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Introduction: Totally Implantable Venous Access Devices (TIVADs) contribute significantly to the treatment progress and comfort of patients requiring longterm therapy. However, the procedure for implanting TIVADs, as well as its very presence, may be associated with complications. Aim: This study evaluates the indications, safety, and complication rates of venous port implantations in pediatric patients. It also explores factors influencing the occurrence of early and late complications post-implantation. Materials and methods: The study included 383 pediatric patients treated at the Department of Pediatric Surgery, Traumatology, and Urology in Poznan between 2013 and 2020 who underwent 474 implantations of intravenous ports. Venous access was achieved using the Seldinger technique. Statistical analysis was performed using Statistica 13 with TIBCO and PQStat 1.8.2.156 with PQStat. Results: Venous ports were used in 345 oncology patients requiring chemotherapy (90% of the total group) and in 38 children (10%) with nononcology indications. There were 36 early complications (7.6%) and 18 late complications (3.8%), excluding infectious complications. The most common early, non-infectious complications included pneumothorax (15 patients; 3%) and port pocket hematoma (12 patients; 2.5%). The most common late, noninfectious complications observed were venous catheter obstruction (8 children; 1.7%) and port system leakage (5 children; 1%). Infectious complications occurred in 129 cases (27.2%). Children with a diagnosis of non-Hodgkin's lymphoma, acute myeloid leukemia, and acute lymphoblastic leukemia had a significantly higher incidence of port infections. Venous ports equipped with a polyurethane catheter, compared to systems with a silicone catheter, functioned significantly shorter. Conclusions: The Seldinger method of port implantation is quick, minimally invasive, and safe. The type of port, including the material of the port's venous catheter, and the underlying disease have an impact on the durability of implantable intravenous systems. The experience of the surgeon is related to the frequency of complications associated with the procedure. [ABSTRACT FROM AUTHOR]

IntroductionTotally Implantable Venous Access Devices (TIVADs) contribute significantly to the treatment progress and comfort of patients requiring long-term therapy. However, the procedure for implanting TIVADs, as well as its very presence, may be associated with complications.AimThis study evaluates the indications, safety, and complication rates of venous port implantations in pediatric patients. It also explores factors influencing the occurrence of early and late complications post-implantation.Materials and methodsThe study included 383 pediatric patients treated at the Department of Pediatric Surgery, Traumatology, and Urology in Poznan between 2013 and 2020 who underwent 474 implantations of intravenous ports. Venous access was achieved using the Seldinger technique. Statistical analysis was performed using Statistica 13 with TIBCO and PQStat 1.8.2.156 with PQStat.ResultsVenous ports were used in 345 oncology patients requiring chemotherapy (90% of the total group) and in 38 children (10%) with non-oncology indications. There were 36 early complications (7.6%) and 18 late complications (3.8%), excluding infectious complications. The most common early, non-infectious complications included pneumothorax (15 patients; 3%) and port pocket hematoma (12 patients; 2.5%). The most common late, non-infectious complications observed were venous catheter obstruction (8 children; 1.7%) and port system leakage (5 children; 1%). Infectious complications occurred in 129 cases (27.2%). Children with a diagnosis of non-Hodgkin’s lymphoma, acute myeloid leukemia, and acute lymphoblastic leukemia had a significantly higher incidence of port infections. Venous ports equipped with a polyurethane catheter, compared to systems with a silicone catheter, functioned significantly shorter.ConclusionsThe Seldinger method of port implantation is quick, minimally invasive, and safe. The type of port, including the material of the port’s venous catheter, and the underlying disease have an impact on the durability of implantable intravenous systems. The experience of the surgeon is related to the frequency of complications associated with the procedure.

Background: We assessed the outcomes of a push–pull monorail technique to overcome a difficult anatomical course through the left internal jugular vein in implantable port insertions. Methods: From December 2018 to May 2021, a total of 5326 patients were referred for implantable port insertion in our interventional unit, among which 472 cases were requested for insertion on the left side. Our monorail technique was applied only when the catheter tip entered the azygos vein instead of the superior vena cava (n=8). The technique consists of a puncture at the distal tip of the port catheter with a 21-gauge micropuncture needle, advancing a 0.018-inch hair-wire to the guide, providing support for the pre-assembled port, and advancing the microsheath over the hair-wire to prevent extrusion of the catheter. Results: The push–pull monorail technique was performed in eight patients, and all cases were technically successful, exhibiting a technical success rate of 100%. There were no immediate or delayed complications. Conclusions: The push–pull monorail technique is helpful in overcoming the difficult anatomical course through the left internal jugular vein during implantable port insertion. [ABSTRACT FROM AUTHOR]

Purpose While central venous port placement is common, there remains variation in placement technique and rates of technical complications. The aim of this study was to assess variability in techniques and identify predictors of complications for children undergoing port placement. Methods We retrospectively reviewed all 331 patients who underwent venous port placement at a single tertiary children's hospital from May 2018 to June 2020. The primary outcome was early revision or replacement (R/R) for complications occurring within 30 days. Secondary outcomes included radiation exposure and rate of intraoperative conversion to a secondary site. Results The median age was 7 years (Interquartile Range 3–13 years) and the most common diagnoses were leukemia (30.2%), solid tumors (27.8%), and brain tumors (16.9%). Initial approach for port placement was ultrasound-guided internal jugular (IJV) in 255 (147 by surgery and 108 by interventional radiology [IR]) and landmark subclavian vein (SCV) in 76 (all by surgery). Early R/R occurred in 5.1%, including 9.0% of patients with leukemia but 1.1% with solid tumors. Individual proceduralist volume ranged from 2 to 98 cases and was inversely correlated with early R/R (r = -0.12, p = 0.30). In univariate analysis, ports placed by IR had an increased rate of early R/R (9.3%, n = 10) compared to those placed by surgery (3.2%, n = 7, p = 0.036) but this was not significant in multivariable regression controlling for diagnosis and age (Hazard Ratio 2.04; p = 0.19). Mean fluoroscopy time was significantly longer for ports placed by IR (59.9 s) compared to those placed by surgery (15.1 s, p < 0.001). Initial SCV access was associated with an increased (14.5 vs 0.4%) rate of conversion to a secondary site. Conclusions Though venous port placement is a largely safe procedure in children, a substantial minority of patients, particularly those with leukemia, require early R/R. Proceduralist volume and training may influence early R/R, fluoroscopy exposure, and anatomic site preferences. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the feasibility and safety of power injection of contrast media through totally implantable venous power ports during computed tomography scans in oncologic patients. Methods: The study population consisted of 417 patients who underwent computed tomography scan through a totally implantable venous power port. Clinical data were examined. Logistic regression analysis was used to assess the associations between clinical covariables and computed tomography scan failure. Results: Successful computed tomography scans were achieved in 534 of 540 examinations (98.9%). Logistic regression analysis showed that contrast media above a 350 concentration was significantly associated with computed tomography scan failure (95% confidence interval: 1.01–1.13, p = 0.012). No major complications were noted. Conclusions: Power injection of contrast media through a totally implantable venous power port for computed tomography examination is feasible and safe. This procedure provides an acceptable alternative in oncologic patients with inadequate peripheral intravenous access when computed tomography examination with contrast enhancement is needed. [ABSTRACT FROM AUTHOR]

The aim of the present study was to describe the procedure of totally implantable central venous port system (TICVPS) insertion performed at our center and investigate associated complications. The study retrospectively evaluated 827 patients who underwent a single-type TICVPS insertion from January 2013 to July 2015. The length of the procedure, long-term device function, angle (chamber-to-tip) and complications of TICVPS, including infection, skin erosion, occlusion, malposition and thrombosis, were analyzed from the patients' medical records. A total of 843 TICVPS insertions were performed in 827 patients. The TICVPS implantation was successful in all cases (100%). A total of 34 cases (4.0%) with complications were recorded. Complications at the chamber insertion site occurred in 11 patients (1.3%), including 5 infection (0.6%) and 6 erosion cases (0.7%). All patients with chamber insertion site infection were treated by administration of antibiotics and dressing. Of the patients in which chamber insertion site erosion occurred, 2 were subjected to TICVPS removal and reinsertion and 4 were treated with debridement, irrigation and resuture. The most common type of complication was catheter-associated (2.3%; n=19). Among these cases, 7 had catheter-associated infection (0.8%), 8 had catheter migration (1.0%) confirmed by chest radiography, 4 had catheter-associated thrombosis (0.5%) and 2 had chamber malposition (0.3%). The present retrospective study on TICVPS, which used a relatively large cohort, demonstrated a low complication rate (4.0%) compared with that reported in previous studies (5–20%). A well-designed procedure, experienced vascular surgeons, an aseptic operating room environment, ultrasound-guided puncture, a wide angle (chamber-to-tip) and the use of fluoroscopy with contrast agent may reduce the complication rate of TICVPS insertion. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the efficacy and safety of radiologic venous port placement in children under venous anesthesia. Materials and Methods Between April 2009 and July 2011, 44 ports were implanted in 41 children (24 boys, 17 girls). The age of patients ranged from 9 months to 19 years (mean, 6.5 years) and their body weights ranged from 6.8 kg to 56.3 kg (mean, 23.2 kg). Right internal jugular vein access was used in 42 ports, right subclavian vein in 1, and left subclavian in 1. Durability and complications of port implantation were reviewed. Results The technical success rate was 100%. The catheter life was 10-661 days (mean 246 days). Two patients died during the follow-up period, 21 and 6 ports were removed at the end of treatment or as a result of complications, respectively. One port was removed and replaced by a Hickmann catheter. Three ports were explanted due to port-related sepsis, one due to a catheter kink, and two for unexplained fever or insertion site pain. The overall port-related infection was 3 cases (6.8%, 0.28/1000 catheter days). Conclusion Venous port placement by interventional radiologists in children under intravenous sedation is relatively safe, with a high rate of technical success and low rate of complications.

Objective: The difficulty of accessing recurrent intravenous (IV) routes in patients with a diagnosis of malignancy is a frequently encountered problem. Our aim is to evaluate retrospectively our port catheter placement procedures in patients who will undergo chemotherapy. Material and Method: We retrospectively reviewed the files of 98 patients who underwent chemotherapy port catheterization between May 2012 and November 2012 in our clinic. Patients' demographic data, primary diagnoses, localization of the procedure, number of interventions, fluoroscopy requirement, patient comfort (1, 2, moderate, 3 good) were recorded. Patients were evaluated as right internal jugular vein (Group J) and right subclavian vein (Group S) groups according to their entrance veins. Results: Fifty (%51) patients were male and 48 (48.9%) were female. Their ages ranged from 19 to 84 years, and the mean age was 49.55±14.57 years. Complications were seen in 8 (26.7%) of right internal jugular vein, and 4 (5.9%) of right subclavian vein port applications. The complications developed were due to misplacement (n=9), and infection (n=3). When the groups were compared in terms of patient comfort. In groups J (7: 23.3%), and S (3: 4.4%) satisfaction score of 1 point (worse) were estimated in respective number of patients. Conclusion: We believe that implantation of port catheter in patients planned for long- term chemotherapy improves patient comfort and has a low complication rate. [ABSTRACT FROM AUTHOR]

Background Insertion of totally implanted venous access devices; that is, port systems, in the forearm is an option for long-term venous access. To better understand the radiology literature reported for this anatomic location, we performed a search for, and an analysis of, previous publications related to forearm implantation of these devices by interventional radiology department personnel. Materials and Methods A review of the literature was performed for articles describing radiology implantation of forearm ports. Articles published between 1990 and 2015 were reviewed. Results Eleven articles were found that met the review criteria. None were randomized studies and only 1 was a prospective study. All of the other studies were retrospective reviews of a variety of different port devices. An analysis of these articles was performed. Conclusions Forearm port implantation had high technical success rates (range, 98%-100%; mean, 99.7%). A wide variety of complications were encountered, none of which exceeded the Society of Interventional Radiology threshold levels for complications associated with port insertion. A subset of the studies were upper arm venipunctures with the port catheter and housing subsequently implanted in the forearm distal to the antecubital fossa. [ABSTRACT FROM AUTHOR]

Background: Implantable venous access port (IVAP)-related blood stream infections (BSIs) are one of the most common complications of implantable venous ports. The risk factors and pathogens for IVAP-related BSIs are still controversial. Methods: We retrospectively reviewed all patients who received IVAPs at a Hospital in Taiwan from January 1, 2011 to June 31, 2014. Two types of venous port, BardPort® 6.6 fr (Bard port) and Autosuture Chemosite® 7.5 fr (TYCO port) were used. All patients with clinically proven venous port-related BSIs were enrolled. Results: A total of 552 patients were enrolled. There were 34 episodes of IVAP-related BSIs during the study period for a total incidence of 0.177 events/1000 catheter days. Port type (TYCO vs. Bard, HR = 7.105 (95 % confidence interval (CI), 1.688-29.904), p = 0.0075), age > 65 years (HR = 2.320 (95 % CI, 1.179-4.564), p = 0.0148), and lung cancer (HR = 5.807 (95 % CI, 2.946-11.447), p < 0.001) were risk factors for port infections. We also found that no local sign of infection was significantly associated with the growth of gram-negative bacilli (p = 0.031). Conclusions: TYCO venous ports, age > 65 years, and lung cancer were all significant risk factors for IVAP-related BSIs, and no sign of infection was significantly associated with the growth of gram-negative bacilli. [ABSTRACT FROM AUTHOR]

Background An implantable port device provides an easily accessible central route for long-term chemotherapy. Venous catheter migration is one of the rare complications of venous port implantation. It can lead to side effects such as pain in the neck, shoulder, or ear, venous thrombosis, and even life-threatening neurologic problems. To date, there are few published studies that discuss such complications. Methods This retrospective study of venous port implantation in a single center, a Taiwan hospital, was conducted from January 2011 to March 2013. Venous port migration was recorded along with demographic and characteristics of the patients. Results Of 298 patients with an implantable import device, venous port migration had occurred in seven, an incidence rate of 2.3%. All seven were male and had received the Bard port Fr 6.6 which had smaller size than TYCO port Fr 7.5 and is made of silicon. Significantly, migration occurred in male patients (P = 0.0006) and in those with lung cancer (P = 0.004). Multivariable logistic regression analysis revealed that lung cancer was a significant risk factor for port migration (odds ratio: 11.59; P = 0.0059). The migration rate of the Bard port Fr 6.6 was 6.7%. The median time between initial venous port implantation and port migration was 35.4 days (range, 7 to 135 days) and 71.4% (5/7) of patients had port migration within 30 days after initial port implantation. Conclusions Male sex and lung cancer are risk factors for venous port migration. The type of venous port is also an important risk factor. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was the analysis of the feasibility and complication rate of central venous port implantation with the surgical cut-down technique applying an intravasal electrographic control of the catheter tip position performed by urologists. Patients and methods: In the time from December 1999 to November 2010, implantation of 324 subcutaneously implanted venous port systems (NuPort-System) has been performed in 316 patients, 221 men (mean age 59.5 years, range 11-87 years) and 95 women (mean age 57.6 years, range 7-85 years). Two hundred and fifty-nine (79.9%) port systems were placed under electrographic control of the catheter tip position. Duration of procedure, long-term device function, and complications such as infections, occlusions, dislocations, and thrombosis were all retrospectively measured and recorded until removal of the device, patient's death or the last known recorded documentation. Results: In total, 359 devices have been used in 348 surgical procedures, 324 implantations (90.25%), and 35 explantations (9.75%). Port systems were implanted using the cephalic vein in 275 patients (84.9%), and in 49 (15.1%), the subclavian vein was used for insertion of the catheter. Mean surgical implantation time was 38.8 min (15-85 min). The median follow-up was 490.6 days (range 2-2,568); 159,764 catheter days (mean, 234 days, range 2-2,604) were documented. Of 35 explanted devices, the explantation was necessary due to complications in 28 cases (8.6%) with infection n = 6 (1.9%, 0.037 per 1,000 catheter days), occlusion n = 8 (2.5%, 0.050 per 1,000 catheter days), dislocation n = 7 (2.2%, 0.044 per 1,000 catheter days), deep vein thrombosis of the upper extremity n = 6 (1.9%, 0.037 per 1,000 catheter days), and clotting n = 1 (0.3%, 0.006 per 1,000 catheter days). Premature catheter removal (<30d post-operatively) was required in 6 patients (1.9%, 0.037 per 1,000 catheter days) due to complications: 3 catheter dislocations/malfunctions (0.9%, 0.019 per 1,000 catheter days), one port related infection, one pocket port infection, and one deep vein thrombosis of the upper extremity (0.3%, 0.006 per 1,000 catheter days). Conclusions: The intra-atrial ECG techniques to judge correct tip positioning for central venous port implantations are simple and economical. The exact position can be determined intraoperatively. It can justify a delayed postoperative chest X-ray to confirm CVC line tip placement. Nevertheless, the procedure and handling of the device later on has to be performed with care in order to avoid infections and technical problems. [ABSTRACT FROM AUTHOR]

The aim of this study is to present our experience about subcutaneous venous ports placed under guidance of imaging method. In this study, the records of interventional radiology unit were reviewed and 150 consecutive subjects, who underwent subcutaneous venous port implantation under guidance of imaging methods between the dates of 01.03.2007 and 04.09.2008 were presented. Patients were evaluated in terms of technical success, perioperative and late term complications. Thecnical success was 100%. None of the subjects had perioperative (first 30 days) complication. During long term follow-up, 3 subjects had skin necrosis and 4 subjects had infection related with catheter (2.6%). Rate of catheter sepsis calculated ad 1.3%. Complication which required extraction of port (skin necrosis, infection) occurred in 7 subjects (4.6%). One hundred and twenty one (121) of the patients are still alive and their ports are functional. Due to low rates of perioperative and early term complication, if there are qualified staff and adequate equipment, technique of subcutaneous venous port placement under guidance of imaging method should be preferred instead of landmark technique. [ABSTRACT FROM AUTHOR]

Venous ports are mandatory for chemotherapy in cancer patients because prolonged infusions are required. The aim of this study was to assess the safety of peripheral arm ports for chemotherapy in patients with colorectal cancer. A peripheral venous access port was placed in the upper arm in 113 consecutive patients with metastatic colorectal cancer (MCRC). All patients received modifi ed FOLFOX (5-fl uorouracil [5-FU]/l-leucovorin [LV]/oxaliplatin [L-OHP]) 6 or FOLFIRI (5-FU/LV/irinotecan hydrochloride [CPT-11]) regimens at least once via the venous access port. All patients were followed up at least once every 2 weeks. Puncture of the basilic veins was successfully completed under real-time sonographic guidance or radiographic guidance in all patients. The median operative time was 30 min. The cumulative follow-up period was 29 886 catheter days (range, 9–560 days; mean, 264 days). No procedural complications, such as pneumothorax, hemothorax, arterial puncture, or cardiovascular problems, occurred in our series. A total of nine patients (8.0%) had complications. Port-site infection occurred in six patients (5.3%; 0.20 infections per 1000 catheter-days). One patient (0.9%) had an episode of ultrasound-documented deep vein thrombosis in the ipsilateral upper extremity (0.03/1000 catheter-days). Dislocation or migration of the catheter tip occurred in two patients (0.07/1000 catheter-days). A second port was placed in six patients (5.3%) after removal of the fi rst port. Peripheral arm ports can be maintained with excellent short-and long-term outcomes. Peripheral arm ports are considered to be a good alternative to central venous ports implanted in the chest in patients with MCRC. [ABSTRACT FROM AUTHOR]