Percutaneous implantation of intra-arterial port system for regional drug infusion: Results and complications in 110 cases

PURPOSE: To investigate the feasibility and complications of a percutaneously implantable port system for regional drug infusion. MATERIALS AND METHODS: For intra-arterial drug infusion, a 5.8 or 5-F pediatric venous port system was implanted in 110 patients with hepatocelluar carcinoma (n = 79), liver metastasis (n = 16), gallbladder cancer (n = 4), stomach cancer (n = 3), pancreatic cancer (n = 3), Burger's disease (n = 2), diabetes mellitus (n = 2), or lymphoma (n = 1). All intra-arterial port implantations were performed percutaneously in an angiographic ward through the common femoral artery (n = 98), left subclavian artery (n = 10), or left superficial femoral artery (n = 2). Complications were evaluated during the follow-up period, which ranged from 21 to 530 (mean, 163) RESULTS: The technical success rate for percutaneous implantation of the system was 97.3% (107 of 110 patients). The tips of the port catheter were located in the common hepatic artery (n = 34), proper hepatic artery (n = 49), right hepatic artery (n = 8), left hepatic artery (n = 1), descending aorta at T9 level (n = 10), left popliteal artery (n = 2), right external iliac artery (n = 1), left external iliac artery (n = 1), or left deep femoral artery (n = 1). Complications were encountered in 24 patients(22.4%), namely chamber site infection (n = 7), catheter dislodgement (n = 7), catheter occlusion (n = 3), migration of coil (n = 2), disconnection between chamber and catheter (n = 1), kinking of catheter (n = 1), arterial occlusion (n = 1), necrosis of overlying skin (n = 1), and leakage around port chamber (n = 1). Outcomes of complications included removal of port systems or cessation of therapy in 12 cases (11.2%), correction of catheter location using a guide wire in five (4.7%), thrombolysis with urokinase in three (2.8%), and straightening using a snare in one (0.9%). In three patients, the port system was used without reintervention. CONCLUSION: Percutaneous implantation of an intra-arterial port system showed a high technical success rate and a low rate of serious complications. The method may be useful for regional drug infusion in various

Placement of an Implantable Central Venous Access Device

PURPOSE: To evaluate the efficacy and safety of placement of a central venous catheter with infusion portinto the superior vena cava MATERIALS & METHODS: Central venous catheters with a infusion port were implanted in21 patients (M:F=4:17, age range:15-63, mean age:41) diagnosed as suffering from breast cancer(n=9),lymphoma(n=7), thymoma(n=2) rhabdomyosarcoma(n=2) and rectal cancer(n=1). The peripheral portion of the subclaveanvein was punctured under fluoroscopic guidance during injection of contrast media at the site of the ipsilateralperipheral vein (20 cases) and under ultrasonographic guidance (1 case). 9.6F central venous catheters placed inthe superior vena cava via the subclavian vein and the connected infusion ports were implanted in the subcutaneouspocket near the puncture site of the right anterosuperior chest wall. RESULTS: Catheter insertion in the superiorvena cava and port implantation in the subcutaneous pocket were successful in all patients. Mean procedure timewas 23 minutes and there were no early complications. Because the incision site had not healed, one patientunderwent resuturing 3 weeks after the procedure. In one case, thrombotic occlusion of the catheter occurred, butsuccessful recanalization, involving urokinase infusion, was performed. At the end of the chemotherapy schedule,at 180, 157 and 139 days after the procedure, three central venous catheters with a infusion port were removed inthe radiologic suite. Catheter days are 5 days-180 days(mean, 119) from now (1997. 7. 1). CONCLUSIONS: Radiologicplacement under fluoroscopic guidance of a central venous catheter with a infusion port is easy, safe and usefulfor patients requring long-term venous access.