title: Innominate vein stenosis in breast cancer patients after totally implantable venous access port placement.
abstract: OBJECTIVE
  To evaluate the risk factors for central vein stenosis after placement of the totally implantable venous access ports (TIVPs) and the clinical relevance of this condition in breast cancer patients.
  
  
  METHODS
  TIVPs were placed in 191 women with breast cancer via the internal jugular vein (IJV) from January 2009 to December 2012 (mean age, 51.42 years) by left-side (n = 102) and right-side (n = 89) approaches. Medical records were retrospectively reviewed. The presence of significant central vein stenosis, tip location of the catheter and retrosternal space were evaluated on chest computed tomography images. Statistical analysis was performed.
  
  
  RESULTS
  Central vein stenosis developed in 1 and 14 patients after placement via the right and left IJV, respectively. Differences in the cumulative incidence of central vein stenosis were statistically significant between left- and right-side approach groups (log rank test p-value: 0.009). In Cox regression analysis, the hazard ratio for central vein stenosis was 9.441 (p = 0.031) in the left-side approach. The distance between the sternum and the left innominate vein was found to be significantly and independently related to the development of central vein stenosis (p = 0.026). The hazard ratio of distances between the sternum and left innominate vein lt;16 mm was 10.133 (1.319-77.841).
  
  
  CONCLUSIONS
  The incidence of central vein stenosis in breast cancer patients was higher after placement of TIVPs via the left IJV. When left-side TIVP placement is required in a patient with right-side breast cancer, the possibilities of left innominate vein stenosis should be considered.
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Guro-gu, Seoul - Korea.
authors.forename: Myung Gyu
authors.initials: MG
authors.lastname: Song
authors.forename: Tae-Seok
authors.initials: TS
authors.lastname: Seo
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kang
authors.forename: Hwan Seok
authors.initials: HS
authors.lastname: Yong
authors.forename: Jae Hong
authors.initials: JH
authors.lastname: Seo
authors.forename: Yoon Young
authors.initials: YY
authors.lastname: Choi
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000188:drug therapy*; D061807:Catheter Obstruction / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D004867:Equipment Design; D005260:Female; D006801:Humans; D015994:Incidence; D007601:Jugular Veins; D053208:Kaplan-Meier Estimate; D008499:Medical Records; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D016016:Proportional Hazards Models; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents