Totally Implantable Access Ports: Approach via Femoral Vein

Abstract

The purpose of this study was to report our results of totally implantable access ports (TIAP) approached via the femoral vein. Patients and Methods: Seven patients were enrolled. The mean age was 62 years. Four patients were male, and 3 patients were female. Six patients received TIAP via the right femoral vein and 1 patient via the left femoral vein. All patients underwent local anesthesia. The reason for femoral vein TIAP placement, mean operative time, follow-up time and complications were recorded. Results: The mean operative time was 37 ± 12 min, the mean follow-up time 13.5 ± 12.0 months. The causes for repeat TIAP or conversion to femoral vein access are as follows: In 2 cases repeat TIAP was associated with thrombus formation in the subclavian vein, 2 cases developed a superior vena cava syndrome (one was accompanied by chest wall invasion), 2 cases showed repeat catheter obstruction, and in 1 case infection and catheter obstruction was found. Five of the 7 patients had 2 TIAP before, 2 patients only 1 TIAP. All interventions remained free of complications. Conclusion: TIAP via conventional central venous access such as jugular, subclavian or brachial veins are simple. However, not all cases are suitable for these methods. We present an alternative method of central vein access: the approach via the femoral vein. This method is safe and simple, but the port site should be placed far away from the groin region to avoid infections.

Ultrasound-guided cannulation of the superficial femoral vein for central venous access

“…The use of FICCs was first described in patients with mediastinal tumors, bilateral breast cancer, lung cancer with mediastinal infiltration, or lymphoma with SVC compression. 3,4,7 Traditionally, the inferior vena cava approach is performed through common femoral vein cannulation at the groin site. However, this approach, because of the exit site in the groin area, has an elevated risk of late catheter-related complications, in particular infection and thrombosis.…”

“…the femoral vein and placement of the catheter tip in the inferior vena cava (IVC) or at the IVC/RA 3,4 : such type of central access may be defined as FICC (femorally inserted central catheter).…”

“…Compression or infiltration of SVC, large mediastinal tumors, bilateral breast cancers, lung or esophageal cancer with mediastinal infiltration, etc., are well known clinical conditions potentially associated with difficult or impossible progression of the catheter into the SVC. In these situations, central venous access can alternatively be obtained by cannulation of the femoral vein and placement of the catheter tip in the inferior vena cava (IVC) or at the IVC/RA 3,4 : such type of central access may be defined as FICC (femorally inserted central catheter).…”

Totally implantable venous access port via the femoral vein in a femoral port position with CT‐venography

“…The femoral approach in critically ill patients has been shown to have a significantly higher infection rate than the SCV or the jugular vein approach in prospective studies [16]. A potential risk of infection should be discussed because the port implantation site is close to the groin [11]; thus, the port site should be placed as far away from the groin region as possible to avoid infection. Infection rates have been reported to be between 0% and 5% [15,[17][18][19][20].…”

“…Although the IJV, SCV, and external jugular vein (EJV) [8] have been used for secondary access, several studies have suggested that both the SCV and the IJV should be avoided due to the high incidence of procedural complications, as well as central stenosis and thrombosis [5][6][7]9]. The risk of such complications is increased in patients undergoing hemodialysis, as well as in those with a history of multiple central venous catheterizations, bilateral breast cancer, infected tissue, or postradiogenic dermatitis of cutaneous metastasis [6,[9][10][11]. In such cases, the femoral vein (FV) approach could be considered an alternative method for TIVAP implantation, with the port implanted in the anterior abdominal wall, the anteroinferior thoracic wall or the anterior thigh [12,13].…”