External jugular vein cutdown approach for chronic indwelling central venous access in cancer patients: A potentially useful alternative

World Journal of Surgical Oncology

Stephen P Povoski¹ 

[1] Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, Ohio 43210-1228, USA

关键词: malignant;    carcinoma;    neoplasm;    central venous access device;    external jugular vein;    cephalic vein;    venous cutdown;    Venous access;   

Others  :  1207484
DOI  :  10.1186/1477-7819-2-7

 received in 2004-01-30, accepted in 2004-04-16,  发布年份 2004

【 摘 要 】

Background

Cephalic vein (CV) cutdown approach for chronic indwelling central venous access device (CICVAD) placement has previously been shown to be technically feasible in 82% of cancer patients. No data are available as to the potential utilization of external jugular vein (EJV) cutdown approach in cancer patients when CV cutdown approach is not technically feasible.

Patients and methods

One hundred and twenty consecutive cancer patients were taken to the operating room with the intention of placing a CICVAD. All patients were first subjected to attempted CV cutdown approach. If CV cutdown approach was unsuccessful and there were no contraindications to establishing central venous access in the ipsilateral neck region, an ipsilateral EJV cutdown approach was attempted.

Results

Ninety-five cancer patients (79%) underwent CICVAD placement via CV cutdown. Of those 25 patients in which CV cutdown was not technically feasible, 7 had a contraindication to establishing central venous access in the ipsilateral neck region and a CICVAD was placed via the ipsilateral subclavian vein percutaneous approach. Of those remaining 18 patients in which CV cutdown approach was not technically feasible, 17 (94%) underwent CICVAD placement via ipsilateral EJV cutdown approach. Combined success of the CV and EJV cutdown approaches, excluding those 7 patients with a contraindication to central venous access in the ipsilateral neck region, was greater than 99%.

Conclusions

Venous cutdown approaches for CICVAD placement are viable alternatives to subclavian vein percutaneous approach in cancer patients. EJV cutdown approach appears to be a highly successful and safe alternative route when CV cutdown approach is not technically feasible and may be considered a potentially useful primary route for CICVAD placement in cancer patients.

【 授权许可】

   
2004 Povoski; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 参考文献 】

• [1]Povoski SP: Long-term venous access. In Cancer Management: A Multidisciplinary Approach. Medical, Surgical, and Radiation Oncology. 7th edition. Edited by Pazdur R, Coia LR, Hoskins WJ, Wagman LD. Melville: PRR, Inc; 2003:897-908.
• [2]Povoski SP: A prospective analysis of the cephalic vein cutdown approach for chronic indwelling central venous access in 100 consecutive cancer patients. Ann Surg Oncol 2000, 7:496-502.
• [3]Puig-La Calle J Jr, Sánchez SL, Serra EP, Honorato LA, Raventós VA, Puig-La Calle J: Totally implanted device for long-term intravenous chemotherapy: Experience in 123 adult patients with solid neoplasms. J Surg Oncol 1996, 62:273-278.
• [4]Rams JJ, Daicoff GR, Moulder PV: A simple method for central venous pressure measurement. Arch Surg 1966, 92:886.
• [5]Wade JC, Newman KA, Schimpff SC, VanEcho DA, Gelber RA, Reed WP, Wiernik PH: Two methods for improved venous access in acute leukemia patients. JAMA 1981, 246:140-144.
• [6]Wile AG: Technique for placement of an implantable venous access system. Am J Surg 1986, 152:543-544.
• [7]Raaf JH, Heil D: Open insertion of right atrial catheters through the jugular veins. Surg Gynecol Obstet 1993, 177:295-298.
• [8]Redo SF, Dinner MH: Placement of central venous catheters by cut-down with electrocardiogram positioning. Surg Gynecol Obstet 1993, 177:49-53.
• [9]Povoski SP, Zaman SA: Selective utilization of preoperative venous duplex ultrasound and intraoperative venography for central venous access device placement in cancer patients. Ann Surg Oncol 2002, 9:493-499.
• [10]Kock HJ, Pietsch M, Krause U, Wilke H, Eigler FW: Implantable vascular access systems: Experience in 1500 patients with totally implanted central venous port systems. World J Surg 1998, 22:12-16.
• [11]Eastridge BJ, Lefor AT: Complications of indwelling venous access devices in cancer patients. J Clin Oncol 1995, 13:233-238.
• [12]Poorter RL, Lauw FN, Bemelman WA, Bakker PJM, Taat CW, Veenhof CHN: Complications of an inplantable venous access device (port-a-cath) during intermittent continuous infusion of chemotherapy. Eur J Cancer 1996, 32A:2262-2266.
• [13]Nightingale CE, Norman A, Cunningham D, Young J, Webb A, Filshie J: A prospective analysis of 949 long-tern central venous access catheters for ambulatory chemotherapy in patients with gastrointestinal malignancy. Eur J Cancer 1997, 33:398-403.
• [14]Damascelli B, Patelli G, Frigerio LF, Lanocita R, Garbagnati F, Marchiano A, Spreafico C, Di Tolla G, Monfardini L, Porcelli G: Placement of long-term central venous catheters in outpatients: study of 134 patients over 24,596 catheter days. Am J Roentgenol 1997, 168:1235-1239.
• [15]Di Carlo I, Cordio S, La Greca G, Privitera G, Russello D, Puleo S, Latteri F: Totally implantable venous access devices implanted surgically. A retrospective study on early and late complications. Arch Surg 2001, 136:1050-1053.
• [16]Shukla NK, Das DK, Deo SVS, Raina V: An analysis of long-term venous access catheters in cancer patients: Experience from a tertiary care center in India. J Postgrad Med 2002, 48:21-24.
• [17]D'Angelo FA, Ramacciato G, Aurello P, De Angelis R, Amodio P, Magri M, Barillari P: Prospective randomised study of cephalic vein cut-down versus subclavian vein puncture technique in the implantation of subcutaneous venous access devices. Chir Ital 2002, 54:495-500.
• [18]Kamat A, Kramer P, Soisson AP: Cephalic vein cutdown for inserting indwelling subclavian vein catheters in gynecologic oncology patients. W V Med J 2002, 98:15-17.