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

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.