Long-term follow-up of upper extremity implanted venous access devices in oncology patients

Abstract

Purpose: To evaluate function and assess incidence of complications relating to upper extremity implanted venous access devices placed in oncology patients primarily for chemotherapy.

Materials and methods: The authors retrospectively evaluated the clinical course of 205 upper extremity implanted venous access devices placed with fluoroscopic and sonographic guidance in 204 patients during a 2-year period. All patients had a diagnosis of malignancy for which chemotherapy was planned. Follow-up data were collected by patient examination, direct evaluation of device function, as well as chart review and review of relevant imaging procedures. A modified technique for device placement is described.

Results: The devices were placed successfully on the initial attempt in all cases. Clinical follow-up was obtained for 195 devices (95.1%) for a total device service period of 33,619 days (mean service interval = 169 days). Seventy-eight devices (40%) had service intervals greater than 180 days. Thirty-seven devices (19% of total devices) led to 39 complications (0.116 event/100 days). No immediate procedural complications were incurred. Eight complications occurred after 180 days of port service. Nineteen devices (9.7% of total devices followed) required removal as a result of complication. Common complications included port malfunction requiring urokinase to clear (n = 10; 0.030 event/100 days), ipsilateral upper extremity deep venous thrombosis (n = 9; 0.027), and local infection (n = 7, 0.021). A comparison of these results relative to other published series of similar devices placed for mixed indications is presented.

Conclusions: Implanted venous access devices are an effective means of long-term venous access in oncology patients. Complication rates in this large series compared favorably to other published radiologic and surgical series. Analysis of complications in a subgroup of extended use implanted venous access devices (greater than 180 days follow-up) showed no statistically significant (P < .05) difference from the larger group of devices.