by Dr. James Lowe
I am the father of a Li-Fraumeni syndrome son who died from recurrent medulloblastoma 3.5 years ago. I also am an interventional radiologist and have placed many ports.
Pros of Ports:
1. Easy access for meds and blood draws. The chemotherapy you get is delivered into (or at least should be, if you place them appropriately) the big vein right next to your heart which allows for a large volume and mixing of the meds with the blood so as to cause less damage to the inner lining of the blood vessels and the veins are larger, so less likely to have the vein scar down like it might in a smaller peripheral vein (or even the left brachiocephalic vein).
2. It is under the skin and generally protected from outside trauma.
3. It has a lower infection risk than Groshong and Hickman catheters.
4. It causes less pain with injection than a peripheral IV.
The Disadvantages of a Port:
1. It takes a minor surgery to put it in.
2. It has to be accessed every time to use it.
3. The port is only good for 800-900 accesses before it begins to leak (varies by port, but that is generally 12-20 years).
4. If they use the wrong needle, it will leak. If it leaks, the chemo will kill the skin over it. If the skin over it dies or it becomes infected, it has to come out. I have tried many times to save a port after it leaked, but they all had to come out eventually. Chest ports can be officiated by bra straps or should straps with seat belts, but arm ports are very long and will eventually cause the vein to scar down around the catheter which the body will recognize as a foreign body. My recommendation is for the chest port. They are superior in my opinion and also do not have a risk of pinch-off syndrome where the catheter breaks.
5. Pinch-off syndrome. Many surgeons want to put it in through the subclavian vein which passes between the clavicle and the first rib. When the clavicle and the first rib rub against each other, it can cause the catheter to leak or to break. Hence I recommend an internal jugular vein chest port.
6. Pneumothorax or collapsed lung. Placing the catheter via the subclavian vein has a risk of a collapsed lung. It can be easily treated, but there is no risk of collapsed lung via an internal jugular approach with US. Why take the extra risk without benefit; go internal jugular. Surgeon may tell you it does not make a difference because they make money doing it the other way…. Just like shooting a gun up in the air has a low risk of hitting of coming back down and hitting you. Why take unnecessary risks.
7. Many ports will for fibrin sheaths, or protein sheaths around the catheter because it is a foreign body…. One made by Angiodynamics seems to have prevented that, but your physician may not be able to choose the port he/she places…. The hospital may go with the lowest bidder despite the doctor’s objection.
8. It has to be accessed under sterile conditions. If infected, it usually has to come out.
9. It takes a surgery to remove it.
10. It should be flushed every month. The catheter by Angiodynamics does not require heparin and has lower risk of clots, but not zero. (I do not own stock in Angiodynamics, and they do not now or ever pay me anything, they just have a great product per the experiences of my patients).
Now as far as port removal, I personally recommend you keep it for two years after you complete chemo to prove that you are really in Remission. My son’s cancer had a 75% chance the first treatment would work. When it came back after 6 months, he was able to restart chemo 3 days later because he still had his chest port in place. It is your choice. Do what is right for you. I wish you the very best.
Dr. James Lowe is an interventional radiologist and an LFS parent. Living LFS is grateful for his insight from both perspectives.
