Totally implantable venous power ports of the forearm and the chest: initial clinical experience with port devices approved for high-pressure injections

Abstract

Objectives: To evaluate the technical success, clinical outcome and safety of percutaneously placed totally implantable venous power ports (TIVPPs) approved for high-pressure injections, and to analyse their value for arterial phase CT scans.

Methods: Retrospectively, we identified 204 patients who underwent TIVPP implantation in the forearm (n=152) or chest (n=52) between November 2009 and May 2011. Implantation via an upper arm (forearm port, FP) or subclavian vein (chest port, CP) was performed under sonographic and fluoroscopic guidance. Complications were evaluated following the standards of the Society of Interventional Radiology. Power injections via TIVPPs were analysed, focusing on adequate functioning and catheter's tip location after injection. Feasibility of automatic bolus triggering, peak injection pressure and arterial phase aortic enhancement were evaluated and compared with 50 patients who had had power injections via classic peripheral cannulas.

Results: Technical success was 100%. Procedure-related complications were not observed. Catheter-related thrombosis was diagnosed in 15 of 152 FPs (9.9%, 0.02/100 catheter days) and in 1 of 52 CPs (1.9%, 0.002/100 catheter days) (p<0.05). Infectious complications were diagnosed in 9 of 152 FPs (5.9%, 0.014/100 catheter days) and in 2 of 52 CPs (3.8%, 0.003/100 catheter days) (p>0.05). Arterial bolus triggering succeeded in all attempts; the mean injection pressure was 213.8 psi. Aortic enhancement did not significantly differ between injections via cannulas and TIVPPs (p>0.05).

Conclusions: TIVPPs can be implanted with high technical success rates, and are associated with low rates of complications if implanted with sonographic and fluoroscopic guidance. Power injections via TIVPPs are safe and result in satisfying arterial contrast. Conventional ports should be replaced by TIVPPs.

Figure 1

Totally implantable venous power port of the chest. The image was taken following implantation of the device via the left subclavian vein. The smooth curve of the port catheter and catheter tip (arrow) can be seen in the cavo-atrial junction. The curved arrow marks the letters “CT”, which are imprinted on the port chamber to clearly identify the port as a high-pressure tolerating device.

Figure 2

Totally implantable venous power port of the forearm. (a) Image after implantation of the device distal to the cubital fossa with a smooth curve of the catheter crossing the elbow. As with the pectoral device, the letters “CT” (curved arrow) are imprinted on the port chamber to identify the port as a high-pressure tolerating device. The port needle is still in place. (b) The catheter tip is located at the height of the vertebral body below the carina (broken lines).

Figure 3

Freedom from complication after totally implantable venous power port (TIVPP) implantation in the forearm (FP) and the chest (CP) displayed as a Kaplan–Meier graph.