A novel incision technique of totally implanted venous access port in upper arm for patients with breast cancer

Abstract

Abstract Background: Totally implanted venous access port (TIVAP) in upper arm is a safe and cost-effective vascular access device and is widely used in breast cancer patients. Traditional tunnel needle technique increase the operation time and unsatisfied cosmetic effect so we explore the feasibility, cosmetic effect, and complications of an upper arm port with an novel incision in this retrospective study.Methods: We reviewed 489 cases of totally implantable venous access port implantation in the upper arm with two types of incision in our center from 1 January 2018 to 30 January 2022. The patients were divided in to two different incision groups including puncture site incision group(n=282) and conventional tunnel needle group(n=207). The operation time,aesthetic appearance and complications were collected between the two groups and contributing factors were analyzed for major complications. Results: A total of 489 patients were successfully implanted arm port with puncture site incision technique(n=282, 57.7%) and conventional tunnel needle technique(n=207, 42.3%) . The average operation time of two types of incision was (36.5±115) min in the puncture site incision group and (55±18.1) min in the tunnel needle group ( P<0.05) . In terms of complications,33 catheter-related complications occurred (6.4%), including 9 cases of infection, 15 cases of catheter-related thrombosis and 7 cases of skin exposure. 14 patients in the puncture site incision group developed complications compared with 17 in the traditional incision group.There were no significant differences between the two groups in terms of overall complication events (5.0% and 8.2%, p=0.145) while the same result were found in each complication event.Weight, total cholesterol and diabetes were found to be associated with device-related infections in univariate Cox proportional hazard regression models. Diabetes was found to be associated with device-related infections in multivariate analysis while hypertension was associated with thrombosis.Conclusions: The methods of puncture site incision improves the efficiency of the procedure and provide a better cosmetic appearance compared with traditional tunnel needle technique. It is a novel technique and preferable for totally implantable venous access port implantation in upper arm with comparable overall rate of complication for patients with breast cancer. It is worthy of being used and promoted in clinical research.