Hepatic arterial supply in 1297 CT-angiographies.

PURPOSE: Analysis, evaluation and classification of hepatic arterial supply variants and determination of their frequency distribution in CT-angiographies. MATERIALS AND METHODS: CT-angiographies of 1,568 patients were evaluated retrospectively for the period between January 1, 2010 and August 30, 2012. The hepatic arterial anatomy was assessed and categorized according to Michels's classification. So far unclassified variants were considered separately. RESULTS: CT-angiographies of 1297 patients were included in the study. Type I according to Michels was seen in 937 cases (72.2 %), followed by type V in 114 patients (8.8 %) and type III in 83 patients (6.4 %). Type X could not be found in any of the patients. Not yet classified variants were discovered in 26 patients. The most frequent variant in this connection was a right hepatic artery originating from the superior mesenteric artery with the left hepatic artery originating from the left gastric artery (n = 10). CONCLUSION: Michels's classification could be largely confirmed on the basis of a radiologically examined patient population. Not yet classified variants were categorized into subgroups of the existing classification. KEY POINTS: Imaging of hepatic arterial supply variants using CT-angiography. Distribution of variations of arterial liver supply in a general patient population. Expansion of Michels's classification to include new variations of the arterial liver supply.

Evaluation of correlations between underlying disease and port complications.

PURPOSE: Evaluation of correlations between underlying disease and port complications. MATERIALS AND METHODS: Retrospective analysis of a data set of 3160 port systems, which had been interventionally implanted over a period of 10 years. Of these, 1393 were included in the final evaluation. The 7 most common underlying diseases and port-induced complications were considered. Port-related thrombotic events, port pocket infections as well as the port-induced sepsis were evaluated and classified as either early or late complications. RESULTS: In 1393 ports, 131 experienced complications. Of these, 22.1 % (n = 29) were early and 79.6 % (n = 102) late complications. The overall incidence rate of late complications was 0.253/1000 observed days. It differed significantly between the underlying diseases (p < 0.001) and was significantly lower in colon carcinoma when compared with pancreatic (p = 0.049), gastric (p = 0.012) and bronchial carcinoma (p = 0.042). The incidence rate of the port sepsis between the underlying diseases also differed significantly (p =  0.006) and had the highest rate in gastric and bronchial carcinoma. The occurrence of a thrombotic event also showed a significant difference in the incidence rates between the underlying diseases (p = 0.045) and was highest in pancreatic and gastric carcinoma. CONCLUSION: There are significant differences in the incidences of complications between the underlying diseases. Knowledge about this can help to improve the port-care and to take specific preventive measures.

Satisfaction and quality of life: a survey-based assessment in patients with a totally implantable venous port system.

The purpose was to assess the satisfaction and quality of life in patients with a totally implantable central venous port system using a questionnaire-based survey. A self-designed questionnaire to assess patient satisfaction and the impact of the port on daily life was dispatched 180 days after implantation. The questionnaire was combined with the commonly used short form (SF)-12 Health Survey quality of life questionnaire. Of the 98 patients who received a port system, 75 were contacted, and 42 (56%) returned the questionnaire. Most of the responding patients reported high overall satisfaction. The impact of the system on daily life was widely perceived not to be negative. The physical component summary (PCS) and the mental component summary (MCS) scores from the SF-12 were 35.5 and 45.23 respectively (general German population: PCS = 49.6, MCS = 52.3). The multiple stepwise regression showed that the cosmetic result was a predictor of overall satisfaction; the cosmetic result and a painful port together were predictors of the MCS. Overall, it was found that the cosmetic result of the implantation procedure was a predictor of satisfaction and quality of life and should thus not be underestimated.

[Interventional radiological imaging and treatment of port catheter dysfunctions]. / Angiografische Diagnostik und Interventionelle Therapie von Portdysfunktionen.

PURPOSE: To evaluate the impact of interventional radiological imaging and treatment of central venous port catheter complications. MATERIALS AND METHODS: In this retrospective analysis 429 port catheter dysfunctions were evaluated in 393 port catheter systems for a total of 389 patients over a period of 10 years. The study included 193 (49.1 %) patients with radiologically implanted port catheter systems and 200 (50.9 %) referred patients with surgically implanted port systems. Port catheter dysfunctions were subdivided into early and late complications as well as into non-thrombotic and thrombotic events. After administration of contrast medium, the port system was visualized using digital subtraction angiography. Data were retrospectively collected from the in-house databases and then analyzed descriptively. RESULTS: 429 contrast media injections via port catheters were performed in 393 port catheter systems. There were 359 (83.7 %) late complications and 70 (16.3 %) early complications. In 299 (69.7 %) cases thrombotic events occurred and 130 (30.3 %) non-thrombotic events were recorded. The most common reason for contrast media injection via port catheter system was port catheter-related thrombosis in 269 (62.7 %) cases. 70 (16.3 %) catheter migrations and 30 (7.0 %) fibrin sheath formations were detected. 18 (4.2 %) port needle malfunctions could be resolved through needle exchange. All 15 (3.5 %) catheter disconnections had to be revised in all cases. Also six port explantations were performed in 6 (1.4 %) catheter fractures. CONCLUSION: The possibilities of angiographic imaging and interventional radiological correction of port catheter dysfunctions must be exploited fully in order to avoid premature port explantation.