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Central venous access: techniques and indications in oncology

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Abstract

Long lines can be inserted centrally or peripherally through patent veins into the central venous system down to the atrial caval junction. Traditionally surgeons, anesthetists, cardiologists and more recently interventional radiologists have been placing them using vein cutdown or percutaneous needle puncture techniques. Typical candidates for implanted venous catheters are cancer patients undergoing long-term chemotherapy. The most important issues, in addition to the patency of central veins and the history of previous indwelling catheters, pacewires or venous thrombosis, are the patient’s performance status, body mass index, medical history and respiratory status, and the relevant technique. The present article will give an overview of the radiological and surgical implantation techniques and will highlight the impact of imaging means on the technical feasibility, assessment and treatment of device-related complications.

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References

  1. Fang CC, Jao YT, Han SC, Wang SP (2007) Persistent left superior vena cava: multi-slice CT images and report of a case. Int J Cardiol 1:21:112–114

    Article  PubMed  Google Scholar 

  2. Denys BG, Uretsky BF, Reddy PS (1993) Ultrasound-assisted cannulation of the internal jugular vein: a prospective comparison to the external landmark-guided technique. Circulation 87:1557–1562

    PubMed  CAS  Google Scholar 

  3. Farrell J, Gellens M (1997) Ultrasound-guided cannulation versus the landmark-guided technique for acute haemodialysis access. Nephrol Dial Transplant 12:1234–1237

    Article  PubMed  CAS  Google Scholar 

  4. Hind D, Calvert N, Mc Williams R, Davidson A, Paisley S, Beverley C, Thomas S (2003) Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ 327(7411):361

    Article  PubMed  Google Scholar 

  5. Marcy PY, Magné N, Castadot P, Italiano A, Amoretti N, Bailet C, Bentolila F, Gallard JC (2007) Is radiologic placement of an arm port mandatory in oncology patients?: analysis of a large bi-institutional experience. Cancer 110:2331–2338

    Article  PubMed  Google Scholar 

  6. Vardy J, Engelhardt K, Cox K, Jacquet J, McDade A, Boyer M, Beale P, Stockler M, Loneragan R, Dennien B, Waugh R, Clarke SJ (2004) Long-term outcome of radiological-guided insertion of implanted central venous access port devices (CVAPD) for the delivery of chemotherapy in cancer patients: institutional experience and review of the literature. Br J Cancer 91:1045–1049

    PubMed  CAS  Google Scholar 

  7. Povoski SP, Zaman SA (2002) Selective use of preoperative venous duplex ultrasound and intraoperative venography for central venous access device placement in cancer patients. Ann Surg Oncol 9:493–499

    Article  PubMed  Google Scholar 

  8. Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Berg KJ (2003) Nephrotoxicity in high-risk patients study of iso-osmolar and low-osmolar non-ionic contrast media study investigators. N Engl J Med 348:491–499

    Article  PubMed  CAS  Google Scholar 

  9. Marcy PY, Chamorey E, Amoretti N, Benezery K, Bensadoun RJ, Bozec A, Poissonnet G, Dassonville O, Rame M, Italiano A, Peyrade F, Brenac F, Gallard JC (2007) A comparison between distal and proximal port device insertion in head and neck cancer. Eur J Surg Oncol Epub November 5, DOI 10.1016/j.ejso.2007.09.011

  10. Marcy PY, Magne N, Castadot P, Bailet C, Macchiavello JC, Namer M, Gallard JC (2005) Radiological and surgical placement of port devices: a 4-year institutional analysis of procedure performance, quality of life and cost in breast cancer patients. Breast Cancer Res Treat 92:61–67

    Article  PubMed  Google Scholar 

  11. Mallory DK, McGee WT, Shawker TH, Brenner M, Bailey KR, Evans RG, Parker MM, Farmer JC, Parillo JE (1990) Ultrasound guidance improves the success rate of internal jugular vein cannulation. A prospective, randomized trial. Chest 98:157–160

    Article  PubMed  CAS  Google Scholar 

  12. Funaki B, Szymski GX, Hackworth CA, Rosenblum JD, Burke R, Chang T, Leef JA (1997) Radiologic placement of subcutaneous infusion chest ports for long-term central venous access. AJR Am J Roentgenol 169:1431–1434

    PubMed  CAS  Google Scholar 

  13. Cil BE, Canyigit M, Peynircioglu B, Hazirolan T, Carkaci S, Cekirge S, Balkanci F (2006) Subcutaneous venous port implantation in adult patients: a single center experience. Diagn Interv Radiol 12:93–98

    PubMed  Google Scholar 

  14. Sulek CA, Blas ML, Lobato EB (2000) A randomized study of left versus right internal jugular vein cannulation in adults. J Clin Anesth 12:142–145

    Article  PubMed  CAS  Google Scholar 

  15. Charvat J, Linke Z, Horaekova M, Prausova J (2006) Implantation of central venous ports with catheter insertion via the right internal jugular vein in oncology patients: single center experience. Support Care Cancer 14:1162–1165

    Article  PubMed  CAS  Google Scholar 

  16. Lee SH, Hahn ST (2005) Comparison of complications between transjugular and axillosubclavian approach for placement of tunneled, central venous catheters in patients with hematological malignancy: a prospective study. Eur Radiol 15:1100–1104

    Article  PubMed  Google Scholar 

  17. Trerotola SO, Kuhn-Fulton J, Johnson MS, Shah H, Ambrosius WT, Kneebone PH (2000) Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access. Radiology 217:89–93

    PubMed  CAS  Google Scholar 

  18. Patel MC, Berman LH, Moss HA, McPherson SJ (1999) Subclavian and internal jugular veins at Doppler US: abnormal cardiac pulsatility and respiratory phasicity as a predictor of complete central occlusion. Radiology 211:579–583

    PubMed  CAS  Google Scholar 

  19. Aldrighetti L, Paganelli M, Arru M, Caterini R, Ronzoni M, Ferla G (2000) Complications of blind placement in 980 subcutaneous infusion ports. J Vasc Access 1:28–32

    PubMed  CAS  Google Scholar 

  20. Schwarz RE, Groeger JS, Coit DG (1997) Subcutaneously implanted central venous access devices in cancer patients: a prospective analysis. Cancer 79:1635–1640

    Article  PubMed  CAS  Google Scholar 

  21. Nevarre DR, Domingo OH (1997) Supraclavicular approach to subclavian catheterization: review of the literature and results of 178 attempts by the same operator. J Trauma 42:305–309

    PubMed  CAS  Google Scholar 

  22. Zahringer M, Hilgers J, Kruger K, Strohe D, Bangard C, Neumann L, Warm M, Reiser M, Tox U, Lackner KO (2006) Ultrasound guided implantation of chest port systems via the lateral subclavian vein. Rofo 178:324–329

    PubMed  CAS  Google Scholar 

  23. Hinke DH, Zandt-Stastny DA, Goodman LR, Quebbeman EJ, Krzywda EA, Andris DA (1990) Pinch-off syndrome: a complication of implantable subclavian venous access devices. Radiology 177:353–356

    PubMed  CAS  Google Scholar 

  24. Lyon RD, Griggs KA, Johnson AM, Olsen JR (1999) Long-term follow-up of upper extremity implanted venous access devices in oncology patients. J Vasc Interv Radiol 10:463–471

    Article  PubMed  CAS  Google Scholar 

  25. Hata Y, Morita S, Morita Y, Awatani T, Takasaki M, Horimi T, Ozawa Z (1998) Peripheral insertion of a central venous access device under fluoroscopic guidance using a peripherally accessed system (PAS) port in the forearm. Cardiovasc Interv Radiol 21:230–233

    Article  CAS  Google Scholar 

  26. Allen AW, Megargell JL, Brown DB, Lynch FC, Singh H, Singh Y, Waybill PN (2000) Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol 11:1309–1314

    Article  PubMed  CAS  Google Scholar 

  27. Marcy PY, Italiano A (2007) The percutaneous radiological correction rate Is 0.5% in upper extremity port device cancer patients. Cardiovasc Intervent Radiol; Epub October 25, DOI 10.1007/s00270–007–9212–5

  28. Puel V, Caudry M, Le Metayer P, Baste JC, Midy D, Marsault C, Demeaux H, Maire JP (1993) Superior vena cava thrombosis related to catheter malposition in cancer chemotherapy given through implanted ports. Cancer 72:2248–2252

    Article  PubMed  CAS  Google Scholar 

  29. Conwell JA, Cocalis MW, Erickson LC (1993) EAT to the beat: “ectopic” atrial tachycardia caused by catheter whip. Lancet 342:740

    Article  PubMed  CAS  Google Scholar 

  30. Towbin R (2007) The bowed catheter sign: a risk for pericardial tamponade. Pediatr Radiol Epub Nov 20, DOI 10.1007/s00247–007–0674-z

  31. Kock HJ, Pietsch M, Krause U, Wilke H, Eigler FW (1998) Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems. World J Surg 22:12–16

    Article  PubMed  CAS  Google Scholar 

  32. Lersch C, Eckel F, Sader R, Paschalidis M, Zeilhofer F, Schulte-Frohlinde E, Theiss W (1999) Initial experience with Healthport miniMax and other peripheral arm ports in patients with advanced gastrointestinal malignancy. Oncology 57:269–275

    Article  PubMed  CAS  Google Scholar 

  33. Chang HM, Hsieh CB, Hsieh HF, Chen TW, Chen CJ, Chan DC, Yu JC, Liu YC, Shen KL (2006) An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases. Eur J Surg Oncol 32:90–93

    Article  PubMed  CAS  Google Scholar 

  34. Shetty PC, Mody MK, Kastan DJ, Sharma RP, Burke MW, Matthew W, Venugopal C, Burke T (1997) Outcome of 350 implanted chest ports placed by interventional radiologists. J Vasc Interv Radiol 8:991–995

    Article  PubMed  CAS  Google Scholar 

  35. Kuter DJ (2004) Thrombotic complications of central venous catheters in cancer patients. Oncologist 9:207–216

    Article  PubMed  Google Scholar 

  36. Denny DF (1993) Placement and management of long-term central venous access catheters and ports. AJR Am J Roentgenol 161:385–393

    PubMed  Google Scholar 

  37. Gebauer B, Teichgräber UK, Podrabsky P, Werk M, Hänninen EL, Felix R (2007) Radiological interventions for correction of central venous port catheter migrations. Cardiovasc Interv Radiol 30:668–674

    Article  Google Scholar 

  38. Bessoud B, de Baere T, Kuoch V, Desruennes E, Cosset MF, Lassau N, Roche A (2003) Experience at a single institution with endovascular treatment of mechanical complications caused by implanted central venous access devices in pediatric and adult patients. AJR 180:527–532

    PubMed  Google Scholar 

  39. Inoue Y, Miyazaki N, Shimuzu Y, Soh H, Fujita S, Takao T (2000) Indwelling catheter retraction because of pendulous breast. JPEN J Parenter Entrel Nutr 4:251–253

    Article  Google Scholar 

  40. Nazarian GK, Bjarnasan H, Dietz CA, Bernadas CA, Hunter DW (1997) Changes in tunnelled catheter tip position when a patient is upright. J Vasc Interv Radiol 8:437–441

    Article  PubMed  CAS  Google Scholar 

  41. Forauer AR, Alonzo M (2000) Change in peripherally inserted central catheter tip position with abduction and adduction of the upper extremity. J Vasc Interv Radiol 11:1315–1318

    Article  PubMed  CAS  Google Scholar 

  42. Quattrocchi CC, Sammarra M, Carassiti M, Vincenzi B, Tonini G, Grasso RF, Zobel BB (2006) Azygo-tracheal fistula in a complete implantable central venous system. J Clin Oncol 24:4029–4031

    Article  PubMed  Google Scholar 

  43. Winston CB, Wechsler RJ, Kane M (1994) Vertebral vein migration of long-term central venous access catheter: a cause of brachial plexopathy. J Thorac Imaging 9:98–100

    Article  PubMed  CAS  Google Scholar 

  44. Denny MA, Frank LR (2003) Ventricular tachycardia secondary to Port-a-Cath fracture and embolization. J Emerg Med 24:29–34

    Article  PubMed  Google Scholar 

  45. Ouaknine-Orlando B, Desruennes E, Cosset MF, De Baere T, Roche A (1999) The pinch-off syndrome: main cause of catheter embolism. Ann Fr Anesth Reanim 18:949–955

    PubMed  CAS  Google Scholar 

  46. Vorwerk D (2002) Non-traumatic vascular emergencies: management of occluded hemodialysis shunts and venous access. Eur Radiol 12:2644–2650

    PubMed  Google Scholar 

  47. Thony F, Moro D, Ferretti G, Ranchoup Y, Witmeyer P, Brambilla C, Coulomb M (1999) Endovascular treatment of superior vena cava obstruction in patients with malignancies. Eur Radiol 9:965–971

    Article  PubMed  CAS  Google Scholar 

  48. Vorwerk D (2000) Superior vena cava syndrome in the presence of a port catheter. Park it where it is out of the way. DOI 10.1594/EURORAD/CASE.593

  49. Merrer J, De Jonghe B, Golliot F et al (2001) Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 286:700–707

    Article  PubMed  CAS  Google Scholar 

  50. Bertoglio S, DiSomma C, Meszaros P, Gipponi M, Cafiero F, Percivale P (1996) Long-term femoral vein central venous access in cancer patients. Eur J Surg Oncol 22:162–165

    Article  PubMed  CAS  Google Scholar 

  51. Bennett JD, Papadouris D, Rankin RN, McGloughlin RF, Kribs S, Kozak RI, Garvin G, Elliott J (1997) Percutaneous inferior vena caval approach for long-term central venous access. J Vasc Interv Radiol 8:851–855

    Article  PubMed  CAS  Google Scholar 

  52. Azikhan RG, Taylor LA, Jaques PF, Mauro MA, Lacey SR (1992) Percutaneous lumbar and transhepatic inferior vena caval catheters for prolonged vascular access in children. J Pediatr Surg 27:165–169

    Article  Google Scholar 

  53. Bow EJ, Kilpatrick MG, Clinch JJ (1999) Totally implantable venous access ports systems for patients receiving chemotherapy for solid tissue malignancies: A randomized controlled clinical trial examining the safety, efficacy, costs, and impact on quality of life. J Clin Oncol 17:1267

    PubMed  CAS  Google Scholar 

  54. Johansson E, Björkholm M, Björvell H, Hast R, Takolander R, Olofsson P, Backman L, Weitzberg E, Engervall P (2004) Totally implantable subcutaneous port system versus central venous catheter placed before induction chemotherapy in patients with acute leukaemia-a randomized study. Support Care Cancer 12:99–105

    Article  PubMed  Google Scholar 

  55. Ng F, Mastoroudes H, Paul E, Davies N, Tibballs J, Hochhauser D, Mayer A, Begent R, Meyer T (2007) A comparison of Hickman line- and Port-a-Cath-associated complications in patients with solid tumours undergoing chemotherapy. Clin Oncol 19:551–556

    Article  CAS  Google Scholar 

  56. Biffi R, de Braud F, Orsi F, Pozzi S, Mauri S, Goldhirsch A, Nolè F, Andreoni B (1998) Totally implantable central venous access ports for long-term chemotherapy. A prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days. Ann Oncol 9:767–773

    Article  PubMed  CAS  Google Scholar 

  57. Seiler CM, Frohlich BE, Dorsam UJ, Kienle P, Buchler MW, Knaebel HP (2006) Surgical technique for totally implantable access ports (TIAP) needs improvement: a multivariate analysis of 400 patients. J Surg Oncol 93:24–29

    Article  PubMed  Google Scholar 

  58. Povoski SP (2000) A prospective analysis of the cephalic vein cutdown approach for chronic indwelling central venous access in 100 consecutive cancer patients. Ann Surg Oncol 7:496–502

    Article  PubMed  CAS  Google Scholar 

  59. Povoski SP (2004) External jugular vein cutdown approach for chronic indwelling central venous access in cancer patients: a potentially useful alternative. World J Surg Oncol 2:7

    Article  PubMed  Google Scholar 

  60. Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM (1994) Complications and failures of subclavian vein catheterization. N Engl J Med 29(331):1735–1738

    Article  Google Scholar 

  61. Oziuvaci E, Kutlu F (2006) Totally implantable venous access devices via subclavian vein: a retrospective study of 368 oncology patients. Adv Therapy 23:574–581

    Article  Google Scholar 

  62. Troianos CA, Jobes DR, Ellison N (1991) Ultrasound-guided cannulation of the internal jugular vein. A prospective, randomized study. Anesth Analg 72:823–826

    CAS  Google Scholar 

  63. Thalhammer A, Jacobi V, Balzer J, Vogl TJ (2002) Repositioning of malpositioned or flipped central venous catheters. Eur Radiol 12:698–700

    PubMed  CAS  Google Scholar 

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Marcy, PY. Central venous access: techniques and indications in oncology. Eur Radiol 18, 2333–2344 (2008). https://doi.org/10.1007/s00330-008-0981-2

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