Trapezius ports: safe and tolerable for breast cancer patients

Trapezius ports are implantable vascular access devices used for intermittent long-term intravenous access when anterior chest wall placed ports cannot be used. Clinically, they are a viable, safe and acceptable option for breast cancer patients, according to radiologists from Turkey. The radiologists report that their patients were quite satisfied with them, based on survey findings reported online December 6th in the Journal of Vascular and Interventional Radiology. 

A trapezius port was first utilized in a breast cancer patient in 2005 by Chris M. Cooper, MD, at the University of Tennessee Medical Center in Knoxville.¹ Today, it is primarily used with patients who have bilateral mastectomy or who have metastasis in or near the location on a chest wall where a venous port would be implanted.

Principal investigator and interventional radiologist Barbaros Erhan Çil, MD, and colleagues in the Department of Radiology at Hacettepe University in Ankara conducted a study to evaluate complications, long-term follow-up, and patient satisfaction. They identified 70 women who had trapezius ports implanted over a 10-year time span, representing approximately 2% of the total number of venous ports implanted at the hospital. Sixty-seven of the 70 patients had had bilateral breast surgery. The three other patients had a unilateral mastectomy, but metastasis, infection, and a new breast cancer diagnosis of the contralateral breasts made anterior chest wall ports infeasible.

Describing the procedure they performed, the authors wrote that they accessed the jugular vein just above the clavicle and made a skin incision on the apex of the trapezius muscle oriented parallel with the long axis of the upper trapezius muscle for the skin incision. They used a trochar to tunnel the catheter from the pocket incision to the internal jugular vein access, giving particular attention to protect the external jugular vein. They positioned the port catheter tip at the junction of the superior vena cava with the right atrium or at the right atrium. Upon completion of suturing, a fluoroscopic image was taken to verify the position of the port.

The authors were able to follow 68 of the patients, for a total of 65,952 catheter days. None of the patients developed complications during the port implantation procedure, but two patients had their ports removed prior to completion of chemotherapy treatment due to infection and complications.

At the end of the study in 2017, nineteen of these patients had died from breast cancer. Only six patients had their ports removed; 41 patients opted to live with their ports. A total of four patients had experienced complications, which included port malfunction, infection, and skin dehiscence.

When responding to a short survey asking about the comfort, convenience, and satisfaction with the trapezius port, 60 out of 61 responses were positive.

REFERENCES

1. Cooper CM, Pacanowski, JP, Bell JL. The trapezius port: a novel approach for port access. Am Surg. 2005;71(2):106-9.
2. 2. Çil BE, Öcal O, Eldem FG, et al. Trapezius port placement in patients with breast cancer: Long-term follow-up and quality-of-life assessment. J Vasc Interv Radiol. Published online December 6, 2018 doi: 10.1016/j.jvir.2018.08.011.