Complications of totally implantable venous access devices: experience with 852 Moroccan cancer patients

Aziz Bazine, Mohamed Fetohi, Akram Traibi, Fouad Atoini, Walid Bakzaza, Khalil Boukhabrine, Mohamed Ichou


Background: Totally implantable venous access devices (TIVADs) provide easy vascular access in cancer patients for chemotherapy administration, blood products, parenteral nutrition and blood sampling. However, they are associated with several complications which can be divided into early and late. The aim of the present study was to evaluate the various complications related to TIVADs in a single center in Morocco.

Methods: This was a retrospective, observational, descriptive study conducted at the Medical Oncology Department of the Military Hospital Moulay Ismail in Meknes, Morocco, during a 6-year period, between January 1st, 2011 and December 31st, 2016. Author included all patients older than or equal to 18 years, with solid malignancies who had TIVAD placement for chemotherapy.

Results: A total 852 TIVADs were placed. There were 92 complications (10.8% of patients). Early complications included 16 (1.9%) cases of pneumothorax and 12 (1.4%) cases of arterial puncture with a cervical hematoma. Infection was the most common late complications (2.8%), followed by thrombosis (1.8), extravasations of cytotoxic drugs (1.3%), mechanical dysfunction of the catheter (1.3%) and skin necrosis (0.3%).

Conclusions: The results of the analysis confirm the safety and tolerability of TIVADs for chemotherapy administration in Moroccan patients, with similar rates of early and late complications compared to the published data.



Cancer, Complications, Totally implantable venous access device

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Tabatabaie O, Kasumova GG, Eskander MF, Critchlow JF, Tawa NE, Tseng JF. Totally Implantable Venous Access Devices: A Review of Complications and Management Strategies. Am J Clin Oncol. 2017;40(1):94-105.

Wolosker N, Yazbek G, Nishinari K, Malavolta LC, Munia MA, Langer M, et al. Totally implantable venous catheters for chemotherapy: experience in 500 patients. Sao Paulo Med J Rev Paul Med. 2004;122(4):147-51.

de Oliveira EB, Reis MA, Avelar TM, Vieira SC. Totally implantable central venous catheters for chemotherapy: experience with 793 patients. Rev Col Bras Cir. 2013;40(3):186-90.

Vescia S, Baumgärtner AK, Jacobs VR, Kiechle-Bahat M, Rody A, Loibl S, et al. Management of venous port systems in oncology: a review of current evidence. Ann Oncol Off J Eur Soc Med Oncol. 2008;19(1):9-15.

Narducci F, Jean-Laurent M, Boulanger L, El Bédoui S, Mallet Y, Houpeau JL, et al. Totally implantable venous access port systems and risk factors for complications: a one-year prospective study in a cancer centre. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2011;37(10):913-8.

Granic M, Zdravkovic D, Krstajic S, Kostic S, Simic A, Sarac M, et al. Totally implantable central venous catheters of the port-a-cath type: complications due to its use in the treatment of cancer patients. J BUON Off J Balk Union Oncol. 2014;19(3):842-6.

Ignatov A, Hoffman O, Smith B, Fahlke J, Peters B, Bischoff J, et al. An 11-year retrospective study of totally implanted central venous access ports: complications and patient satisfaction. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2009;35(3):241-6.

Zaghal A, Khalife M, Mukherji D, El Majzoub N, Shamseddine A, Hoballah J, et al. Update on totally implantable venous access devices. Surg Oncol. 2012;21(3):207-15.

Mueller BU, Skelton J, Callender DP, Marshall D, Gress J, Longo D, et al. A prospective randomized trial comparing the infectious and noninfectious complications of an externalized catheter versus a subcutaneously implanted device in cancer patients. J Clin Oncol Off J Am Soc Clin Oncol. 1992;10(12):1943-8.

Gleeson NC, Fiorica JV, Mark JE, Pinelli DM, Hoffman MS, Roberts WS, et al. Externalized Groshong catheters and Hickman ports for central venous access in gynecologic oncology patients. Gynecol Oncol. 1993;51(3):372-6.

Hardman D, Englund R, Hanel K. Aspects of central venous access catheter usage in patients with malignancy. N Z Med J. 1994;107(979):224-6.

Koonings PP, Given FT. Long-term experience with a totally implanted catheter system in gynecologic oncologic patients. J Am Coll Surg. 1994;178(2):164-6.

Nelson BE, Mayer AR, Tseng PC, Schwartz PE. Experience with the intravenous totally implanted port in patients with gynecologic malignancies. Gynecol Oncol. 1994;53(1):98-102.

Biffi R, de Braud F, Orsi F, Pozzi S, Mauri S, Goldhirsch A, et al. Totally implantable central venous access ports for long-term chemotherapy. A prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days. Ann Oncol Off J Eur Soc Med Oncol. 1998;9(7):767-73.

Leinung S, Würl P, Anders K, Deckert F, Schönfelder M. Port catheter fractures in 361 implanted port systems. Analysis of the causes-possible solutions--review of the literature. Chir Z Alle Geb Oper Medizen. 2002;73(7):696-9.

Vardy J, Engelhardt K, Cox K, Jacquet J, McDade A, Boyer M, et al. Long-term outcome of radiological-guided insertion of implanted central venous access port devices (CVAPD) for the delivery of chemotherapy in cancer patients: institutional experience and review of the literature. Br J Cancer. 2004;91(6):1045-9.

Araújo C, Silva JP, Antunes P, Fernandes JM, Dias C, Pereira H, et al. A comparative study between two central veins for the introduction of totally implantable venous access devices in 1201 cancer patients. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2008;34(2):222-6.

Hoareau-Gruchet F, Rtail R, Sulaj H, Khirnetkina A, Reyt E, Righini CA. Complications after insertion of a totally implantable venous access port in patients treated with chemotherapy for head and neck squamous cell carcinoma. Ann Oto-Laryngol Chir Cervico Faciale Bull Soc Oto-Laryngol Hopitaux Paris. 2009;126(2):43-52.

Hsieh CC, Weng HH, Huang WS, Wang WK, Kao CL, Lu MS, et al. Analysis of risk factors for central venous port failure in cancer patients. World J Gastroenterol. 2009;15(37):4709-14.

Ma LI, Liu Y, Wang J, Chang Y, Yu L, Geng C. Totally implantable venous access port systems and associated complications: A single-institution retrospective analysis of 2,996 breast cancer patients. Mol Clin Oncol. 2016;4(3):456-60.

Granziera E, Scarpa M, Ciccarese A, Filip B, Cagol M, Manfredi V, et al. Totally implantable venous access devices: retrospective analysis of different insertion techniques and predictors of complications in 796 devices implanted in a single institution. BMC Surg. 2014;14:27.

Vesely TM. Air embolism during insertion of central venous catheters. J Vasc Interv Radiol JVIR. 2001;12(11):129-5.

Innami Y, Oyaizu T, Ouchi T, Umemura N, Koitabashi T. Life-threatening hemothorax resulting from right brachiocephalic vein perforation during right internal jugular vein catheterization. J Anesth. 2009;23(1):135-8.

Porzionato A, Montisci M, Manani G. Brachial plexus injury following subclavian vein catheterization: a case report. J Clin Anesth. 2003;15(8):582-6.

Collier PE, Goodman GB. Cardiac tamponade caused by central venous catheter perforation of the heart: a preventable complication. J Am Coll Surg. 1995;181(5):459-63.

Di Carlo I, Pulvirenti E, Mannino M, Toro A. Increased use of percutaneous technique for totally implantable venous access devices. Is it real progress? A 27-year comprehensive review on early complications. Ann Surg Oncol. 2010;17(6):1649-56.

Orci LA, Meier RPH, Morel P, Staszewicz W, Toso C. Systematic review and meta-analysis of percutaneous subclavian vein puncture versus surgical venous cutdown for the insertion of a totally implantable venous access device. Br J Surg. 2014;101(2):8-16.

Barbetakis N, Asteriou C, Kleontas A, Tsilikas C. Totally implantable central venous access ports. Analysis of 700 cases. J Surg Oncol. 2011;104(6):654-6.

Baumann MH, Noppen M. Pneumothorax. Respirol Carlton Vic. 2004;9(2):157-64.

Ezaru CS, Mangione MP, Oravitz TM, Ibinson JW, Bjerke RJ. Eliminating arterial injury during central venous catheterization using manometry. Anesth Analg. 2009;109(1):130-4.

Lebeaux D, Fernández-Hidalgo N, Chauhan A, Lee S, Ghigo JM, Almirante B, et al. Management of infections related to totally implantable venous-access ports: challenges and perspectives. Lancet Infect Dis. 2014;14(2):146-59.

Samaras P, Dold S, Braun J, Kestenholz P, Breitenstein S, Imhof A, et al. Infectious port complications are more frequent in younger patients with hematologic malignancies than in solid tumor patients. Oncology. 2008;74:237-44.

Chang L, Tsai JS, Huang SJ, Shih CC. Evaluation of infectious complications of the implantable venous access system in a general oncologic population. Am J Infect Control. 2003;31(1):34-9.

Chen IC, Hsu C, Chen YC, Chien SF, Kao HF, Chang SY, et al. Predictors of bloodstream infection associated with permanently implantable venous port in solid cancer patients. Ann Oncol Off J Eur Soc Med Oncol. 2013;24(2):463-8.

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.

Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am. 2009;49(1):1-45.

Baumann KL, Jaffray J, Carrier M. Epidemiology, diagnosis, prevention and treatment of catheter-related thrombosis in children and adults. Thromb Res. 2017;157:64-71.

Piran S, Ngo V, McDiarmid S, Le Gal G, Petrcich W, Carrier M. Incidence and risk factors of symptomatic venous thromboembolism related to implanted ports in cancer patients. Thromb Res. 2014;133(1):30-3.

Goltz JP, Schmid JS, Ritter CO, Knödler P, Petritsch B, Kirchner J, et al. Identification of risk factors for catheter-related thrombosis in patients with totally implantable venous access ports in the forearm. J Vasc Access. 2012;13(1):79-85.

Heibl C, Trommet V, Burgstaller S, Mayrbaeurl B, Baldinger C, Koplmüller R, et al. Complications associated with the use of Port-a-Caths in patients with malignant or haematological disease: a single-centre prospective analysis. Eur J Cancer Care. 2010;19(5):676-81.