Femoral Placement of Totally Implantable Venous Access Ports in Patients with Bilateral Breast Cancer

Abstract

Purpose: Aim of this study was to determine the rate of complications following femoral placement of totally implantable venous access ports (f-TIVAP) in women with bilateral breast cancer, with a special focus on long-term function, deep vein thrombosis (DVT), and port infection. Methods: 73 patients with bilateral breast cancer treated between October 2000 and January 2013 with placement of an f-TIVAP using a transfemoral approach were retrospectively reviewed. All patients were followed up, and all complications of f-TIVAP were recorded. Results: The median age was 62.5 years (range: 35–86 years). Four patients received f-TIVAP under local anesthesia, and 69 underwent placement under general anesthesia. Mean follow-up was 33.7 months (SD 25.9; range: 0.2–93.5 months). Complications over the entire period of observation included infections in 21 %, DVT in 19 % and catheter occlusion in 12 %. Patients receiving chemotherapy who developed leukopenia were more likely to experience DVT at the access site (p = 0.037). There was a trend towards a higher infection rate when the device was used more often (p = 0.084). Conclusion: Although the rates of complications in the longer term, especially device infections and DVTs, appeared to be relatively high, TIVAP implantation using femoral vein access is recommended in patients with bilateral breast cancer not suitable for cephalic vein cut-down.

Zusammenfassung

Einleitung: Ziel dieser Studie war es, die Komplikationsraten von transfemoralen Portsystemen in die Femoralvene (f-TIVAP) bei Patienten mit beidseitigem Mammakarzinom hinsichtlich der Langzeitfunktion, Ausbildung einer tiefen Venenthrombose (TVT) und Portinfektion zu beurteilen. Material und Methodik: 73 Patientinnen mit beidseitigem Mammakarzinom wurden zwischen Oktober 2000 und Januar 2013 mit einem f-TIVAP über einen transfemoralen Zugang zur Therapie versorgt und retrospektiv beurteilt. Alle Patientinnen wurden nachuntersucht und Komplikationen der f-TIVAP wurden aufgezeichnet. Ergebnisse: Das Durchschnittsalter betrug 62,5 Jahre (min. 35, max. 86 Jahre). Vier Patientinnen erhielten eine f-TIVAP in Lokalanästhesie, 69 in Allgemeinanästhesie. Die mittlere Nachuntersuchungszeit lag bei 33,7 Monaten (SD 25,9; min. 0,2, max. 93,5 Monate). Komplikationen über die gesamte Nachuntersuchungszeit waren: Portinfekte in 21 %, in 19 % TVT und in 12 % Portkatheterverschluss. Patientinnen unter Chemotherapie, die eine Leukopenie entwickelten, waren öfter durch eine TVT an der Portkatheter-Implantationsseite betroffen (p = 0,037). Ein Trend für eine höhere Infektrate des Portsystems in der Leiste konnte bei öfterem Gebrauch ermittelt werden (p = 0,084). Diskussion und Fazit: Obwohl Langzeitkomplikationen wie Portinfektionen und TVT relativ häufig aufzutreten scheinen, ist die TIVAP-Implantation über die Femoralvene durch einen Leistenzugang empfehlenswert bei Patienten mit beidseitigem Mammakarzinom, die für eine Portimplantation über die V. cephalica nicht infrage kommen.

Key words

breast cancer - femoral vein - thrombosis - venous access port

Schlüsselwörter

Brustkrebs - Femoralvene - Thrombose - venöses Portsystem

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