Yusuf VELİOĞLU, Emrah SINMAZ, Ahmet YÜKSEL

Perkütan subklaviyen ven yoluyla tamamen implante edilebilir venöz erişim portu yerleştirilmesinin komplikasyonları ve tedavi stratejileri

Amaç: Bu çalışmada perkütan subklaviyen ven yoluyla tamamen implante edilebilir venöz erişim portu yerleştirilen hastaların klinik özellikleri, periprosedürel sonuçları, erken ve geç komplikasyonları ve tedavi stratejileri sunuldu. Çalışma planı: Mart 2012 - Haziran 2018 tarihleri arasında perkütan landmark yöntemi ile subklaviyen ven yoluyla 2000 kanser hastasına (1066 erkek, 934 kadın; ort. yaş: 58.4±12.7 yıl; dağılım, 18-88 yıl) toplam 2084 port cihazı yerleştirildi. Demografik özellikler, primer tanı, teknik başarı, işlem süresi, cihazın kalma süresi, cihazın çıkarılma nedenleri ve erken ve geç komplikasyonlar dahil olmak üzere tıbbi veriler retrospektif olarak incelendi. Bulgular: En sık görülen kanser türü erkeklerde kolon kanseri, kadınlarda meme kanseri idi. İşlemin teknik başarı oranı %98.5 idi. Hastaların çoğunda (%92.4) sağ subklaviyen ven üzerinden erişim sağlandı. Arteriyel ponksiyon, kateter malpozisyonu, yüzeyel hematom ve pnömotoraks gibi erken komplikasyonlar 143 hastada (%6.9) gözlenir iken, 118 hastada (%5.7) enfeksiyon, kateter tıkanması, venöz tromboz, yara problemleri, kateter göçü ve embolizasyonu ve pinch-off sendromu gibi geç komplikasyonlar gelişti. En sık erken komplikasyon 63 hastada (%3) hatalı arteriyel ponksiyon iken, 44 hastada (%2.1) enfeksiyon en sık görülen geç komplikasyondu. Kemoterapinin tamamlanması veya komplikasyon gelişmesi nedeniyle toplam 192 port cihazı çıkarıldı. Sonuç: Çalışmamız yüksek teknik başarı ve düşük komplikasyon oranları ile perkütan subklavyen ven yoluyla tamamen implante edilebilir venöz erişim portu yerleştirilmesinin güvenliğini ve tolerabilitesini doğrulamıştır.

Complications and management strategies of totally implantable venous access port insertion through percutaneous subclavian vein

Background: The aim of this study was to present clinicalcharacteristics, peri-procedural outcomes, early and late complications,and management strategies in patients undergoing totally implantablevenous access port insertion through percutaneous subclavian vein.Methods: A total of 2,084 port devices were inserted to 2,000cancer patients (1,066 males, 934 females; mean age 58.4±12.7 years;range, 18 to 88 years) through subclavian vein using percutaneouslandmark method between March 2012 and June 2018. Medical dataincluding demographic features, primary diagnosis, technical success,procedural time, duration of device use, reasons for the device removal,and early and late complications were retrospectively analyzed.Results: The most common type of cancer was colon cancer inmales and breast cancer in females. Technical success rate ofthe procedure was 98.5%. Right subclavian vein was accessed inthe majority of patients (92.4%). Early complications includinginadvertent arterial puncture, catheter malposition, superficialhematoma, and pneumothorax occurred in 143 patients (6.9%), whilelate complications including infection, catheter occlusion, venousthrombosis, wound problems, catheter migration and embolization andpinch-off syndrome was developed in 118 patients (5.7%). Inadvertentarterial puncture in 63 patients (3%) was the most common earlycomplication, while infection in 44 patients (2.1%) was the mostcommon late complication. A total of 192 devices were removed dueto the completion of chemotherapy or development of complications.Conclusion: Our study confirmed the safety and tolerabilityof totally implantable venous access port insertion throughpercutaneous subclavian vein with high technical success and lowcomplication rates.

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