Implantable Venous Access Ports for Chemotherapy in Lung Cancer Patients: Comparison of the Femoral and Subclavian Vein Approaches without Guidance

Abstract

Background: The goal of this study was to retrospectively compare the initial success rate and rate of intraoperative and late complications between the femoral and subclavian vein approaches used to implant venous access ports without guidance in lung cancer patients. Methods: We conducted a retrospective review of total 163 lung cancer patients who underwent implantations of a central venous access port for chemotherapy. 95 patients received the ports by the femoral vein blind-puncture technique and 68patients had the port implanted via the subclavian vein blind-puncture technique. The initial success rate of port implantation and the frequency of occurrence of complications were calculated. Results: The primary success rate of venous port implantation was 93.7% for femoral approach and 88.2% for the subclavian approach respectively (p < 0.05). Intraoperative complications developed in two patients (2.1%) in the femoral approach group and in five patients (7.4%) in the subclavian approach group. Although a higher intraoperative complication ratio for the subclavian approach was encountered compared to that for the femoral vein approach, there was no statistically significant difference (p = 0.103). Nor was there any statistically significant difference in terms of the occurrence of late complications. Conclusions: Venous access port implantation via the femoral vein approach is safe, and its success rate is very high, with the equal complication rates comparable to the subclavian approach. This approach avoids many of the intraoperative complications. Thus, the femoral vein approach for implanting a venous access port in lung cancer patients should be considered a valid, and safe technique.

Share and Cite:

Fujita, T. , Tanabe, M. , Kato, M. , Kobayashi, T. , Iida, E. and Matsunaga, N. (2012) Implantable Venous Access Ports for Chemotherapy in Lung Cancer Patients: Comparison of the Femoral and Subclavian Vein Approaches without Guidance. Open Journal of Radiology, 2, 39-45. doi: 10.4236/ojrad.2012.22007.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] E. J. Bow, M. G. Kilpatrick and J. J. Clinch, “Totally Implantable Venous Access Ports Systems for Patients Receiving Chemotherapy for Solid Tissue Malignancies: A Randomized Controlled Clinical Trial Examining the Safety, Efficacy, Costs, and Impact on Quality of Life,” Journal of Clinical Oncology, Vol. 17, No. 4, 1999, p. 1267.
[2] S. Kurul, P. Saip and T. Aydin, “Totally Implantable Venous-Access Ports: Local Problems and Extravasation Injury,” Lancet Oncology, Vol. 3, No. 11, 2002, pp. 684692. doi:10.1016/S1470-2045(02)00905-1
[3] R. O. Hickman, C. D. Buckner, R. A. Clift, J. E. Sanders, P. Stewart and E. D. Thomas, “A Modified Right Atrial Catheter for Access to the Venous System in Marrow Transplant Recipients,” Surg Gynecol Obstet, Vol. 148 No. 6, 1979, pp. 871-875.
[4] J. M. Estes, R. Rocconi, J. M. Straughn, S. Bhoola, C. A. Leath, R. D. Alvarez, L. C. Kilgore and W. K. Huh, “Complications of Indwelling Venous Access Devices in Patients with Gynecologic Malignancies,” Gynecologic Oncology, Vol. 91.No. 3, 2003, pp. 591-595. doi:10.1016/j.ygyno.2003.08.015
[5] R. E. Schwarz, J. S. Groeger and D. G. Coit, “Subcutaneous Implanted Central Venous Access Devices in Cancer Patients: A Prospective Analysis,” Cancer, Vol. 79, No. 8, 1997, pp. 1635-1640. doi:10.1002/(SICI)1097-0142(19970415)79:8<1635::AID-CNCR30>3.0.CO;2-X
[6] S. Ruesch, B. Walder and M. R. Tramer, “Complications of Central Venous Catheters: Internal Jugular Versus Subclavian Access-Asystematic Review,” Critical Care Medicine, Vol. 30, No. 2, 2002, pp.454-460. doi:10.1097/00003246-200202000-00031
[7] L. K. Jablon, K. R. Ugolini and N. C. Nahmias, “Cephalic Vein Cut-Down Verses Percutaneous Access: A Retrospective Study of Complications of Implantable Venous Access Devices,” American Journal of Surgery, Vol. 192, No. 1, 2006, pp. 63-67. doi:10.1016/j.amjsurg.2005.11.012
[8] P. F. Mansfield, D. C. Hohn, B. D. Fornage, M. A. Gregurich and D. M. Ota, “Complications and Failures of Subclavian-Vein Catheterization,” New England Journal of Medicine, Vol. 331, No. 26, 1994, pp. 1735-1738. doi:10.1056/NEJM199412293312602
[9] C. Ballarini, M. Intra, A. P. Ceretti, A. Cordovana, P. Papani, G. Farina, S. Perrone, M. Tomirotti, A. Scanni and G. P. Spina, “Complications of Subcutaneous Infusion Port in the General Oncology Population,” Oncology, Vol. 56, No. 2, 1999, pp. 97-102.
[10] H. M. Chang, H. F. Hsieh, S. D. Hsu, G. S. Liao, C. H. Lin, C. B. Hsiehand J. C. Yu, “Guidewire Assisted Cephalic Vein Cutdown for Insertion of Totally Implantable Access Ports,” Journal of Surgical Oncology, Vol. 95, No. 2, 2007, pp. 156-157. doi:10.1002/jso.20584
[11] S. P. Povoski, “A Prospective Analysis of the Cephalic Vein Cutdown Approach for Chronic Indwelling Central Venous Access in 100 Consecutive Cancer Patients,” Annals of Surgical Oncology, Vol. 7, No. 7, 2000, pp. 496-502. doi:10.1007/s10434-000-0496-9
[12] F. A. D’Angelo, G. Ramacciato, R. A. P De Angelis, P. Amodio, M. Magri and P. Barillari, “Prospective Randomised Study of Cephalic Vein Cut-Down versus Subclavian Vein Puncture Technique in the Implantation of Subcutaneous Venous Access Devices,” Chirurgia Italiana, Vol. 54, No.4, 2002, pp.495-500.
[13] C. M. Seiler, B. E. Frohlich, U. J. Dorsam, P. Kienle, M. W. Buchler and H. P. Knaebel, “ Surgical Technique for Totally Implantable Access Ports (TIAP) Needs Improvement: A Multivariate Analysis of 400 Patients,” Journal of Surgical Oncology, Vol. 93, No. 1, 2006, pp. 24-29. doi:10.1002/jso.20410
[14] P. Knebel, L. Fischer, J. Huesing, R. Hennes, M. W. Buchler and C. M. Seiler, “Randomized Clinical Trial of a Modified Seldinger Technique for Open Central Venous Cannulation for Implantable Access Devices,”British Journal of Surgery, Vol. 96, No. 2, 2009, pp. 159-165. doi:10.1002/bjs.6457
[15] R. L. Poorter, F. N. Lauw, W. A. Bemelman, P. J. M. Bakker, C. W. Taat and C. H. N. Veehof, “Complications of an Implantable Venous Access Device (Port-a-Cath) during Intermittent Continuous Infusion of Chemotherapy,” European Journal of Cancer, Vol. 32, No. 13, 1996, pp. 2262-2266. doi:10.1016/S0959-8049(96)00274-2
[16] N. Wolosker, G. Yazbek, M. A. Munia, A. E. Zerati, M. Langer and K. Nishinari, “Totally Implantable Femoral Vein Catheters in Cancer Patients,” European Journal of Surgical Oncology, Vol. 30, No. 7, 2004, pp. 771-775.
[17] S. Y. Chen, C. H. Lin, H. M. Chang, H. M. Hsu and J. C. Yu, “A Safe and Effective Method to Implant a Totally Implantable Access Port in Patients With Synchronous Bilateral Mastectomies: Modified Femoral Vein Approach,” Journal of Surgical Oncology, Vol. 98, No. 3, 2008, pp. 197-199. doi:10.1002/jso.21048
[18] L. M. Perlmutt, W. W. Johnston and N. R. Dunnick, “Percutaneous Transthoracic Needle Aspiration: A Review,” American Journal of Roentgenology, Vol. 152, No. 3, 1989, pp. 451-455.
[19] P. A. Rubio and E. M. Farrell, “Percutaneous Infraclavicular Subclavian Catheterization,” American Journal of Surgery, Vol. 48, No. 5, 1982, pp. 230-231.
[20] S. L. Morris, P. F. Jaques and M. A. Mauro, “RadiologyAssisted Placement of Implantable Subcutaneous Infusion Ports for Long-Term Venous Access,” Radiology, Vol. 184, 1992, pp. 149-151.
[21] B. Gebauer, M. El-Sheik, M. Vogt and H. J. Wagner, “Combined Ultrasound and Fluoroscopy Guided Port Catheter Implantation-High Success and Low Complication Rate,” European Journal of Radiology, Vol. 69, No. 3, 2009, pp. 517-522. doi:10.1016/j.ejrad.2007.10.018
[22] P. Y. Marcy, N. Magne, P. Castadot, C. Bailet, J. C. Macchiavello, M. Namer and J. C. Gaard, “Radiological and Surgical Placement of Port Devices: A 4-Year Institutional Analysis of Procedure Performance, Quality of Life and Cost in Breast Cancer Patients,” Breast Cancer Research and Treatment, Vol. 92, No. 1, 2005, pp. 61-67. doi:10.1007/s10549-005-1711-y
[23] H. M. Chang, C. B. Hsieh, H. F. Hsieh, T. W. Chen, C. J. Chen, D. C. Chan, J. C. Yu, Y. C. Liu and K. L. Shen, “An Alternative Technique for Totally Implantable Central Venous Access Devices. A Retrospective Study of 1311 Cases,” European Journal of Surgical Oncology, Vol. 32, No. 1, 2006, pp. 90-93.
[24] W. Zingg, A. Imhof, M. Maggiorini, R. Stocker, E. Keller and C. Ruef, “Impact of a Prevention Strategy Targeting Hand Hygiene and Catheter Care on the Incidence of Catheter-Related Bloodstream Infections,” Critical Care Medicine, Vol. 37, No. 7, 2009, pp. 2167-2173. doi:10.1097/CCM.0b013e3181a02d8f
[25] D. G. Maki, M. Ringer and C. J. Alvarado, “Prospective randomised Trial of Povidone-Iodine, Alcohol, and Chlorhexidine for Prevention of Infection Associated with Central Venous and Arterial Catheters,” Lancet, Vol. 338, No. 8763, 1991, pp. 339-343. doi:10.1016/0140-6736(91)90479-9
[26] A. W. Allen, J. L.Megargell, D. B. Brown, F. C. Lynch, Y. Singh and P. N. Waybill, “Venous Thrombosis Associated with the Placement of Peripherally Inserted Central Catheters,” Journal of Vascular and Interventional Radiology, Vol. 11, No. 10, 2000, pp. 1309-1314. doi:10.1016/S1051-0443(07)61307-4
[27] R. Biffi, F. Corrado, F. de Braud, F. de Lucia, D. Scarpa, A. Testori, F. Orsi, M. Bellomi, S. Mauri, M. Aparo and B. Andreoni, “Long Term, Totally Implantable Central Venous Access Ports Connected to Groshong Catheter for Chemotherapy of Solid Tumours: Experience on 178 Cases Using a Single Type of Device,” European Journal of Cancer, Vol. 33, No. 8, 1997, pp. 1190-1194. doi:10.1016/S0959-8049(97)00039-7
[28] D. H. Hinke, D. A. Zandt-Stastny, L. R. Goodman, E. J. Quebbeman, E. A. Krzywda and D. A. Andris, “Pinch-Off Syndrome: A Complication of Implantable Subclavian Venous Access Devices,” Radiology, Vol. 177, No. 2, 1990, pp. 353-356.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.