CV approach was found unfeasible. Patient characteristics, operating time, and early and late complications were recorded. RESULTS The mean patient age was 50 years (range: 33-75). The mean operating time was 54.5 ± 7.5 minutes. Early complications within the first 30 postoperative days included port hematoma (2%) and catheter migration (2%). The late postoperative complications included catheter occlusion (2.5%), venous thrombosis (2%), and port infection (1.5%). There were no complications associated with TIAP disconnection. CONCLUSIONS The EJV approach is an easy and safe alternative method for TIAP implantation when the CV approach is not feasible. This method can avoid conversion to percutaneous puncture of the subclavian vein, which could result in life-threatening complications such as pneumothorax and hemothorax. In patients with breast cancer or those who are contraindicated for TIAP implantation on the opposite side, the EJV cutdown approach provides an alternative route with comfortable and satisfactory results as complications with this approach are rare.
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Koketsu S, Samesima S, Yoneyama S, Okada T, Tomozawa S, Horikoshi H, Sawada T. Outcome of cephalic vein cut-down approach: A safe and feasible approach for totally implantable venous access device placement. Oncol Lett 2010; 1:1029-1031. [PMID: 22870107 DOI: 10.3892/ol.2010.189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 09/11/2010] [Indexed: 11/06/2022] Open
Abstract
This study aimed to evaluate the safety and feasibility of the venous access via the cephalic vein cut-down (CVCD) approach for totally implantable venous access device (TIVAD) placements. A total of 79 patients who received TIVAD for the treatment of unresectable or recurrent colorectal carcinomas were recruited. The operation time and the complications were evaluated. Results showed the TIVAD placement via the CVCD approach was successful in 74 patients. A total of 5 patients required conversion to a percutaneous puncture approach. The mean operation time was 34.7 min. No intraoperative or postoperative complications were observed. Therefore, the CVCD approach is a safe and feasible method for TIVAD placement.
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Affiliation(s)
- Shinichiro Koketsu
- First Department of Surgery, Koshigaya Hospital, Dokkyo Medical University, Saitama
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Di Carlo I, Pulvirenti E, Mannino M, Toro A. Increased use of percutaneous technique for totally implantable venous access devices. Is it real progress? A 27-year comprehensive review on early complications. Ann Surg Oncol 2010; 17:1649-56. [PMID: 20204533 DOI: 10.1245/s10434-010-1005-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND First implantation of a totally implantable venous access device (TIVAD) was performed in 1982 with surgical technique. Since then, these devices have permitted infusion of total parenteral nutrition, antibiotics, blood products, and, above all, they have definitively changed the quality of life of patients with cancer. However, with the increase of percutaneous procedures, we have assisted with a concomitant raise of immediate postprocedural life-threatening complications. The aim of this study was to review the literature during a 27-year period, with regard to the changes of incidence of immediate complications after percutaneous or surgical cutdown for TIVAD's implant. MATERIALS AND METHODS An extensive search of relevant literature was carried out by using MEDLINE (PubMed) and Google Scholar. We gathered articles from 1982 to 2009 that quoted patient's number, type of pathology, specialist involved, number of devices implanted, site and technique of implantation (surgical cutdown or percutaneous technique), and immediate complications occurrence. RESULTS A total of 952 reports were screened, and finally only 45 articles addressing all inclusion criteria were used for the present study. A total of 11,430 TIVADs implanted in 11,381 patients were analyzed. Pneumothorax, hemothorax, arterial puncture, and hemoptysis developed only after percutaneous procedures. Atrial fibrillation, hematomas, and malpositioning were more frequent after percutaneous approach. The total amount of immediate complications in patients submitted to percutaneous implant was 4.5%, compared with 0.9% subsequent to cutdown technique. CONCLUSIONS Despite the increased use of percutaneous technique for TIVADs' implantation, surgical cutdown, because of its safety, remains the best approach to avoid possible fatal immediate complications.
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Affiliation(s)
- Isidoro Di Carlo
- Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies, University of Catania, Catania, Italy,
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Nocito A, Wildi S, Rufibach K, Clavien PA, Weber M. Randomized clinical trial comparing venous cutdown with the Seldinger technique for placement of implantable venous access ports. Br J Surg 2009; 96:1129-34. [DOI: 10.1002/bjs.6730] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
The aim of this randomized controlled study was to compare the primary success rate between venous cutdown and the Seldinger technique for placement of the totally implantable venous access port (TIVAP).
Methods
A total of 152 patients were randomized to receive TIVAP placement by either venous cutdown or the Seldinger technique. The main endpoint was the primary success rate. Secondary endpoints included overall success rate, procedure time and perioperative complication rates. Multiple logistic regression analysis was undertaken to assess the influence of different variables on primary success.
Results
The primary success rate was 71 per cent for venous cutdown and 90 per cent for the Seldinger technique (P = 0·007). The mean procedure time was significantly shorter for the Seldinger technique (48·9 versus 64·8 min; P < 0·001). The overall success rate was 97·4 per cent. The rate of perioperative complications was similar for the two approaches (5 per cent), but was higher when a procedure was converted. The variables sex, body mass index, implantation side and surgeon experience had no impact on the primary success rate.
Conclusion
The Seldinger technique was more effective and quicker than venous cutdown, and should be regarded as the method of choice for TIVAP placement. Registration number: NCT00272623 (http://www.clinicaltrials.gov).
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Affiliation(s)
- A Nocito
- Department of Surgery, University Hospital Zurich, Switzerland
| | - S Wildi
- Department of Surgery, University Hospital Zurich, Switzerland
| | - K Rufibach
- Biostatistics Unit, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - P-A Clavien
- Department of Surgery, University Hospital Zurich, Switzerland
| | - M Weber
- Department of Surgery, University Hospital Zurich, Switzerland
- Cantonal Hospital of Schaffhausen, Schaffhausen, Switzerland
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Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M. ESPEN Guidelines on Parenteral Nutrition: Central Venous Catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009; 28:365-77. [DOI: 10.1016/j.clnu.2009.03.015] [Citation(s) in RCA: 345] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
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Sonobe M, Chen F, Fujinaga T, Sato K, Shoji T, Sakai H, Miyahara R, Bando T, Okubo K, Hirata T, Date H. Use of totally implantable central venous access port via the basilic vein in patients with thoracic malignancies. Int J Clin Oncol 2009; 14:208-12. [PMID: 19593611 DOI: 10.1007/s10147-008-0835-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 09/03/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND For patients with a thoracic malignancy whose peripheral veins are not suitable for blood access for chemotherapy, we evaluated a totally implantable central venous access port, in which the port is implanted in the ulnar side of the arm and the catheter is introduced via the basilic vein into the superior vena cava (TIAP-BV). METHODS Twenty-five patients (21 with lung cancer, 2 with malignant pleural mesothelioma, and 2 with thymoma) receiving TIAP-BV were included. Indications, surgical complications, and long-term complications were analyzed. RESULTS Indications for TIAP-BV were: chemotherapy (17 patients) and chemotherapy with parenteral nutrition (8 patients). The following surgical complications occurred: arrhythmia due to misplacement of the tip of catheter (1 patient); intraoperative conversion from the left to right arm (2 patients); and hematoma at the implantation site (1 patient). Short-term problems were: death 1 week after implantation without the use of TIAP-BV (2 patients). Long-term complications were: skin ulcer at the port site (1 patient); early removal of TIAP-BV because of port site infection (1 patient); catheter occlusion (1 patient); and venous thrombosis of basilic vein (2 patients). In the 22 patients who did not die early or have the device withdrawn early, the median duration of TIAP-BV use was 7 months (range, 1 to 20 months) without any break to the port system, leakage of drugs, or catheter-related infections. CONCLUSION TIAP-BV can be employed for long-term use for chemotherapy and parenteral nutrition. However, a patient's expected prognosis and infectious disease status at the time of implantation surgery should be considered before the surgery proceeds.
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Affiliation(s)
- Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University Hospital, 54 Shogoin-kawaracho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Karanlik H, Kurul S. Modification of approach for totally implantable venous access device decreases rate of complications. J Surg Oncol 2009; 100:279-83. [DOI: 10.1002/jso.21341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Complications d’un dispositif intraveineux implantable pour chimiothérapie dans les cancers des voies aérodigestives supérieures. ACTA ACUST UNITED AC 2009; 126:43-52. [DOI: 10.1016/j.aorl.2009.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 02/13/2009] [Indexed: 11/18/2022]
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Knebel P, Fischer L, Huesing J, Hennes R, Büchler MW, Seiler CM. Randomized clinical trial of a modified Seldinger technique for open central venous cannulation for implantable access devices. Br J Surg 2009; 96:159-65. [PMID: 19160366 DOI: 10.1002/bjs.6457] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Totally implantable access ports (TIAPs) are often used for patients who need permanent venous access. The primary success rate using direct open insertion is about 80 per cent, so rescue strategies are needed. This study compared the primary success rates of standard open insertion and a modified Seldinger technique. METHODS This randomized trial recruited 164 patients scheduled for primary implantation of a TIAP and compared two interventions. The primary endpoint was the success rate of the implantation technique. RESULTS The primary success rates were similar: 66 (80 per cent) of 82 patients who had standard open insertion versus 69 (84 per cent) of 82 patients undergoing the modified Seldinger method (P = 0.686). A logistic mixed regression analysis including treatment group, age, Karnofsky index, body mass index and surgeon's experience showed no advantage for the Seldinger method: odds ratio 1.30 (95 per cent confidence interval 0.62 to 2.70). TIAPs were eventually implanted successfully in 163 (99.4 per cent) of 164 patients. In 11 patients randomized to standard surgery, the Seldinger method was a successful rescue strategy. CONCLUSION The primary success rate was similar for both open insertion methods. The modified Seldinger method is useful if standard open insertion fails. REGISTRATION NUMBER ISRCTN 52368201 (http://www.controlled-trials.com).
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Affiliation(s)
- P Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Biffi R, Orsi F, Pozzi S, Pace U, Bonomo G, Monfardini L, Della Vigna P, Rotmensz N, Radice D, Zampino MG, Fazio N, de Braud F, Andreoni B, Goldhirsch A. 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; 20:935-40. [PMID: 19179550 DOI: 10.1093/annonc/mdn701] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Central venous access is extensively used in oncology, though practical information from randomized trials on the most convenient insertion modality and site is unavailable. METHODS Four hundred and three patients eligible for receiving i.v. chemotherapy for solid tumors were randomly assigned to implantation of a single type of port (Bard Port, Bard Inc., Salt Lake City, UT), through a percutaneous landmark access to the internal jugular, a ultrasound (US)-guided access to the subclavian or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove. Early and late complications were prospectively recorded until removal of the device, patient's death or ending of the study. RESULTS Four hundred and one patients (99.9%) were assessable: 132 with the internal jugular, 136 with the subclavian and 133 with the cephalic vein access. The median follow-up was 356.5 days (range 0-1087). No differences were found for early complication rate in the three groups {internal jugular: 0% [95% confidence interval (CI) 0.0% to 2.7%], subclavian: 0% (95% CI 0.0% to 2.7%), cephalic: 1.5% (95% CI 0.1% to 5.3%)}. US-guided subclavian insertion site had significantly lower failures (e.g. failed attempts to place the catheter in agreement with the original arm of randomization, P = 0.001). Infections occurred in one, three and one patients (internal jugular, subclavian and cephalic access, respectively, P = 0.464), whereas venous thrombosis was observed in 15, 8 and 11 patients (P = 0.272). CONCLUSIONS Central venous insertion modality and sites had no impact on either early or late complication rates, but US-guided subclavian insertion showed the lowest proportion of failures.
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Affiliation(s)
- R Biffi
- Division of Abdomino-Pelvic Surgery, European Institute of Oncology, via Ripamonti 435, I-20141 Milan, Italy.
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Knebel P, Fischer L, Cremonese E, Lopez-Benitez R, Stampfl U, Radeleff B, Kauczor HU, Büchler MW, Seiler CM. Protocol of an expertise based randomized trial comparing surgical Venae Sectio versus radiological puncture of Vena Subclavia for insertion of Totally Implantable Access Port in oncological patients. Trials 2008; 9:60. [PMID: 18950491 PMCID: PMC2579421 DOI: 10.1186/1745-6215-9-60] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 10/24/2008] [Indexed: 11/10/2022] Open
Abstract
Background Totally Implantable Access Ports (TIAP) are being extensively used world-wide and can be expected to gain further importance with the introduction of new neoadjuvant and adjuvant treatments in oncology. Two different techniques for the implantation can be selected: A direct puncture of a central vein and the utilization of a Seldinger device or the surgical Venae sectio. It is still unclear which technique has the optimal benefit/risk ratio for the patient. Design A single-center, expertise based randomized, controlled superiority trial to compare two different TIAP implantation techniques. 100 patients will be included and randomized pre-operatively. All patients aged 18 years or older scheduled for primary elective implantation of a TIAP under local anesthesia who signed the informed consent will be included. The primary endpoint is the primary success rate of the randomized technique. Control Intervention: Venae Sectio will be employed to insert a TIAP by a surgeon; Experimental intervention: Punction of V. Subclavia will be used to place a TIAP by a radiologist. Duration of study: Approximately 10 months, follow up time: 90 days. Organisation/Responsibility The PORTAS 2 – Trial will be conducted in accordance with the protocol and in compliance with the moral, ethical, and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989) and Good Clinical Practice (GCP). The Center of Clinical Trials at the Department of Surgery, University Hospital Heidelberg is responsible for design and conduct of the trial including randomization and documentation of patients' data. Data management and statistical analysis will be performed by the independent Institute for Medical Biometry and Informatics (IMBI), University of Heidelberg. Trial Registration The trial is registered at ClinicalTrials.gov (NCT00600444).
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Affiliation(s)
- Philip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
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Central venous access: techniques and indications in oncology. Eur Radiol 2008; 18:2333-44. [PMID: 18458909 DOI: 10.1007/s00330-008-0981-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 03/21/2008] [Indexed: 10/22/2022]
Abstract
Long lines can be inserted centrally or peripherally through patent veins into the central venous system down to the atrial caval junction. Traditionally surgeons, anesthetists, cardiologists and more recently interventional radiologists have been placing them using vein cutdown or percutaneous needle puncture techniques. Typical candidates for implanted venous catheters are cancer patients undergoing long-term chemotherapy. The most important issues, in addition to the patency of central veins and the history of previous indwelling catheters, pacewires or venous thrombosis, are the patient's performance status, body mass index, medical history and respiratory status, and the relevant technique. The present article will give an overview of the radiological and surgical implantation techniques and will highlight the impact of imaging means on the technical feasibility, assessment and treatment of device-related complications.
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Totally implantable venous access ports via the external jugular vein: safety and effectiveness for young pediatric patients. J Pediatr Hematol Oncol 2008; 30:366-8. [PMID: 18458570 DOI: 10.1097/mph.0b013e31816916bf] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Various venous approaches are possible during implanting a totally venous access port. The veins, which are commonly used in pediatric patients are internal and external jugular veins. Comparison of different venous approaches has been discussed in a few reports only. The present study reviews the complication rate, operation time of implanting the port via different veins in children. PATIENTS AND METHODS From January 2003 to December 2005, 94 venous access ports were implanted in 88 consecutive patients in the Pediatric Surgical section of the Taipei Veterans General Hospital. The patients were classified according to the vein used. Group A (n=45), the external jugular vein access group; and group B (n=43), the internal jugular vein access group. RESULTS The operation time in group A and B were 38.4+/-11.1 and 57.6+/-20.3 min, respectively. The mean operation time of group A was significantly shorter than that of group B (P<0.001). The overall complication rates in group A and B were 8.5%, and 19.1%, respectively. These differences, however, were not significant (P>0.05). CONCLUSIONS The external jugular vein approach has a shorter operation time and a lower complication rate than the internal jugular vein approach. This approach may be a method of choice in selected pediatric patients.
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