title: Ultrasound-guided infraclavicular axillary vein puncture is effective to avoid pinch-off syndrome: a long-term follow-up study.
abstract: OBJECTIVE
  Pinch-off syndrome (POS) is a serious complication encountered during the long-term management of totally implantable access ports (TIAPs). The aim of this study was to examine the effect of ultrasound-guided infraclavicular axillary vein puncture to avoid POS in patients with long-term use of a TIAP.
  
  
  METHODS
  This was a retrospective review of 207 consecutive TIAPs: one hundred devices implanted using an anatomical landmark technique were used as historical controls (Landmark group), while 107 devices were implanted using an ultrasound (US)-guided puncture method (US group). The pinch-off grade (POG) was determined using chest X-ray findings following the definition of Hinke, and the progression of POG during the follow-up period of the Landmark and US groups was compared.
  
  
  RESULTS
  Sixteen cases in the Landmark group were POG-1 and 3 were POG-2, while all cases in the US group were POG-0 at the time of venipuncture (p < 0.001). Eleven patients in the Landmark group showed some degree of progression of the POG during the follow-up period. In contrast, there were no cases showing progression of the POG in the US group (p = 0.002).
  
  
  CONCLUSIONS
  US-guided infraclavicular axillary vein puncture was found to effectively make it possible to avoid POS for the long-term management of TIAPs, as well as at the time of implantation.
authors.affiliation: Department of Surgery, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Osawa
authors.forename: Junichi
authors.initials: J
authors.lastname: Hasegawa
authors.forename: Kazuma
authors.initials: K
authors.lastname: Yamakawa
authors.forename: Nobuki
authors.initials: N
authors.lastname: Matsunami
authors.forename: Shoki
authors.initials: S
authors.lastname: Mikata
authors.forename: Junzo
authors.initials: J
authors.lastname: Shimizu
authors.forename: Yong Kook
authors.initials: YK
authors.lastname: Kim
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Morishima
authors.forename: Masaki
authors.initials: M
authors.lastname: Hirota
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Souma
authors.forename: Ho Min
authors.initials: HM
authors.lastname: Kim
authors.forename: Genta
authors.initials: G
authors.lastname: Sawada
authors.forename: Riichiro
authors.initials: R
authors.lastname: Nezu
mesh_terms: D000368:Aged; D001367:Axillary Vein / Q000000981:diagnostic imaging*; D002968:Clavicle / Q000098:blood supply*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy / Q000379:methods*; D012189:Retrospective Studies; D013577:Syndrome; D013997:Time Factors; D018084:Ultrasonography, Interventional; D062666:Vascular Access Devices / Q000009:adverse effects*