Does the Implantation Technique for Totally Implantable Venous Access Ports (TIVAPs) Influence Long-Term Outcome?
BACKGROUND
Totally implantable venous access ports (TIVAP) are eventually explanted for various reasons, related or unrelated to the implantation technique used. Having more information on long-term explantation would help improve placement techniques.


METHODS
From a series of 1572 cancer patients who had TIVAPs implanted in our center with the cutdown technique or Seldinger technique, we studied the 542 patients who returned to us to have their TIVAP explanted after 70 days or more. As outcome measures we distinguished between TIVAPs explanted for long-term complications (infection, catheter-, reservoir-, and patient-related complications) and TIVAPs no longer needed. Univariate and multivariate analyses were run to investigate the reasons for explantation and their possible correlation with implantation techniques.


RESULTS
The most common reason for explantation was infection (47.6 %), followed by catheter-related (20.8 %), patient-related (14.7 %), and reservoir-related complications (4.7 %). In the remaining 12.2 % of cases, the TIVAP was explanted complication free after the planned treatments ended. Infection correlated closely with longer TIVAP use. Univariate and multivariate analyses identified the Seldinger technique as a major risk factor for venous thrombosis and catheter dislocation.


CONCLUSIONS
The need for long-term TIVAP explantation in about one-third of cancer patients is related to the implantation techniques used.
Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Azienda Policlinico Umberto I, viale del Policlinico, 155, 00161, Rome, Italy. daniele.biacchi@uniroma1.it.
Daniele
D
Biacchi
Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Azienda Policlinico Umberto I, viale del Policlinico, 155, 00161, Rome, Italy.
Paolo
P
Sammartino
Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Azienda Policlinico Umberto I, viale del Policlinico, 155, 00161, Rome, Italy.
Simone
S
Sibio
Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Azienda Policlinico Umberto I, viale del Policlinico, 155, 00161, Rome, Italy.
Fabio
F
Accarpio
Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Azienda Policlinico Umberto I, viale del Policlinico, 155, 00161, Rome, Italy.
Maurizio
M
Cardi
Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Azienda Policlinico Umberto I, viale del Policlinico, 155, 00161, Rome, Italy.
Paolo
P
Sapienza
Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Azienda Policlinico Umberto I, viale del Policlinico, 155, 00161, Rome, Italy.
Alessandro
A
De Cesare
Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Azienda Policlinico Umberto I, viale del Policlinico, 155, 00161, Rome, Italy.
Joseph Maher Fouad
JM
Atta
Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Azienda Policlinico Umberto I, viale del Policlinico, 155, 00161, Rome, Italy.
Alessio
A
Impagnatiello
Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Azienda Policlinico Umberto I, viale del Policlinico, 155, 00161, Rome, Italy.
Angelo
A
Di Giorgio
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D055499:Catheter-Related Infections / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology; D055815:Young Adult
D000970:Antineoplastic Agents