[Insertion of permanent perfusion systems for chemotherapy. A ray of hope for the patients]

The number of patients undergoing chemotherapy for tumor disease has considerably increased in the last years. One of the problems of these long-term treatment modalities is the destruction of the peripheral venous system due to the repeated venous punctures for the therapy itself as well as for the laboratory analyses. This has been the motive for the research on permanent perfusion systems which would work at long term in a reliable way. Nowadays, several industrial products are available, devices for the standard implantation intravenously but also devices for intraarterial and intraperitoneal use. In our hands, the access through the subclavian vein with the end of the catheter in the superior caval vein has proven to be a safe and easy method. The port is placed in the triangle between the coracoid process and the clavicula. The large experience made by the centers in Basle and Berne as well as our own experiences in Bienne have clearly demonstrated the benefit of these systems for the patient. Nevertheless, some complications have to be mentioned such as the wellknown complications of the puncture of the subclavian vein. The risk of complete occlusion of the catheter must be expected at the rate of 0.5%. Hematomas immediately after the punction of the port have also been described. We would like to outline that complications of these permanent infusion systems are rare, especially in comparison with the complication rate of the normal percutaneous central venous sets. We therefore strongly advocate the implantation of these devices in the first instance before the beginning of any treatment in order to save the peripheral venous system of these patients.