title: Surgical technique for totally implantable access ports (TIAP) needs improvement: a multivariate analysis of 400 patients.
abstract: BACKGROUND
  The objective of this study was to analyze factors that may have an impact on the failure rate of the surgical implantation technique for totally implantable access ports (TIAP) and to assess whether morbidity rates differ between a primarily successful surgical and a secondary Seldinger approach.
  
  
  METHODS
  Four hundred consecutive patients receiving a primary TIAP in local anesthesia were included into this retrospective cohort study. A logistic regression-model was used to evaluate reasons for failure of the TIAP method.
  
  
  RESULTS
  Three hundred eighteen (79.5%) patients had a successful TIAP procedure, 82 patients were intraoperatively converted to a Seldinger technique. Reasons for failure were: correct positioning impossible n = 54, no or only an undersized vessel for insertion available n = 17, other reasons n = 11. Logistic regression analysis did not reveal any significant factor for failure of the primary surgical approach. In the group with primarily successful TIAP, 8 of 318 patients (3%) developed complications compared to 7 of 82 patients (9%) converted to a Seldinger technique.
  
  
  CONCLUSIONS
  Failure of the surgical approach for implanting totally implantable access ports is related to insertion and positioning. Conversion to a Seldinger technique results in a higher complication rate. A modified approach for surgical port placement should be considered in order to reduce complications.
authors.affiliation: Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Seiler
authors.forename: Boris E
authors.initials: BE
authors.lastname: Frohlich
authors.forename: Ulrich J
authors.initials: UJ
authors.lastname: Dorsam
authors.forename: Peter
authors.initials: P
authors.lastname: Kienle
authors.forename: Markus W
authors.initials: MW
authors.lastname: Buchler
authors.forename: Hanns-Peter
authors.initials: HP
authors.lastname: Knaebel
mesh_terms: D000368:Aged; D000772:Anesthesia, Local; D020516:Brachial Plexus Neuropathies / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000592:standards* / Q000706:statistics & numerical data; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D004868:Equipment Failure; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D015918:Infusion Pumps, Implantable; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy*; D011030:Pneumothorax / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D017445:Skin Diseases, Vascular / Q000209:etiology; D016748:Venous Cutdown