Vélez Ángel Barba
Department of Angiology and Vascular Surgery, IMQ Zorrotzaurre University Hospital, Ballets Olaeta Kalea, 4, Bilbao, Spain.
EJVES Vasc Forum. 2023 Apr 11;59:2-7. doi: 10.1016/j.ejvsvf.2023.04.002. eCollection 2023.
The aim of this work was to describe the early and late success rates of cephalic vein cut down (CVC) in the implantation of totally implantable venous access ports (TIVAP) for chemotherapy treatment in oncological patients.
This was a retrospective study of 1 047 TIVAP performed in a private institution between 2008 and 2021. The CVC with pre-operative ultrasound (PUS) was the initial approach. All cephalic veins (CVs) were mapped pre-operatively with Doppler ultrasound, measuring their diameter and course in oncological patients who required a TIVAP. With a CV diameter ≥ 3.2 mm TIVAP was carried out by CVC; with CV diameter < 3.2 mm, subclavian vein puncture (SVP) was performed.
1 047 TIVAPs were implanted in 998 patients. The mean age was 61.5 ± 11.5 years, 624 were women (65.5%). Male patients were significantly older and with a higher incidence of colonic, digestive system, and laryngeal cancer. Initially, TIVAP was indicated in 858 cases (82%) by CVC and 189 (18%) by SVP. The success rate was 98.5% for CVC and 98.4% for SVP. There were no complications for CVC (0%) but five early complications (2.5%) in the SVP group. The rates of late complications were 4.4% in the CVC group and 5.0% in the SVP group, foreign body infection being the most frequent (57.5% of the cases) ( = .85).
The CVC or SVP using PUS for TIVAP deployment, performed through a single incision, is a safe and effective technique. This open but minimally invasive technique should be considered in oncological patients.
本研究旨在描述在肿瘤患者化疗中植入全植入式静脉通路端口（TIVAP）时头静脉切开术（CVC）的早期和晚期成功率。
这是一项对2008年至2021年在一家私立机构进行的1047例TIVAP植入术的回顾性研究。术前超声引导下的CVC是初始方法。在所有需要TIVAP的肿瘤患者中，术前使用多普勒超声对头静脉（CV）进行定位，测量其直径和走行。CV直径≥3.2mm时通过CVC进行TIVAP植入；CV直径<3.2mm时，进行锁骨下静脉穿刺（SVP）。
998例患者共植入1047个TIVAP。平均年龄为61.5±11.5岁，女性624例（65.5%）。男性患者年龄显著更大，结肠癌、消化系统癌和喉癌的发病率更高。最初，858例（82%）患者通过CVC植入TIVAP，189例（18%）通过SVP植入。CVC的成功率为98.5%，SVP的成功率为98.4%。CVC组无并发症（0%），但SVP组有5例早期并发症（2.5%）。晚期并发症发生率在CVC组为4.4%，在SVP组为5.0%，异物感染最为常见（占病例的57.5%）（P = 0.85）。
通过单一切口使用术前超声引导进行TIVAP植入的CVC或SVP是一种安全有效的技术。这种开放但微创的技术应在肿瘤患者中考虑应用。
