Initial experience with Healthport miniMax and other peripheral arm ports in patients with advanced gastrointestinal malignancy.

While central ports are located at the chest, peripheral ports (PP) are inserted at the patients' forearms. Two new PPs (Healthport miniMax((R)) and Bard Titan Low Profile Port) and two well-established types (Port-A-Cath((R)) P.A.S. Port and PeriPort(TM) peripheral access system) were tested. 125 patients were given the choice between PP and chest ports, and 100 of them chose PP. PP were inserted in patients suffering from gastrointestinal malignancies (n = 95), AIDS (n = 3) or Crohn's disease (n = 2). The first 30 patients were prospectively monitored by repeated color-coded duplex sonography examinations in order to evaluate clinically inapparent thromboses. Easy percutaneous needle puncture as early as 1 day after surgery was possible using innovative ports with large septa. The following complications arose during 12,688 catheter placement days: difficult implantation (n = 5), intolerable pain at the insertion site (n = 1), port erosion of the skin (n = 1), catheter leaks (n = 4), disconnection of the catheter from the port (n = 1), systemic infections (n = 4), local infections (n = 6) and symptomatic deep vein thrombosis (n = 8) despite anticoagulation in 1 of these. Only systemic infections and intolerable pain resulted in PP explantation (n = 5); other complications were easily dealt with. No serious or life-threatening complications occurred.

[Deep venous thrombosis caused by central venous catheter]. / Tiefe Venenthrombosen durch zentralvenöse Katheter.

Infections and venous thromboses are the major complications of central venous access catheters and ports. The frequency of thrombosis depends on the venous access systems used, their material, their diameters and the position of their tips. The lowest rate of thrombotic complications is seen with single or double lumen Hickman- or port catheters made of silicone with their tips in the lower half of the superior vena cava or in the right atrium. Antibiotics given preoperatively and heparin for at least 90 days after catheter placement must be recommended in oncological patients with a high risk of thrombosis. In case of thrombosis-related occlusion of the catheters low-dose urokinase and streptokinase can be helpful to restore the catheter's function. Else, therapy is identical to that of other types of thrombosis.

Management of 219 consecutive cases of postcatheterization pseudoaneurysm.

OBJECTIVES: We attempted to evaluate nonsurgical methods of treating postcatheterization pseudoaneurysm. BACKGROUND: The value of reapplication of a compression bandage, ultrasound-guided compression repair (UGCR) and awaiting spontaneous thrombosis in the treatment of postcatheterization pseudoaneurysms is unsettled. METHODS: We followed a stepwise treatment strategy of primarily conservative management using 1) reapplication of a compression bandage, followed by 2) UGCR, if needed, and 3) observation of the natural course. Surgical repair was reserved for patients with a rapidly expanding or complicated lesion. RESULTS: Reapplication of a compression bandage was performed in 128 patients and was successful in 32%. The success rate correlated inversely with anticoagulant therapy and the size of the aneurysm. In case of failure this pretreatment with a compression bandage significantly enhanced the success rate of subsequent UGCR (p = 0.04). UGCR was performed in 124 cases with a success rate of 84%. In 54 patients with a stable lesion, refraining from any (further) active measures resulted in spontaneous thrombosis of the aneurysm in 50 patients (93%) after 1 to 180 days (median 40 days). The course of the remaining four femoral artery aneurysms was uneventful. Definitive repair by operation or collagen plug implantation was required in only 20 patients (9%). CONCLUSIONS: The first measure performed in the treatment of pseudoaneurysms should be reapplication of a compression bandage, followed, if necessary, by UGCR. After failure of UGCR, spontaneous healing occurs in the majority of patients. Operation can be reserved for progressive and complicated lesions.