Implantation, removal, and adjustment of the totally implantable venous access port under the guidance of digital subtraction angiography: a ten-year experience at a territory medical center.

Abstract

Objective: This study aimed to report the 10-year experience of implantation, removal, and adjustment of a totally implantable venous access port (TIVAP) under the guidance of digital subtraction angiography (DSA) at a territory medical center.

Methods: The medical records of consecutive patients who underwent implantation, removal, and adjustment of the TIVAP under DSA guidance from January 2014 to March 2024 were retrospectively reviewed.

Results: In total, 290 consecutive patients who underwent TIVAP implantation were included, of which, 136 (46.9%) were men and 154 (53.1%) were women, with a mean age of 44.4 ± 16.5 years. The mean radiation dose was 4.9 ± 1.4 mGy. The operation time was 34.1 ± 3.8 min. The technical success rate was 100%. During a median follow-up of 239 days, 9 cases showed complications. No significant differences were found in age, sex, operation time, and radiation dose between the subclavian vein (SCV) and internal jugular vein (IJV) groups, while there were fewer complications in the IJV group (p = 0.039), and 114 consecutive patients who underwent TIVAP removal were included, of which, 49 (43.0%) were men and 65 (57.0%) were women, with a mean age of 44.3 ± 15.4 years. The median radiation dose was 3.8 (1.3-62.3) mGy. The median interval time from implantation to removal was 358.5 (2-3650) days. The operation time was 34.4 ± 6.1 min. The technical success rate was 100%. No significant differences were observed between the SCV and IJV groups. Cases with fracture and dislocation of the catheters were defined as the complicated group, while the others were defined as the uncomplicated group. The operation time (45.7 ± 12.4 vs. 33.7 ± 4.6 min) and radiation dose (45.4 ± 10.8 vs. 4.2 ± 2.2 mGy) between the above two groups were significantly different (both p < 0.05); A total of nine consecutive patients who underwent adjustment of the TIVAP were included, of which three patients had dislocation of the catheter and six patients had kinking of the catheters. They were all successfully adjusted using a pigtail catheter and/or gooseneck snare. The average operation time and radiation dose were 20.8 ± 5.6 min and 3.2 ± 1.3 mGy.

Conclusion: Implantation, removal, and adjustment of the venous port access under DSA guidance were safe and efficient. For the removal and adjustment of complicated cases, using the pigtail catheter and/or gooseneck snare under DSA guidance was efficient. In addition, the IJV seems to be a safer venous access site with a lower complication rate than the SCV.