Femoral ports are used in patients with indication to a totally implanted venous access device but with contraindication to chest-ports and brachial ports because of obstruction of the superior vena cava. In the last three decades, femoral ports have been implanted almost exclusively by cannulation of the common femoral vein at the groin, while the position of the tip has been assessed by X-ray.
Methods:
We report our experience with a new approach to femoral ports, which includes recent methods and techniques developed in the last few years. These novel femoral ports, which we call “FICC-ports,” are characterized by (a) long femoral 5 Fr polyurethane catheter inserted by ultrasound-guided puncture of the superficial femoral vein at mid-thigh; (b) intraprocedural location of the tip in the sub-diaphragmatic inferior vena cava, using ultrasound visualization by the transhepatic and/or the subcostal view; (c) low-profile or very low-profile reservoir implanted above the quadriceps muscle, at mid-thigh.
Results:
In the last 3 years, we have implanted 47 FICC-ports in young adults with mediastinal lymphoma compressing the superior vena cava. We had no immediate/early complication, and only three late complications (one kinking of the catheter in the subcutaneous tissue; one tip migration with secondary venous thrombosis; one persistent withdrawal occlusion due to fibroblastic sleeve).
Conclusion:
If there is indication to a femoral port, the implantation of a “FICC-port”—as described above—is to be strongly considered in terms of safety, effectiveness, and cost-effectiveness: no immediate-early complications, minimal late complications, no X-ray exposure, low invasiveness, low cost.
BertoglioSAnnettaMGBresciaF, et al. A multicenter retrospective study on 4480 implanted PICC-ports: a GAVeCeLT project. J Vasc Access2023; 24: 1114–1120.
4.
BresciaFAnnettaMGPinelliF, et al. A GAVeCeLT bundle for PICC-port insertion: the SIP-Port protocol. J Vasc Access. Epub ahead of print 13 November 2023. DOI: 10.1177/11297298231209521.
5.
BertoglioSDiSommaCMeszarosP, et al. Long-term femoral vein central venous access in cancer patients. Eur J Surg Oncol1996; 22(2): 162–165.
6.
WoloskerNYazbekGMuniaMA, et al. Totally implantable femoral vein catheters in cancer patients. Eur J Surg Oncol2004; 30(7): 771–775.
7.
HuangWHChuangCHYuJC, et al. Totally implantable access port: approach via femoral vein. Chirurgische Gastroenterpologie2007; 23(3): 300–302.
8.
ChenSYLinCHChangHM, 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 Oncol2008; 98(3): 197–199.
9.
ToroAManninoMCappelloG, 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 Surg2012; 26(8): 1127.e9–1127.e13.
10.
GoltzJPJanssenHPetritschB, et al. Femoral placement of totally implantable venous power ports as an alternative implantation site for patients with central vein occlusions. Support Care Cancer2014; 22(2): 383–387.
11.
KatoKIwasakiYOnoderaK, et al. Totally implantable venous access port via the femoral vein in a femoral port position with CT-venography. J Surg Oncol2016; 114(8): 1024–1028.
12.
Almasi-SperlingVHieberSLermannJ, et al. Femoral placement of totally implantable venous access ports in patients with bilateral breast cancer. Geburtshilfe Frauenheilkd2016; 76(1): 53–58.
13.
CherkashinMBerezinaNPuchkovD, et al. Femoral access for central venous port system implantation. Cureus2018; 10(3): e2327.
14.
KondoTMatsumotoSDoiK, et al. Femoral placement of a totally implantable venous access port with spontaneous catheter fracture: case report. CVIR Endovasc2020; 3(1): 2.
15.
AnnettaMGElliSMarcheB, et al. Femoral venous access: state of the art and future perspectives. J Vasc Access. Epub ahead of print 13 November 2023. DOI: 10.1177/11297298231209253.
16.
ZhangJTangSHuC, et al. Femorally inserted central venous catheter in patients with superior vena cava obstruction: choice of the optimal exit site. J Vasc Access2017; 18(1): 82–88.
17.
WanYChuYQiuY, et al. The feasibility and safety of PICCs accessed via the superficial femoral vein in patients with superior vena cava syndrome. J Vasc Access2018; 19(1): 34–39.
18.
ZhaoLCaoXWangY.Cannulation of the superficial femoral vein at mid-thigh when catheterization of the superior vena cava system is contraindicated. J Vasc Access2020; 21(4): 524–528.
19.
AnnettaMGMarcheBDolcettiL, et al. Ultrasound-guided cannulation of the superficial femoral vein for central venous access. J Vasc Access2022; 23(4): 598–605.
20.
La GrecaAIacoboneEEliseiD, et al. ECHOTIP: a structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients. J Vasc Access2023; 24(4): 535–544.
21.
AnnettaMGMarcheBGiarrettaI, et al. Applicability and feasibility of intraprocedural tip location of femorally inserted central catheters by transhepatic ultrasound visualization of the inferior vena cava in adult patients. J Vasc Access. Epub ahead of print 10 February 2023. DOI: 10.1177/11297298231153979.
22.
LampertiMBiasucciDGDismaN, et al. European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access). Eur J Anaesthesiol2020; 37(5): 344–376. Erratum in: Eur J Anaesthesiol 2020; 37(7): 623.
23.
AnnettaMGBertoglioSBiffiR, et al. Management of antithrombotic treatment and bleeding disorders in patients requiring venous access devices: a systematic review and a GAVeCeLT consensus statement. J Vasc Access2022; 23(4): 660–671.
24.
BresciaFPittirutiMOstroffM, et al. Rapid Femoral Vein Assessment (RaFeVA): a systematic protocol for ultrasound evaluation of the veins of the lower limb, so to optimize the insertion of femorally inserted central catheters. J Vasc Access2021; 22(6): 863–872.
25.
AnnettaMGMarcheBMercurioG, et al. Ultrasound based tip location of femorally inserted central catheters into the inferior vena cava: a comparison between the transhepatic and the subcostal view. J Vasc Access. Epub ahead of print 30 May 2023. DOI: 10.1177/11297298231178063.
26.
D’ArrigoSAnnettaMGPittirutiM.An ultrasound-based technique in the management of totally implantable venous access devices with persistent withdrawal occlusion. J Vasc Access2023; 24(1): 140–144.
27.
PinelliFBalsoranoPMuraB, et al. Reconsidering the GAVeCeLT Consensus on catheter-related thrombosis, 13 years later. J Vasc Access2021; 22(4): 501–508.
28.
PassaroGPittirutiMLa GrecaA.The fibroblastic sleeve, the neglected complication of venous access devices: a narrative review. J Vasc Access2021; 22(5): 801–813.
29.
AnnettaMGOstroffMMarcheB, et al. Chest-to-arm tunneling: a novel technique for medium/long term venous access devices. J Vasc Access2023; 24(1): 92–98.
30.
BartoliADonadoniMQuiciM, et al. Safety of mid-thigh exit site venous catheters in multidrug resistant colonized patients. J Vasc Access. Epub ahead of print 18 July 2023. DOI: 10.1177/11297298231188150.
31.
FinnertyNMPanchalARBoulgerC, et al. Inferior vena cava measurement with ultrasound: what is the best view and best mode?West J Emerg Med2017; 18(3): 496–501.
32.
StrachinaruMBowenDJConstatinescuA, et al. Transhepatic echocardiography: a novel approach for imaging in left ventricle assist device patients with difficult acoustic windows. Eur Heart J Cardiovasc Imaging2020; 21(5): 491–497.
33.
WeberMDHimebauchASConlonT.Use of intracavitary-ECG for tip location of femorally inserted central catheters. J Vasc Access2022; 23(1): 166–170.
34.
MaMZhangJHouJ, et al. The application of intracavitary electrocardiogram for tip location of femoral vein catheters in chemotherapy patients with superior vena cava obstruction. J Vasc Access2021; 22(4): 613–622.
35.
GibaultPDesruennesEBourgainJL.Peroperative electrocardiographic control of catheter tip position during implantation of femoral venous ports. J Vasc Access2015; 16(4): 294–298.
