Long-term clinical outcomes of the single-incision technique for implantation of implantable venous access ports via the axillary vein

Purpose To evaluate long-term clinical outcomes and complications of the single-incision technique for implantation of totally implantable venous access ports (TIVAPs) via the axillary vein. Materials and Methods A total of 932 TIVAPs were placed in 927 patients between May 2012 and October 2014 using a single-incision technique. Patients included 620 men and 307 women with a mean age of 60.0 years. TIVAPs were placed via the left (n = 475) and right (n = 457) axillary veins after making a single oblique vertical incision and medial side pocket without subcutaneous tunneling. We retrospectively reviewed medical records to evaluate status of the patients and TIVAPs, complications, and reasons for explantation. In patients who still had a TIVAP in place, we calculated the duration of TIVAP use from the cut-off day of November 1, 2015. Results Clinical follow-up was obtained for a total device service period of 311,069 days with a median indwelling time of 467 days (range: 3-1097 days). A total of 37 (4.0%) complications developed. Early complications (n = 4) were one case each of stenosis of the brachiocephalic vein by tumor growth, thrombosis of axillary vein, intravascular migration, and malfunction depending on patient's position. Late complications (n = 33) were suspected catheter-related blood stream infection (n = 23), local infection of the pocket (n = 4), symptomatic stenosis and thrombosis of central vein (n = 4), malfunction by fibrin sleeve (n = 1), and intravascular migration (n = 1). Conclusions A single-incision technique for TIVAP implantation via the axillary vein seems to be safe with a low risk of complication.

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Placement of Totally Implantable Venous Access Ports Using the Single-Incision Technique: Outcomes and Complications

Iranian Journal of Radiology ◽

10.5812/iranjradiol.101804 ◽

2020 ◽

Vol 17 (3) ◽

Author(s):

Seo Jin Jang ◽

Jae Hyun Kwon ◽

Yoon Ki Cha ◽

Do Yeun Kim

Keyword(s):

Single Incision ◽

Clinical Success ◽

Wound Dehiscence ◽

Venous Access ◽

Complication Rates ◽

Axillary Vein ◽

Success Rates ◽

Access Port ◽

Incision Technique ◽

Subcutaneous Tunneling

Background: A totally implantable venous access port (TIVAP) is an essential component of care for oncology patients. Conventional placement of the TIVAP is performed through the internal jugular vein or the subclavian vein using a tunneled catheter, which involves creating two incisions. However, the conventional technique has several potential limitations. To address these limitations, a single-incision technique without a second incision or subcutaneous tunneling has been extensively tested since first being introduced by Glenn in 2007. Objectives: The purpose of this study was to evaluate the technical success, clinical outcomes, and complications of the single-incision technique for the placement of TIVAPs. Patients and Methods: Between January 2013 and June 2017, 182 TIVAPs were placed by a single-incision technique in 175 patients, including 79 men and 96 women (mean age, 62.4 years; range: 20 - 88 years). Electronic medical records were retrospectively reviewed to obtain patient data, outcomes, and complication rates. Results: A total of 40,594 catheter maintenance days (median, 221.9 days; range, 1 - 889 days) were recorded for 182 TIVAPs in 176 patients. Technical and clinical success rates were both 100%. A total of 25 complications (complication rate, 13.74%) occurred, including catheter occlusion (5.49%), catheter-related infection (5.49%), wound dehiscence (1.10%), catheter kinking (0.55%), venous thrombosis (0.55%), and extravasation during infusion (0.55%). Conclusion: The single-incision technique for TIVAP via the axillary vein was safe and efficient with high technical and clinical success rates. This new technique may be a good alternative to conventional techniques.

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Ultrasound-guided percutaneous right brachiocephalic vein cannulation in a 5-year-old patient with bilaterally occluded internal jugular veins due to previous access by venous cut-down: A case report

The Journal of Vascular Access ◽

10.1177/11297298211011883 ◽

2021 ◽

pp. 112972982110118

Author(s):

Filiz Uzumcugil

Keyword(s):

Venous Access ◽

Term Treatment ◽

Brachiocephalic Vein ◽

Central Vein ◽

Ultrasound Guided ◽

Central Venous ◽

Jugular Veins ◽

Assessment Protocol ◽

Long Term Treatment

The open surgical venous cut-down technique is widely performed in cases of long-term treatment including administration of chemotherapy, parenteral nutrition, or replacement therapies. However, it has been recommended to avoid this technique considering the resultant unpredictable alterations in the veins draining the relevant site, especially in patients who may need central venous cannulation (CVC) during disease progression. We aimed to report on CVC in a 5-year-old child who had previously undergone bilateral internal jugular venous access by the open venous cut-down technique, in order to highlight the importance of performing the Rapid Central Vein Assessment protocol prior to any intervention and considering to abandon the use of the open surgical venous cut-down technique by gaining experience with ultrasound-guided percutaneous techniques.

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A Single-Incision Technique for Placement of Implantable Venous Access Ports via the Axillary Vein

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2013.12.571 ◽

2014 ◽

Vol 25 (9) ◽

pp. 1439-1446 ◽

Cited By ~ 14

Author(s):

Tae-Seok Seo ◽

Myung Gyu Song ◽

Eun-Young Kang ◽

Chang Hee Lee ◽

Hwan Seok Yong ◽

...

Keyword(s):

Single Incision ◽

Venous Access ◽

Axillary Vein ◽

Incision Technique

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Catheter-related obstruction of the right brachiocephalic vein following hemodialysis in a patient with lupus nephritis

The Journal of Vascular Access ◽

10.1177/1129729820926081 ◽

2020 ◽

pp. 112972982092608

Author(s):

Mitsutoshi Shindo ◽

Kenichi Oguchi ◽

Chihiro Kimikawa ◽

Kiyonori Ito ◽

Jyunki Morino ◽

...

Keyword(s):

Lupus Nephritis ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Brachiocephalic Vein ◽

Central Vein ◽

Axillary Vein ◽

Arteriovenous Graft ◽

Complete Obstruction ◽

Hemodialysis Catheter ◽

The Right

Vascular access is necessary for hemodialysis, and in some cases where it is difficult to establish an arteriovenous fistula or arteriovenous graft, a permanent hemodialysis catheter may be used. However, serious catheter-related complications, such as central vein stenosis or thrombosis, can occur. We herein present a case of complete brachiocephalic vein obstruction in a patient with lupus nephritis receiving hemodialysis using a tunneled hemodialysis catheter. A 64-year-old patient underwent maintenance hemodialysis while taking an anticoagulant, with a tunneled hemodialysis catheter in the right internal jugular vein, because of arteriovenous fistula failure when hemodialysis was introduced. However, the catheter was removed because of a catheter-related bloodstream infection. Following the administration of antibiotics, an arteriovenous graft was implanted between the brachial artery and axillary vein in the right arm. Surprisingly, arteriovenous graft failure and complete obstruction of the right brachiocephalic vein were observed 3 days after arteriovenous graft creation. In conclusion, we report the case of tunneled hemodialysis catheter-related complete obstruction of the right brachiocephalic vein in a lupus nephritis patient undergoing hemodialysis. Clinicians should be aware of this potential complication when tunneled hemodialysis catheters are used and consider the next vascular access type before a tunneled hemodialysis catheter has been indwelled for the long term.

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Abstract No. 23: Single Incision Technique for Tunneled Central Venous Access

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2007.12.026 ◽

2008 ◽

Vol 19 (2) ◽

pp. S10-S11

Author(s):

S.G. Contractor ◽

T.D. Phatak ◽

N. Bhagat ◽

J.W. Mitchell

Keyword(s):

Single Incision ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Incision Technique

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Puncture of the Axillary Vein for the Implant for Electronic Cardiac Devices

Journal of Cardiac Arrhythmias ◽

10.24207/jac.v32i1.511_in ◽

2018 ◽

pp. 17-24

Author(s):

Vagner Rossato Pegoraro ◽

Eduardo Rodrigues Bento Costa ◽

Luiz Fernando Fagundes Gouvea Filho ◽

Beatriz Tose Costa Paiva

Keyword(s):

Subclavian Vein ◽

Venous Access ◽

Long Term Results ◽

Axillary Vein ◽

Success Rates ◽

Cardiac Devices ◽

Increased Risk ◽

Different Types ◽

Short And Long Term

Introduction: The obtaining of venous access for implantation of implantable electronic cardiac devices (IECDs) has been traditionally made by intrathoracic subclavian vein puncture (SVP) or cephalic vein phlebotomy (CVP). Evidence indicates, however, the increased risk of short-term and long-term complications with SVP due to the fact that it is intrathoracic access and the risk of compression of the electrodes by the costoclavicular ligament, leading to different types of defects. CVP, in turn, has been associated with a failure rate that reaches 45%. Axillary vein puncture (AVP) has been described in the literature and is presented here as an alternative to the two techniques mentioned. Methods: A PubMed survey was conducted on articles that mention the AVP, SVP and CVP techniques and compare them to the immediate, short and long term results and success rates for obtaining venous access. Emphasis was placed on comparisons between the various AVP techniques. Conclusion: The AVP technique for obtaining venous access presents some variations among the different authors. It has CVP-like safety, success rates comparable to those of the subclavian vein, and better medium and long term results for electrode function.

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Insertion of a tunnelled picc through the brachiocephalic vein as a long-term venous access in a small infant: Thinking outside the box

Pediatrics & Neonatology ◽

10.1016/j.pedneo.2020.12.005 ◽

2020 ◽

Author(s):

Ignacio Oulego-Erroz ◽

Gloria López-Blanco ◽

Roger Benavent-Torres ◽

Sandra Terroba-Seara

Keyword(s):

Venous Access ◽

Brachiocephalic Vein ◽

Small Infant ◽

Outside The Box

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Long-term clinical outcomes following the central incision technique for insertional achilles tendinopathy

Fuß & Sprunggelenk ◽

10.1016/j.fuspru.2012.01.012 ◽

2012 ◽

Vol 10 (1) ◽

pp. 80

Keyword(s):

Clinical Outcomes ◽

Achilles Tendinopathy ◽

Incision Technique ◽

Insertional Achilles Tendinopathy

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Rapid Assessment of Vascular Exit Site and Tunneling Options (RAVESTO): A new decision tool in the management of the complex vascular access patients

The Journal of Vascular Access ◽

10.1177/11297298211034306 ◽

2021 ◽

pp. 112972982110343

Author(s):

Matthew D Ostroff ◽

Nancy Moureau ◽

Mauro Pittiruti

Keyword(s):

Vascular Access ◽

Femoral Vein ◽

Central Venous Access ◽

Rapid Assessment ◽

Venous Access ◽

Central Vein ◽

Exit Site ◽

Central Venous ◽

Venous Catheterization ◽

Subcutaneous Tunneling

In the last decade, different standardized protocols have been developed for a systematic ultrasound venous assessment before central venous catheterization: RaCeVA (Rapid Central Vein Assessment), RaPeVA (Rapid Peripheral Vein Assessment), and RaFeVA (Rapid Femoral Vein Assessment). Such protocols were designed to locate the ideal puncture site to minimize insertion-related complications. Recently, subcutaneous tunneling of non-cuffed central venous access devices at bedside has also grown in acceptance. The main rationale for tunneling is to relocate the exit site based on patient factors and concerns for dislodgement. The tool we describe (RAVESTO—Rapid Assessment of Vascular Exit Site and Tunneling Options) defines the different options of subcutaneous tunneling and their indications in different clinical situations in patients with complex vascular access.

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