The Implantation of Totally Implantable Venus Access Ports Way: Cephalic Vein Cut-Down in Oncologycal Patients| Stephy Publishers


Surgery International Open Access Journal - (SIOAJ)| Stephy Publishers


Abstract

Introduction: In an observational and retrospective study we wish to demonstrate that the performance of Preoperative Ultrasound prior to implantation of a Totally Implantable Venous Access Port (TIVAP) using Cephalic Vein Cut-down (CVC) improves the success rate and reduces complications.

Method: Between 2008 and 2018, 860 Cephalic Veins (CV) were studied preoperatively with Ultrasound. The Cephalic Vein was not suitable with a diameter less than or equal to 3.3mm. Diameters, procedure times, success rate, follow-ups and complications were studied.

Results: An Ultrasound was performed on 860CV, 146 (16.9%) were ruled out for implantation for various reasons. Of the 714CV to study, they belonged to 681 patients (63.3% women), with a mean age of 60.5 years (19-87). Age and colon neoplasia were significantly higher in males

(p<0.001). Of the 714 valid cases, in 12 cases (1.7%) there was a spasm of the CV so that the overall success rate was 97.9%, being higher via the LCV (98.5%). The 85.2% were accessed using the Left Cephalic Vein (LCV). The mean diameter was 3.8±0.2mm and the mean procedure time was

25.0±2.6 minutes, being less via the LCV (p<0.02). There were no intraoperative complications, and 1.3% experienced postoperative complications, predominantly Deep Vein Thrombosis (0.8%). There were 26 delayed complications (3.7%), the most frequent being system infection (1.7%) and

catheter occlusion (1.3%). 200 TIVAPs (28.6%) were explanted, 24.5% due to end of treatment, 3.2% due to complications and 0.9% due to other causes.

Conclusion: The Cephalic Vein Cut-down whit preoperative ultrasound is an excellent via for the implantation of TIVAP with high rate the success, without intraoperative complications and with few postoperative complications.

Keywords: Totally implantable venous access ports, Preoperative ultrasound, Cephalic vein cut-down

Introduction

The history of the Totally Implantable Venous Access Port (TIVAP) began in 1982, when the surgeon Niederhuber implanted the first through Cephalic Vein Cut-down (CVC). The subsequent evolution of both the systems and the access routes have been excellently presented by authors such as Zerati.1 With regard to the access route, the fact that various professionals (intensive care specialists, radiologists, oncologists, etc.) have become involved in the implantation of TIVAP has changed a purely surgical act into another, in principle less aggressive, procedure, such as percutaneous access of various veins (subclavian, internal and external jugular, axillary, etc). Angiologists and Vascular Surgeons are, from their training onwards, accustomed to performing invasive and non-invasive diagnostic techniques, as well as surgical and percutaneous procedures. In the implantation of TIVAP via CVC, we found that the conversion


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