Incidents and Complications of Permanent Venous Central Access Systems: A Series of 1,460 Cases

다국어 초록 (Multilingual Abstract)

Background: Implanted venous access devices or permanent central venous access systems (PCVASs) are routinely used in oncologic patients. Complications can occur during the implantation or use of such devices. We describe such complications of the PCVAS and their management. Methods: Our retrospective study included 1,460 cases in which PCVAS was implanted in the 11 years between January 2002 and January 2013, including 810 women and 650 men with an average age of 45.2 years. We used polyurethane or silicone catheters. The site of insertion and the surgical or percutaneous procedure were selected on the basis of clinical data and disease information. The subclavian and cephalic veins were our most common sites of insertion. Results: About 1,100 cases (75%) underwent surgery by training surgeons and 360 patients by expert surgeons. Perioperative incidents occurred in 33% and 12% of these patients, respectively. Incidents (28%) included technical difficulties (n=64), a subcutaneous hematoma (n=37), pneumothoraces (n=15), and an intrapleural catheter (n=1). Complications in the short and medium term were present in 14.2% of the cases. Distortion and rupture of the catheter (n=5) were noted in the costoclavicular area (pinch-off syndrome). There were 5 cases of catheter migration into the jugular vein (n=1), superior vena cava (n=1), and heart cavities (n=3). No patient died of PCVAS insertion or complication.
Conclusion: PCVAS complications should be diagnosed early and treated with probable removal of this material for preventing any life-threatening outcome associated with complicated PVCAS.

참고문헌 (Reference)

1 Haire WD, "Utility of duplex ultrasound in the diagnosis of asymptomatic catheter-induced subclavian vein thrombosis" 10 : 493-496, 1991

2 Niederhuber JE, "Totally implanted venous and arterial access system to replace external catheters in cancer treatment" 92 : 706-712, 1982

3 Lebeaux D, "Totally implanted access port-related infections: features and management" 31 : 819-827, 2010

4 Wolosker N, "Totally implantable venous catheters for chemotherapy: experience in 500patients" 122 : 147-151, 2004

5 Bow EJ, "Totally implantable venous access ports systems for patients receiving chemotherapy for solid tissue malignancies: a randomized controlled clinical trial examining the safety, efficacy, costs, and impact on quality of life" 17 : 1267-, 1999

6 Narducci F, "Totally implantable venous access port systems and risk factors for complications: a one-year prospective study in a cancer centre" 37 : 913-918, 2011

7 Maki DG, "The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies" 81 : 1159-1171, 2006

8 Muller H, "Risiken und Komplikationen implantierter Kathetersysteme" 38 : 79-84, 2006

9 Stockx L, "Repositioning and leaving in situ the central venous catheter during percutaneous treatment of associated superior vena cava syndrome: a report of eight cases" 22 : 224-226, 1999

10 Beckmann M, "Platzierung und pflege von venosen verweilkathetern und portsystemen" 33 : 255-260, 2000

11 Hinke DH, "Pinch-off syndrome: a complication of implantable subclavian venous access devices" 177 : 353-356, 1990

12 Theard JL, "Outcome of usage protocols on implantable devices" 14 : 534-535, 1995

13 Brown DF, "Mode of chemotherapy does not affect complications with an implantable venous access device" 80 : 966-972, 1997

14 Desruennes E, "Mechanical complications at implantation sites" 47 : 269-272, 1999

15 Vescia S, "Management of venous port systems in oncology: a review of current evidence" 19 : 9-15, 2008

16 Inan I, "Management of malignant pleural effusion and ascites by a triple access multi perforated large diameter catheter port system" 6 : 85-, 2008

17 Stelzer S, "Langzeitergebnisse nach implantation von zentralvenosen port- systemen: dissertation Klinik und Poliklinik fur Mund-, Kiefer- und Gesichtschirurgie, Klinikum rechts der Isar" 105 : 18-21, 2008

18 Sarzo G, "Insertion of prolonged venous access device: a comparison between surgical cutdown and percutaneous techniques" 56 : 437-442, 2004

19 Groeger JS, "Infectious morbidity associated with long-term use of venous access devices in patients with cancer" 119 : 1168-1174, 1993

20 El Hammoumi MM, "Iatrogenic pneumothorax: experience of a Moroccan Emergency Center" 19 : 65-69, 2013

21 Borow M, "Evaluation of central venous catheter thrombogenicity" 81 : 59-64, 1985

22 Hasskarl J, "Complete caval thrombosis secondary to an implanted venous port: a case study" 105 : 18-21, 2008

23 Male C, "Comparison of venography and ultrasound for the diagnosis of asymptomatic deep vein thrombosis in the upper body in children: results of the PARKAA study. Prophylactic Antithrombin Replacement in Kids with ALL treated with Asparaginase" 87 : 593-598, 2002

24 Luciani A, "Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US" 220 : 655-660, 2001

25 Chang HM, "An alternative technique for totally implantable central venous access devices:a retrospective study of 1311 cases" 32 : 90-93, 2006

26 Reichardt P, "A phase III, randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of daily low-molecular-weightheparin (dalteparin sodium) in preventing catheter-related complications (CRCs) in cancer patients with central venous catheters (CVCs)" 21 : 369-, 2002