Complications Associated With Totally Implanted Venous Access Devices in the Arm Versus the Chest: A Short-Term Retrospective Study.

PURPOSE: To retrospectively compare complications for totally implanted venous access devices (TIVADs or ports) in the arm vs. the chest. One participating institution implanted all TIVADs in the arm, whereas the other institution implanted them in the chest. METHODS: Subjects were consecutive patients > 18 years with a device inserted between July 2017 and January 2019 at either Hospital A, where all devices were implanted in the arm, or at Hospital B, where all devices were implanted in the chest. Complications (rates/1,000 catheter-days and frequencies) were compared between the arm and chest locations. RESULTS: 201 arm devices (71% female, mean age 59.4 years) and 203 chest devices (66% female, mean age 61.5 years) were assessed. Overall complication rates did not differ between the arm and chest [arm: 30 complications per 56,938 catheter-days (0.530/1,000 catheter-days) vs. chest: 47 complications per 63,324 catheter-days (0.742/1,000 catheter-days), p-value 0.173]. Periprocedural complications and mechanical malfunction also did not differ. Although prophylactic antibiotic use was higher in the chest (79.3% vs. 1.50%, p-value < 0.0001), infection rates did not differ. Arm venous thrombosis was significantly higher in the arm cohort (0.205 vs. 0.017/1,000 catheter-days, p-value 0.003) and pulmonary thromboembolism in the chest cohort (0.269 vs 0.056/1,000 catheter-days, p-value 0.002). CONCLUSIONS: While arm venous thrombosis was higher in the arm and pulmonary thromboembolism in the chest cohort, other complications were similar. Antibiotic use was more frequent in the chest cohort, while infection rates remained similar in both cohorts.

Proximal femoral epiphyseal spurs and their association with acetabular labral tears on MRI in symptomatic patients.

OBJECTIVE: Femoral epiphyseal spurs are developmental projections that form at the edge of the physis. Although considered incidental, their association with acetabular labral tears has never been examined. Our aim was to assess the prevalence of femoral epiphyseal spurs in symptomatic patients with mechanical hip pain and explore if they are associated with labral tears on MRI. MATERIALS AND METHODS: Hip MRI scans performed on a Siemens 3 T MRI using femoroacetabular impingement protocol were retrospectively reviewed. All patients were referred by orthopaedic surgeons for mechanical hip pain. Two musculoskeletal radiologists blinded to initial reports evaluated MRI images for the presence of an epiphyseal spur and acetabular labral changes. A consensus was achieved on all cases by the two readers. The association between epiphyseal spurs and labral changes was assessed using Fisher's exact test. RESULTS: A total of 115 patients (178 hip MRI scans) were reviewed; the mean age was 28.8 years (SD 7.1). There were 52 females (45.2%) and 63 males (54.8%). There were 115 hips with labral tears (64.6%). Fourteen hips (7.8%) in ten patients (8.7%) demonstrated epiphyseal spurs and all of them showed labral tears (100%). There was statistically significant association between epiphyseal spurs and labral tears on MRI (p value = 0.0024). CONCLUSION: Femoral epiphyseal spurs were observed in 8.7% of our defined patient population, and all patients with epiphyseal spurs demonstrated labral tears. Epiphyseal spurs should be documented on imaging reports due to their potential association with labral tears. Future research is needed to further delineate and guide management of these entities.