Totally Implantable

Venous Access Ports Systems

(TIVAPS)One cancer center prospective study

Medical team•Access reliability•Care

Patient •Veinous integrity•Normal physical activity

Totally Implantable Venous Access Ports Systems (TIVAPS)

Prospective study

815 patientsMay 2nd 2006 – April 30th 2007

TIVAPSPolysite

PEROUSE (Ivry Le Temple-France)

5732

7 4

Performance status (%)

PS0PS1PS2PS3BMI = 25.03 (12.7-58.4)

Use of low weight heparin14%

56.2 years (0.8 – 85.2)

Women: 64%

Brea

st c

ance

r

Colo

n ca

ncer

Lung

can

cer

Head

and

nec

k ca

...

Gyna

ecol

ogic

ca...

Urol

ogic

canc

er

Sarc

oma

othe

rs

0100200300400 314

12379 77 77

47 33

24% in tumoral progressionIndication = 97% for chemotherapy

64

One-Year TIVAPS

PEROPERATIVE DATA

Local anesthesia = 91% Final venous access in 96% External jugular vein Cephalic vein

Number of attempts >=2 in 17%

OPERATING DATA

Surgeon

01020304050 38

50

12

%

Operating time30 min skin to skin

FIRST USE OF TIVAPS

Median time= 8 days (0 – 135) Use easiness

0 = easy 7 = hard

%

0 1 2 3 4 5 6 70

102030405060708090

100

TIAPS and Morbidity2006-2007

16.1%LITT = 8.6-31%

Schwarz RE et al . Cancer 1999;79:1635Kock HJ et al. World J Surg 1998;22:12Lersch C et al. Oncology 1999;57:269Aldrighetti L et al. J Vasc Access 2000;1:28Chang HM et al. Eur J Surg Oncol 2006;32:90Shetty PC et al. J Vasc Interv Radiol 1997;8:991Hata Y et al. Cardiovasc Intervent Radiol 1998;21:230Zahringer M et al. Rofo 2006;178:324Cil BE et al. Diagn Interv Radiol 2006;12:93Marcy PY et al. Cancer 2007;110:2331

Author

NFoolow-up (mont

h)

Venous accessSucces (%)

Global morbidit

y(%)

Infection(%)

Hématoma

(%)

Thrombosis

(%)

Macanic troubles

(%)

Early removal

(%)death(%)

Chang 2006

533?

Vce88% 14.1 7.7 2.1 0 5.3 ? 0.19

Chang 2006

598?

SCV/seldinger? 24.4 8.7 1.2 0 ? ? 0

Zahringer2006

2718.9

SCV/ultrasono100 12.9 6.6 1.5 0.5 2.2 1.9 ?

Cil2006

47112.6

IJV/ultrasono99.6 14.1 1.9 0.6 1 7.4 3.2 ?

Marcy2006

10008.4

IJV/phlébography94.2 10.4 3.2 0.9 1.9 4.4 5.3 0.4

COL 2009

81512

EJV-CV-IJV83% 16.1 5.3 3.2 0.9 1.6 6.8 0

Vardy 2004

11037

SCV/fluorscopic guidance

99%18.5 4.0 4.5 2.0 1 6.3 0

Biffi 2009 4016

IJV 132SCV/ULtrasono136

CV 133

17,913

17,5

0.82.42.5

?12.86.59.2

00

5.7

0.80.85

000

Global morbidity

(%)

14.1

24.4

12.9

14.1

10.4

16.118.5

17,913

17,5

Morbidité CCI2006-2007 N=131/815

Infe

ctio

n

Infla

mm

atio

n

Hem

atom

a

Cuta

neou

s t..

.

Pain

Drug

Ext

rav.

..

incis

ion

deh.

..

Mec

anic

tro...

Occlu

sion

Cath

eter

Mig

...

Thro

mbo

sis

0123456 5.3

3.4 3.2 2.8 2.3 1.8 1.8 1.6 1.3 0.9 0.9

Morbidity=16.1%Death=0

19

14

75

3 2 2 2 2

Causes for early removal of TIVAPS

N=55 (6.8%) Median time before removal

3.7 months (0.2-12)

60% Infection Incision dehiscence

Facteurs prédictifs complications

Time before first use 0-3

days4-7 days

>7 days

Complications 24.4% 17.1% 12.1% P<0.001

Complications Infection+++ Cutaneous troubles+++ Inflammation Incision Dehiscence

DELAI pose-1ère utilisationDifficulté de pose

Time before1rst use ≤ 7 days

Time before1rst use > 7 days p

Removal rate 8.5% 4.9% 0.05

Predictive factors of complication

Not to use TIVAPS before 8 days

Not to use TIVAPS before 8 days

Key points for improvementHind et al BMJ 2003;327:361. MetaanalysisNarducci et al EJSO 2011;37,913

Increase rate of successwith first attempt (> 83%)

Decrease of early removal for complicationInfection

Cutaneous troubles Incision dehiscence

ULTRA SOUND GUIDED VENIPUNCTURE• 90% success rate of puncture

• complications (anatomic variations)• operating time (20 min)

• patient comfort