Hataoka Tsutomu, Sanmoto Yohei, Kinuta Shunji
Department of Surgery, Takeda General Hospital, Fukushima, Japan.
Department of Surgery, Takeda General Hospital, Fukushima, Japan.
Ann Vasc Surg. 2024 Jan;98:244-250. doi: 10.1016/j.avsg.2023.06.011. Epub 2023 Jun 24.
The widespread use of chemotherapies has increased the need for totally implantable venous access ports (TIVAPs). Previously, the subclavian puncture approach with the landmark technique was the most used implantation method; however, it has been related to early complications such as pneumothorax, hemothorax, and arterial puncture. Therefore, a safer implantation method is required. This study aimed to assess the safety and efficacy of the cephalic vein cut-down method used in our institution.
Patients who underwent TIVAPs implantation using the cephalic vein cut-down method as the first choice between January 1, 2018, and December 31, 2020, were included in this study. We retrospectively evaluated the technical success rates, operation times, and early complications.
This study included 221 adult patients (men, 129; women, 92), with a mean age of 68 ± 11 years. The mean body mass index (BMI) was 21 ± 4 kg/m. A total of 213 patients (96.4%) had malignant tumors that required chemotherapy. The mean postoperative follow-up period was 659 ± 442 days (range, 5-1,698 days). A total of 127 patients (57.5%) died during the follow-up period. The technical success rate was 86.4% (191/221). There were 30 failures, 24 of which were converted to the subclavian vein puncture approach. The mean operation time was 53 ± 21 min. Early complications were observed in 4 (1.8%) patients, corresponding to an incidence of 0.028 complications/1,000 catheter days. One patient had an unintended arterial puncture; however, it was not a result of the cephalic vein cut-down method but a secondary result of the subclavian vein puncture. No complications of pneumothorax, hemothorax, or arterial puncture were observed with the cephalic vein cut-down method.
This study showed that the cephalic vein cut-down method for TIVAPs had an acceptable success rate and fewer early complications than the conventional puncture techniques.
化疗的广泛应用增加了对完全植入式静脉通路端口（TIVAPs）的需求。以前，采用体表标志技术的锁骨下穿刺法是最常用的植入方法；然而，它与气胸、血胸和动脉穿刺等早期并发症有关。因此，需要一种更安全的植入方法。本研究旨在评估我院采用的头静脉切开法的安全性和有效性。
本研究纳入了2018年1月1日至2020年12月31日期间首选头静脉切开法进行TIVAPs植入的患者。我们回顾性评估了技术成功率、手术时间和早期并发症。
本研究包括221例成年患者（男性129例，女性92例），平均年龄68±11岁。平均体重指数（BMI）为21±4kg/m²。共有213例患者（96.4%）患有需要化疗的恶性肿瘤。术后平均随访期为659±442天（范围5 - 1698天）。共有127例患者（57.5%）在随访期间死亡。技术成功率为86.4%（191/221）。有30例失败，其中24例转为锁骨下静脉穿刺法。平均手术时间为53±21分钟。4例（1.8%）患者出现早期并发症，并发症发生率为0.028例/1000导管日。1例患者意外发生动脉穿刺；然而，这不是头静脉切开法的结果，而是锁骨下静脉穿刺的继发结果。头静脉切开法未观察到气胸、血胸或动脉穿刺并发症。
本研究表明TIVAPs头静脉切开法具有可接受的成功率且早期并发症比传统穿刺技术少。
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