Deltoid Branch of Thoracoacromial Vein

An entry vessel is crucial for intravenous port implantation. A safe alternative entry vessel that can be easily explored is crucial for patients without feasible cephalic vein or for those who need port reimplantation because of disease relapse. In this study, we tried to analyze the safety and feasibility of catheter implantation via the deltoid branch of the thoracoacromial vein. From March 2012 to November 2013, 802 consecutive oncology patients who had received intravenous port implantation via the superior vena cava were enrolled in this study. The functional results and complications of different entry vessels were compared. The majority of patients (93.6%) could be identified as thoracoacromial vessel. The deltoid branch of the thoracoacromial vein is located on the medial aspect of the deltopectoral groove beneath the pectoralis major muscle (85.8%) and in the deep part of the deltopectoral groove (14.2%). Due to the various calibers employed and tortuous routes followed, we utilized 3 different methods for catheter implantation, including vessel cutdown (47.4%), wire assisted (17.9%), and modified puncture method (34.6%). The functional results and complication rate were similar to other entry vessels. The deltoid branch of the thoracoacromial vein is located in the neighborhood of the cephalic vein. The functional results of intravenous port implantation via the deltoid branch of the thoracoacromial vein are similar to other entry vessels. It is a safe alternative entry vessel for intravenous port implantation. (Medicine 94(17):e728) -Jen Ko, Sheng-Yu hi Kao, nd Ching-Yang Wu caliber. Three different entry vessels candidates, including cephalic vein, subclavian vein, and internal jugular vein, can be utilized for superior vena cava catheter implantation. The cephalic vein is the most common and easiest choice because of its relatively consistent location and large caliber. However, in about 18% of patients the cephalic vein cannot be identified and another entry vessel is needed for catheter implantation. Other common alternative entry vessels for catheter implantation are the subclavian and internal jugular veins. In the case of the subclavian vein, the risk of hemopneumothorax and pinch-off symptoms cannot be totally eliminated even for an experienced surgeon. In the case of the internal jugular vein, the risk of vessel injury still remains, even under echoguidance assist and vessel repair is warranted. Furthermore, an additional subcutaneous tunnel between the entry site and the injection chamber is necessary in order to embed the catheter. Postoperation pain can last from days to weeks, decreasing the patient’s quality of life. Therefore, the above mentioned alternative entry vessels are not ideal for catheter implantation. However, a safe alternative entry vessel that can be easily explored is crucial for patients without feasible cephalic vein or for those who need port reimplantation because of disease relapse. The deltoid branch of the thoracoacromial artery and vein are located in the neighborhood of the deltopectoral groove and have been reported as recipient vessels of reconstructed muscle or free jejunum flap. From an anatomic view, a cadaveric study done by Loukas et al revealed that 65.2% of the cephalic vein travels with the deltoid branches of the thoracoacromial trunk. These characteristics suggest the deltoid branch of the thoracoacromial vein as an entry vessel candidate for catheter implantation. In this study, we try to identify the availability and feasibility of catheter implantation in the deltoid branch of the thoracoacromial vein. MATERIALS AND METHODS