Advantages and disadvantages of femoral port systems in hematоlogical patients with superior vena cava syndrome

Background. In the superior vena cava syndrome, vein catheterisation provides an alternative for vascular access. Few reports describe the usage of femoral ports.

Aim. Description of pros and contras for femoral port installation in patients with haematological malignancies and the superior vena cava syndrome.

Materials and methods. This prospective non-randomised, single-centre study included 163 haematological patients implanted 72 ports in superior vena cava, 35 — in inferior vena cava and inserted with 156 non-tunnelled femoral catheters. Catheterisation properties, complications, duration of use and reasons for port and catheter removal were registered.

Results. No significant differences were observed between ports in superior and inferior vena cava as per the frequency of urokinase use in catheter dysfunction, catheter dislocation, catheter-associated bloodstream and pocket infections. Differences were revealed in the catheter-associated thrombosis rate, which was higher with femoral access (17.0 % or 0.9/1000 catheter days vs. 8.3 % or 0.2/1000 catheter days, p = 0.017). Ports in inferior vena cava had a lesser duration of use than in superior vena cava (p = 0.0001). Unlike femoral ports, non-tunnelled femoral catheters had higher rates of catheter-associated thrombosis (9/1000 vs. 0.9/1000 catheter days, p = 0.002) and infection (4.9/1000 vs. 0.3/1000 catheter days, p = 0.002). One lymphoma therapy course required one femoral port or 1 to 14 (median 3) non-tunnelled femoral catheters.

Conclusion. Femoral port implantation is a necessary measure in patients with the superior vena cava syndrome. It has advantages in terms of catheterisation frequency, lower infectious and thrombotic complication rates compared to non-tunnelled femoral catheters.

1. Gow K.W., Tapper D., Hickman R.O. Between the lines: The 50th anniversary of long-term central venous catheters. Am J Surg. 2017; 213(5): 837–48. DOI: 10.1016/j.amjsurg.2017.03.021.

2. Niederhuber J.E., Ensminger W., Gyves J.W. et al. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery. 1982; 92(4): 706–12.

3. Kim D., Ryu D., Jung H. et al. Evaluation of complications of totally implantable central venous port system insertion. Exp Ther Med. 2019; 17(3): 2013–8. DOI: 10.3892/etm.2019.7185.

4. Wu O., Boyd K., Paul J. et al. Hickman catheter and implantable port devices for the delivery of chemotherapy: A phase II randomised controlled trial and economic evaluation. Br J Cancer. 2016; 114(9): 979–85. DOI: 10.1038/bjc.2016.76.

5. Fang S., Yang J., Song L. et al. Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy. Patient Prefer Adherence. 2017; 11: 1197–204. DOI: 10.2147/PPA.S142556.

6. Ng F., Mastoroudes H., Paul E. et al. A comparison of Hickman line- and Port-aCath-associated complications in patients with solid tumours undergoing chemotherapy. Clin Oncol. 2007; 19(7): 551–6. DOI: 10.1016/j.clon.2007.04.003.

7. Galstyan G.M., Spirin M.V., Terekhova I.V. et al. Features of providing central venous access in patients with lymphomas. Anestesiologiya i reanimatologiya. 2018; 63(2): 119–26 (In Russian).

8. Wolosker N., Yazbek G., Munia M.A. et al. Totally implantable femoral vein catheters in cancer patients. Eur J Surg Oncol. 2004; 30(7): 771–5. DOI: 10.1016/j.ejso.2004.05.019.

9. Harish K., Madhu Y.C. Femoral Port Placement — Report of Two Cases. Indian J Surg Oncol. 2011; 2(1): 31–3. DOI: 10.1007/s13193-011-0071-9.

10. Almasi-Sperling V., Hieber S., Lermann J. et al. Femoral placement of totally implantable venous access ports in patients with bilateral breast cancer. Geburtshilfe Frauenheilkd. 2016; 76(1): 53–8. DOI: 10.1055/s-0035-1558173.

11. Chen S.-Y., Lin C.H., Chang H.-M. et al. A safe and effective method to implant a totally implantable access port in patients with synchronous bilateral mastectomies: Modified femoral vein approach. J Surg Oncol. 2008; 98(3): 197–9. DOI: 10.1002/jso.21048.

12. Goltz J.P., Janssen H., Petritsch B. et al. Femoral placement of totally implantable venous power ports as an alternative implantation site for patients with central vein occlusions. Support Care Cancer. 2014; 22(2): 383–7. DOI: 10.1007/s00520-013-1984-3.

13. Heiss P., Stroszczynski C., Gössmann H. Okklusion der V. cava superior. Radiologische implantation eines zentralvenösen portsystems über einen femoralen zugang. Radiologe. 2012; 52(5): 455–8. DOI: 10.1007/s00117-012-2317-0.

14. Dholaria S., Yadav D., Gupta A. Chemo port insertion through femoral vein approach: A rare indication and a rare complication. Indian J Cancer. 2017; 54(1): 361. DOI: 10.4103/ijc.ijc_193_17.

15. Meyer F., Buerger T., Gebauer T. et al. Unusual implantation site of a port-acath system via the right femoral vein. J Cancer Res Clin Oncol. 2002; 128(7): 400–1. DOI: 10.1007/s00432-002-0353-2.

16. Dubovik P.L., Khlebnikov B.A., Shaydorov M.V. Implantable infusion port systems in oncology. Tol’yattinskiy meditsinskiy konsilium. 2011; (5–6): 55–60 (In Russian).

17. Dobysh K.N., Glushanina A.S. Totally implantable central venous access ports for M/XDR-TB treatment. Belarusian State Medical University, Minsk, 2017; 1258 (In Russian).

18. Cherkashin M., Berezina N., Puchkov D. et al. Femoral access for central venous port system implantation. Cureus. 2018; 10(3): 3–6. DOI: 10.7759/cureus.2327.

19. Toro A., Mannino M., Cappello G. et al. Totally implanted venous access devices implanted in the saphenous vein. Relation between the reservoir site and comfort / discomfort of the patients. Ann Vasc Surg. 2012; 26(8): 1127.e9–13. DOI: 10.1016/j.avsg.2012.02.025.

20. Sharp R., Cummings M., Fielder A. et al. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): A prospective cohort study. Int J Nurs Stud. 2015; 52(3): 677–85. DOI: 10.1016/j.ijnurstu.2014.12.002.

21. Seldinger S.I.S.I. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol. 1953; 39(5): 368–76. DOI: 10.3109/00016925309136722.

22. Nosocomial infection rates for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol. 1991; 12(10): 609–21. DOI: 10.1086/646250.

23. Parienti J.J., Mongardon N., Mégarbane B. et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015; 373(13): 1220–9. DOI: 10.1056/NEJMoa1500964.

24. Brass P., Hellmich M., Kolodziej L. et al. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev. 2015; 1(1). DOI: 10.1002/14651858.CD011447. www.cochranelibrary.com.

25. Deshpande K.S., Hatem C., Ulrich H.L. et al. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med. 2005; 33(1): 13–20. DOI: 10.1097/01.CCM.0000149838.47048.60.