title: Wound healing and catheter thrombosis after implantable venous access device placement in 266 breast cancers treated with bevacizumab therapy.
abstract: The aim of this study was to determine, in a population with metastatic breast cancer treated with bevacizumab therapy, the incidence of wound dehiscence after placement of an implantable venous access device (VAD) and to study the risk of catheter thrombosis. This study enrolled all VADs placed by 14 anesthetists between 1 January 2007 and 31 December 2009: 273 VADs in patients treated with bevacizumab therapy and 4196 VADs in patients not treated with bevacizumab therapy. In the bevacizumab therapy group, 13 cases of wound dehiscence occurred in 12 patients requiring removal of the VAD (4.76%). All cases of dehiscence occurred when bevacizumab therapy was initiated less than 7 days after VAD placement. Bevacizumab therapy was initiated less than 7 days after VAD placement in 150 cases (13 of 150: 8.6%). The risk of dehiscence was the same from 0 to 7 days. In parallel, the VAD wound dehiscence rate in patients not receiving bevacizumab therapy was eight of 4197 cases (0.19%) (Fisher's test significant, P<0.001). No risk factors of dehiscence were identified: anesthetists, learning curves, and irradiated patients. VAD thrombosis occurred in four patients (1.5%). In parallel, VAD thrombosis occurred in 51 of 4197 patients (1.2%) not receiving bevacizumab therapy (Fisher's test not significant; P=0.43). Bevacizumab therapy was permanently discontinued in five patients related to wound dehiscence and in one patient due to extensive skin necrosis. These data suggest the need to observe an interval of at least 7 days between VAD placement and initiation of bevacizumab therapy to avoid the risk of a wound dehiscence requiring chest wall port explant. The risk of VAD thrombosis does not require any particular primary prevention.
authors.affiliation: Department of Anesthésiology, Institut Curie, Paris, France. irene.kriegel@curie.net
authors.forename: Irène
authors.initials: I
authors.lastname: Kriegel
authors.forename: Paul H
authors.initials: PH
authors.lastname: Cottu
authors.forename: Virginie
authors.initials: V
authors.lastname: Fourchotte
authors.forename: Sebastian
authors.initials: S
authors.lastname: Sanchez
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fromantin
authors.forename: Krassen
authors.initials: K
authors.lastname: Kirov
authors.forename: Alain
authors.initials: A
authors.lastname: Guillaume
authors.forename: Anne
authors.initials: A
authors.lastname: Pelloquin
authors.forename: Marc
authors.initials: M
authors.lastname: Esteve
authors.forename: Remy J
authors.initials: RJ
authors.lastname: Salmon
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D057785:Catheters / Q000009:adverse effects; D005260:Female; D006801:Humans; D013529:Surgical Wound Dehiscence / Q000453:epidemiology* / Q000209:etiology; D013927:Thrombosis / Q000209:etiology*; D014945:Wound Healing
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab