Morbidity of implantation of a port-a-cath: Monocentric study conducted at the Salah Azaiez institute Tunis

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Published Nov 9, 2025
https://doi.org/10.62438/tunismed.v103i9.5227
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Vol. 103 No. 9 (2025): Tunis Med sept 2025

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Heykel Gueffrache
Faculty of medecine of Tunis, University of Tunis El-Manar, 1006 Tunis, Tunisia
Montassar Ghalleb
Surgical Oncology Department, Salah Azaiez Instiute, Faculty of medecine of Tunis, University of Tunis El-Manar, 1006, Tunis, Tunisia
Mohamed Amine Bouida
Surgical Oncology Department, Salah Azaiez Instiute, Faculty of medecine of Tunis, University of Tunis El-Manar, 1006, Tunis, Tunisia
Ayoub Ghazouani
Surgical Oncology Department, Salah Azaiez Instiute, Faculty of medecine of Tunis, University of Tunis El-Manar, 1006, Tunis, Tunisia
Mohamed Mtaalah
Surgical Oncology Department, Salah Azaiez Instiute, Faculty of medecine of Tunis, University of Tunis El-Manar, 1006, Tunis, Tunisia
Yosr Zenzri
Medical Oncology Department, Salah Azaiez Instiute, Faculty of medecine of Tunis, University of Tunis El-Manar, 1006, Tunis, Tunisia
Mohamed Ali Ayadi
Surgical Oncology Department, Salah Azaiez Instiute, Faculty of medecine of Tunis, University of Tunis El-Manar, 1006, Tunis, Tunisia
Tarek Ben Dhiab
Surgical Oncology Department, Salah Azaiez Instiute, Faculty of medecine of Tunis, University of Tunis El-Manar, 1006, Tunis, Tunisia

Abstract

Introduction: Port-A-cath (PAC), sinceits introduction in 1982, has seenrapid expansion in its use. However, its placement and use are not withoutrisk, as evidenced by the associated complication rate, which ranges from 10 to 38% in variousseries. Moreover, few Tunisianstudies have investigated ports and their complications. The aim of ourstudywas to evaluate the complications associatedwiththisdevice, identifyriskfactors for complications, and gather patient satisfaction.


Methods: Weconducted an observational, descriptive, and analyticalstudy, involving 112 patients whounderwent PAC implantation at the Salah Azaiez Institut (SAI) betweenFebruary and April 2021. These patients werethenfollowed up at day 0, 3 months, 9 months, and 15 months post-implantation.


Results: All our port placement procedureswereperformedusing the percutaneousmethodguided by anatomicallandmarks. The internaljugularveinwasusedin 98.2% of ourprocedures. Over the 16-month follow-up, 17 complications wereidentified, resulting in an incidence rate of 15%. Most complications (59%) occurredintraoperatively, corresponding to the formation of an intraoperativehematoma, graded Clavien-Dindo I. The main risk factor for complication wasseveralvenouspuncturesgreaterthantwo. Introducingultrasound guidance during placement reduces the complication rate. Regarding patient satisfaction withtheir care at SAI, only 8% reportedbeing "unsatisfied". The reasonsgiven for this dissatisfaction weremainlyrelated to organizationalfactorsinherent to SAI.


Conclusion: PAC placement is a safeprocedurewith a low rate of complications. However, implementing specific measures could reduce its morbidity.


 

Keywords:

Cancer, Central venous catheter, Postoperative complications, Intraoperative complications, Vascular access devices

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References

  1. 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. juin 2010;17(6):1649‑56.
  2. 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. déc 2014;14(1):27.
  3. Agence nationale d’accréditation et d’évaluation en santé. Évaluation de la prescription et de la réalisation des examens paracliniques préopératoires. Paris, France: Agence nationale d’accréditation et d’évaluation en santé; 1998.
  4. Tabatabaie O, Kasumova GG, Eskander MF, Critchlow JF, Tawa NE, Tseng JF. Totally Implantable Venous Access Devices: A Review of Complications and Management Strategies. American Journal of Clinical Oncology [Internet]. 2017;40(1). Disponible sur: https://journals.lww.com/amjclinicaloncology/fulltext/2017/02000/totally_implantable_venous_access_devices__a.16.aspx
  5. Hsu CCT, Kwan GNC, Evans-Barns H, Rophael JA, van Driel ML. Venous cutdown versus the Seldinger technique for placement of totally implantable venous access ports. Cochrane Database Syst Rev. 21 août 2016;2016(8):CD008942.
  6. Granic M, Zdravkovic D, Krstajic S, Kostic S, Sarac M, Ivanovic N, et al. Totally implantable central venous catheters of the port-a- cath type: complications due to its use in the treatment of cancer patients.
  7. Dindo D, Demartines N, Clavien PA. Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Annals of Surgery. août 2004;240(2):205‑13.
  8. Biffi R, Pozzi S, Bonomo G, Della Vigna P, Monfardini L, Radice D, et al. Cost Effectiveness of Different Central Venous Approaches for Port Placement and Use in Adult Oncology Patients: Evidence From a Randomized Three-Arm Trial. Ann Surg Oncol. nov 2014;21(12):3725‑31.
  9. Gordon AC, Saliken JC, Johns D, Owen R, Gray RR. US-guided puncture of the internal jugular vein: complications and anatomic considerations. J Vasc Interv Radiol. avr 1998;9(2):333‑8.
  10. Zetlaoui PJ, Bouaziz H, Jochum D, Desruennes E, Fritsch N, Lapostolle F, et al. Recommandations sur l’utilisation de l’échographie lors de la mise en place des accès vasculaires. Anesthésie & Réanimation. avr 2015;1(2):183‑9.
  11. Hind D, Calvert N, McWilliams R, Davidson A, Paisley S, Beverley C, et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ. 16 août 2003;327(7411):361.
  12. Fragou M, Gravvanis A, Dimitriou V, Papalois A, Kouraklis G, Karabinis A, et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study. Crit Care Med. juill 2011;39(7):1607‑12.
  13. Milling TJJ, Rose J, Briggs WM, Birkhahn R, Gaeta TJ, Bove JJ, et al. Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: the Third Sonography Outcomes Assessment Program (SOAP-3) Trial. Crit Care Med. août 2005;33(8):1764‑9.
  14. Kartsouni V, Moschouris H, Bersimis F, Gkeneralis G, Gkeli M, Dodoura S, et al. Complications of Totally Implantable Central Venous Catheters (Ports) Inserted via the Internal Jugular Vein Under Ultrasound and Fluoroscopy Guidance in Adult Oncology Patients: A Single-Center Experience. Cureus. 30 août 2023;14(7):e27485.
  15. 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(3‑4):237‑44.
  16. Hüttner FJ, Bruckner T, Hackbusch M, Weitz J, Bork U, Kotschenreuther P, et al. Primary Open Versus Closed Implantation Strategy for Totally Implantable Venous Access Ports: The Multicentre Randomized Controlled PORTAS-3 Trial (DRKS 00004900). Ann Surg. déc 2020;272(6):950‑60.
  17. McGee DC, Gould MK. Preventing Complications of Central Venous Catheterization. N Engl J Med. 20 mars 2003;348(12):1123‑33.
  18. O’Grady NP. Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011). 2017;
  19. Zhou Y, Lan Y, Zhang Q, Song J, He J, Peng N, et al. Totally implantable venous access ports: A systematic review and meta-analysis comparing subclavian and internal jugular vein punctures. Phlebology. mai 2022;37(4):279‑88.
  20. de Oliveira EB, Reis MA, Avelar TM, Vieira SC. Totally implantable central venous catheters for chemotherapy: experience with 793 patients. Rev Col Bras Cir. juin 2013;40(3):186‑90.
  21. Yazigi A, Yazbeck P, Bou Saba R, Antakly MC. [Complications and outcome of implantable infusion pumps: apropos of 60 cases]. Ann Fr Anesth Reanim. 1994;13(3):297‑300.
  22. Morazin F, Kriegel I, Asselain B, Falcou MC. Thrombose symptomatique sur cathéter veineux central de longue durée en oncologie : un score de risque prédictif? La Revue de Médecine Interne. avr 2005;26(4):273‑9.
  23. Horne MK 3rd, May DJ, Alexander HR, Steinhaus EP, Whitman ED, Chang RC, et al. Venographic surveillance of tunneled venous access devices in adult oncology patients. Ann Surg Oncol. mars 1995;2(2):174‑8.
  24. De Cicco M, Matovic M, Balestreri L, Panarello G, Fantin D, Morassut S, et al. Central venous thrombosis: an early and frequent complication in cancer patients bearing long-term silastic catheter. A prospective study. Thromb Res. 15 avr 1997;86(2):101‑13.
  25. Parienti JJ, Mongardon N, Mégarbane B, Mira JP, Kalfon P, Gros A, et al. Intravascular Complications of Central Venous Catheterization by Insertion Site. N Engl J Med. 24 sept 2015;373(13):1220‑9.
  26. Chang L, Tsai JS, Huang SJ, Shih CC. Evaluation of infectious complications of the implantable venous access system in a general oncologic population. American Journal of Infection Control. févr 2003;31(1):34‑9.
  27. Gallieni M, Pittiruti M, Biffi R. Vascular access in oncology patients. CA Cancer J Clin. déc 2008;58(6):323‑46.
  28. Pinelli F, Cecero E, Degl’Innocenti D, Selmi V, Giua R, Villa G, et al. Infection of totally implantable venous access devices: A review of the literature. J Vasc Access. mai 2018;19(3):230‑42.
  29. 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. Annals of Oncology. janv 2008;19(1):9‑15.
  30. Sci-Hub | Évaluation des sites implantables en cancérologie médicale en Tunisie. Étude prospective à propos de 205 cas. Annales Françaises d’Anesthésie et de Réanimation, 20(6), 509–513 | 10.1016/s0750-7658(01)00413-0 [Internet]. [cité 8 févr 2024]. Disponible sur: https://sci-hub.se/https://doi.org/10.1016/s0750-7658(01)00413-0
  31. Nagel SN, Teichgräber UKM, Kausche S, Lehmann A. Satisfaction and quality of life: a survey-based assessment in patients with a totally implantable venous port system: Satisfaction and quality of life in patients with venous ports. European Journal of Cancer Care. mars 2012;21(2):197‑204.
  32. Burbridge B, Chan IYM, Bryce R, Lim HJ, Stoneham G, Haggag H, et al. Satisfaction and Quality of Life Related to Chemotherapy with an Arm Port: A Pilot Study. Can Assoc Radiol J. août 2016;67(3):290‑7.