Totally Implantable Venous Access Devices

Retrospective Analysis of Different Insertion Techniques and Predictors of Complications in 796 Devices Implanted in a Single Institution

Elisa Granziera; Marco Scarpa; Angelo Ciccarese; Bogdan Filip; Matteo Cagol; Valentina Manfredi; Rita Alfieri; Connie Celentano; Sandra Cappellato; Carlo Castoro; Muzio Meroni

Disclosures

BMC Surg. 2014;14(27) 

In This Article

Background

The use of totally implantable venous access devices (TIVADs) has changed the care and quality of life for cancer patients treated with chemotherapy. TIVADs represent a convenient option when long-term venous access is indicated, particularly for administration of cytotoxic medications or intravenous targeted agents in cancer patients over a long period of time.[1] The current debate regarding TIVAD utilisation in clinical practice includes the access site (internal, external jugular and subclavian vein) and the insertion technique (open, percutaneous or with ultrasound guidance). Cephalic vein approach has the advantage of safety and low incidence of early complications[2] but it is affected by a high rate of failure. Subclavian vein catheters are located in an easy accessible area but they are affected by a relatively high risk of thrombosis, vein stenosis, catheter fatigue and they have the highest risk of pneumothorax at insertion.[3] The internal jugular approach is the preferred approach for tunnelled infusion catheter approach with the lowest incidence of venous thrombosis.[4] Usually percutaneus techniques through the Seldinger technique are preferred[5–7] but in some cases surgeons prefer the open approach in the cephalic or subclavian vein. Early complications include: pneumothorax, hemothorax, air embolism, accidental arterial puncture, cardiac arrhythmia, pericardial tamponade and brachial plexus injury.[8,9] Late complications include: bloodstream infection, thrombosis, catheter dysfunction, rupture, migration or embolisation, "pinch-off" syndrome, superior vein cava erosion and perforation, extravasation, pocket infection and port inversion.[10–12] The refinement of the technique and the implanted devices led to a decreased rate of potential life threatening complications.

The aim of this study was to evaluate the short and long term outcomes after TIVAD implantation in a, consecutive series of patients by comparing the different insertion techniques.

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