title: Technical benefits and outcomes of modified upwardly created subcutaneous chest pockets for placing central venous ports: single-center experience.
abstract: BACKGROUND
  Traditionally, port pockets are created in a surgical fashion, with the chest pocket dissection performed by moving in the caudal direction from the incision site. However, most right-handed operators can more easily make the port pocket by dissecting upward.
  
  
  OBJECTIVE
  To evaluate the technical benefits and outcomes of modified upwardly created subcutaneous chest pockets to allow for placement of central venous ports.
  
  
  METHODS
  We retrospectively reviewed the clinical and radiological records of 756 insertion procedures in 750 patients who were referred for image-guided implantation of chest ports. Of the 121 removal procedures reviewed, a modified chest pocket was created in 104 of them. The technical benefits and outcomes of the modified procedures were evaluated.
  
  
  RESULTS
  The technical success rate of the modified method was 99% for implantation and 100% for removal procedures. No patients had major immediate complications related to the procedure. Early mechanical complications were observed in two patients: one was due to a port that turned over following implantation, and the other was due to separation of the catheter and hub-port. Late mechanical complications were observed in six patients: catheter malfunction occurred in three patients due to fibrin sheath formation, and three patients experienced catheter fracture. The rate of early and late infectious complications was 0.10 and 0.09 per 100 catheter days, respectively. There were five patients with symptomatic central venous thrombosis (range 34-167 days).
  
  
  CONCLUSIONS
  Modified upwardly created chest pockets are useful for implantable central venous port systems, and may be easier to implant and remove than conventional downward pocket methods.
authors.affiliation: Department of Radiology, St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Ho Jong
authors.initials: HJ
authors.lastname: Chun
authors.forename: Byung Gil
authors.initials: BG
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D013350:Subclavian Vein; D040521:Subcutaneous Tissue