title: Peripherally placed totally implantable venous-access port systems of the forearm: clinical experience in 763 consecutive patients.
abstract: The aim of this study is to evaluate the effectiveness and safety of percutaneously placed totally implantable venous-access ports (TIVAPs) of the forearm. Between January 2006 and October 2008, peripheral TIVAPs were implanted in 763 consecutive patients by ultrasound and fluoroscopic guidance. All catheters were implanted under local anesthesia and were tunneled subcutaneously. Indication, technical success, and complications were retrospectively analyzed according to Society of Interventional Radiology (SIR) criteria. Presence of antibiotic prophylaxis, periprocedurally administered drugs (e.g., sedation), and laboratory results at the time of implantation were analyzed. Maintenance during the service interval was evaluated. In total, 327,499 catheter-days were analyzed. Technical success rate was 99.3%. Reasons for initial failure of implantation were either unexpected thrombosis of the subclavian vein, expanding tumor mass of the mediastinum, or failure of peripheral venous access due to fragile vessels. Mean follow-up was 430 days. There were 115 complications observed (15.1%, 0.03 per 100 catheter-days), of which 33 (4.3%) were classified as early (within 30 days from implantation) and 82 (10.7%) as late. Catheter-related venous thrombosis was found in 65 (8.5%) of 763 (0.02 per 100 catheter-days) TIVAPs. Infections were observed in 41 (5.4%) of 763 (0.01 per 100 catheter-days) devices. Other complications observed included dislocation of the catheter tip (0.8%), occlusion (0.1%), or rupture (0.1%) of the port catheter. Dislocated catheters were corrected during a second interventional procedure. In conclusion, implantation of percutaneously placed peripheral TIVAPs shows a high technical success rate and low risk of early complications when ultrasound and fluoroscopic guidance are used. Late complications are observed three times as often as early complications.
authors.affiliation: Institute of Radiology, University of Wuerzburg, Oberduerrbacher Str 6, 97080 Wuerzburg, Germany. Goltz@roentgen.uni-wuerzburg.de
authors.forename: Jan P
authors.initials: JP
authors.lastname: Goltz
authors.forename: Anne
authors.initials: A
authors.lastname: Scholl
authors.forename: Christian O
authors.initials: CO
authors.lastname: Ritter
authors.forename: Günther
authors.initials: G
authors.lastname: Wittenberg
authors.forename: Dietbert
authors.initials: D
authors.lastname: Hahn
authors.forename: Ralph
authors.initials: R
authors.lastname: Kickuth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D019072:Antibiotic Prophylaxis; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling; D016009:Chi-Square Distribution; D016292:Procedural Sedation; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional