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

RFS  Journal  Primer  

BOTTOM  LINE  •  The  single-­‐incision  technique  for  placing  ports  via  the  axillary  vein  is  a  feasible  and  safe  procedure  

with  high  technical  success  and  low  risk  of  complications.    MAJOR  POINTS    •  Conventional   techniques   for   placing   catheters   use   two   incisions   to   create   a   subcutaneous   tunnel  

with  several  associated  drawbacks.  •  To   overcome   the   disadvantages   associated   with   the   conventional   technique,   a   single-­‐incision  

technique  to  access  the  IVJ  via  an  infraclavicular  incision  is  proposed.  •  Potential  advantages  include  cosmetic  beneFits,  reduction  of  post-­‐procedural  discomfort,  and  easier  

placement  in  patients  with  tracheostomies  •  Potential  drawbacks  include  limited  subcutaneous  tunnel   length,  a  potentially   inaccessible  IVJ,  and  

difFiculty  advancing  devices.  

CRITICISM    

•  Port  pocket  location  was  not  randomized  because  this  was  a  retrospective  review.  

•  Patient  follow-­‐up  and  CT  imaging  were  inconsistent,  and  follow-­‐up  period  was  generally  short.  

•  Comparison  to  a  control  group,  port  placement  using  the  traditional  two  incision  technique,  was  not  made.  

Quick  Summary  

IRB-­‐approved  retrospective  study  •  216  patients  with  a  variety  of  underlying  malignancies  who  underwent  port  

placement  for  long-­‐term  chemotherapy  administration.  •  Time  range:  May  2012  to  October  2012  

INCLUSION  CRITERIA  •  Ports  placed  via  a  single-­‐incision  technique  by  the  same  interventional  radiologist  •  Patients  with  malignancies  requiring  port  placement  for  chemotherapy  

administration  •  Access  possible  via  axillary  vein  (*preferred,  not  absolute)    EXCLUSION  CRITERIA  •  Patients  with  high  body  mass  index  •  Patients  with  pendulous  breasts    

Study  design  

•  To  evaluate  the  technical  feasibility  and  safety  of  a  single-­‐incision  technique  for  placement  of  implantable  venous  access  ports  via  the  axillary  vein    

Purpose  

•  Ports  were  placed  in  112  men  and  104  women  with  a  mean  age  of  58.2  years  

•  Ports  were  placed  via  the  left  axillary  vein  in  172  patients  and  via  the  right  axillary  vein  in  44  patients  •  The  most  common  reason  for  placing  a  right-­‐sided  port  was  

left-­‐sided  breast  cancer  (n=25)  

•  A  single  vertical  incision  without  subcutaneous  tunneling  was  made    •  Axillary  vein  was  then  punctured  under  US  guidance,  typically  3  cm  

lateral  to  the  junction  of  the  axillary  vein  and  the  clavicle  and  directed  medially  

•  Procedure  details  were  retrospectively  reviewed,  including:  •  Technical  success  rate  

•  Final  location  of  the  micropuncture  needle  tip  

•  Procedure  time  

•  Fluoroscopy  time  

•  Complications  -­‐  identiFied  according  to  Society  of  Interventional  Radiology  criteria  

 

Interven7on  

Outcome    

•  All  procedures  using  single-­‐incision  technique  were  successful,  with  a  mean  Fluoroscopy  time  of  0.65  minutes  and  mean  procedure  time  of  nearly  14  minutes.  

•  The  most  common  Final  needle  tip  location  was  overlapping  the  First  rib  on  Fluoroscopic  imaging  

•  On  CT  scan,  the  entry  points  into  the  vein  was  the  axillary  vein  in  161  patients  and  the  subclavian  vein  in  31  patients.  

•  Most  common  problem  encountered  was  advancement  of  the  wire  or  catheter  into  unintended  veins,  which  occurred  in  33  patients  

•  1  major  and  2  minor  complications  occurred  •  Major  –  thrombosis  of  the  axillary  vein  

•  Minor  –  hematoma  formation  after  puncture  of  the  axillary  artery  

Credits  

SUMMARY  BY:    Justin  Shafa,  MSIV  The  George  Washington  University  School  of  Medicine  and  Health  Sciences    FULL  CITATION:  Seo  T,  Song  M,  Kang  E,  Lee  C,  Yong  H,  Doo  K.  Clinical  Study:  A  Single-­‐Incision  Technique  for  Placement  of  Implantable  Venous  Access  Ports  via  the  Axillary  Vein.  Journal  Of  Vascular  And  Interven4onal  Radiology  [serial  online].  September  1,  2014;25:1439-­‐1446.  Available  from:  ScienceDirect,  Ipswich,  MA.    

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