Long-term outcome of radiological-guided insertion of implanted central venous access port devices (CVAPD) for the delivery of chemotherapy in cancer patients: institutional experience and review of the literature

Abstract

Central venous access port devices (CVAPD) are necessary for delivery of prolonged infusional chemotherapy or in patients with poor peripheral venous access. Previous studies of Hickman catheters report complication rates in about 45% of patients. Our aim was to assess the early and late complication rate, and duration that the CVAPD remained functional, following insertion by interventional radiologists in patients with solid tumours. A prospective study was undertaken in 110 consecutive patients who had insertion of 111 subclavian CVAPD. The median age of patients was 57 years (range 17 -83), 64 were females; 68 patients (61%) had gastrointestinal tumours and 25 (23%) had breast cancer. CVAPD were successfully implanted in all but one patient. There were four (4%) immediate major complications: thrombosis 2 and pneumothorax 2. Nine patients (8%) had bruising or pain. Four devices (4%) became infected. In total, 100 CVAPD (90%) were either removed as planned at the end of treatment (n ¼ 23) after a median 203 days, or remained in situ for a median of 237 days (7 -1133). Premature removal occurred in eight patients due to infection (n ¼ 4), thrombosis (n ¼ 3) or faulty device (n ¼ 1). Four patients were lost to follow-up. Radiological insertion of CVAPD is safe and convenient with low rates of complications.

Totally implantable venous access port systems and risk factors for complications: A one-year prospective study in a cancer centre

“…As in other studies, [7,9,11,13,14] the main complication observed in our study was infection, occurring in 5.3% of patients and accounting for half the total number of premature device removals.…”

“…Cancer patients have an intrinsically high risk of venous thrombosis, related to both the disease process itself and certain cancer treatments, [8] this risk being further increased by placement of a catheter or TIVAPS. [1] Several studies in cancer patients have investigated potential risk factors for TIVAPS-related complications, including the vein accessed [5,9,10] and patient age and gender [11,12], with somewhat conflicting results. Yildizeli analysis of paediatric patients, showed a higher risk of infection after TIVAPS implantation in younger patients.…”

Totally Implantable Central Venous Port Catheters: Radiation Exposure as a Function of Puncture Site and Operator Experience

“…Landmark-mark based punctures of the subclavian vein in particular were associated with increased rates of pneumothorax (11,(13)(14)(15)(16)(17). In addition, infection rates were lower for ultrasound-guided approaches with the Seldinger technique (1.1-8.8%) (3,11,13,18,19) compared with surgical cut-down (0.8-16.3%) (10,(20)(21)(22)(23)(24)(25). Moreover, the radiological technique does not require general anesthesia and is cost effective (26).…”

Use of totally implantable catheters for peripheral blood stem cell apheresis

“…The option of using the IVAD already in place must be considered as it is easier for the patients, especially for children in whom this IVAD can further be used for administering high-dose treatments and PBSC rescue. 7 Finally, the use of previously implanted IVAD might provide a significant advantage both in terms of patient quality of life and cost savings and should thus be discussed in this setting. This retrospective study provides a sound basis for a future prospective work addressing the question of the use of larger devices (high-resistance totally implantable VA port systems) allowing the use of higher pressure, which should soon become available in our institution.…”

“…[4][5][6][7] There is no literature addressing the feasibility of apheresis using this type of central venous device. In most French centers, a second central or peripheral venous catheter is usually required for apheresis procedures.…”