Totally implantable venous access devices implanted surgically - A retrospective study on early and late complications

Background: The techniques used for the implantation of totally implantable venous access devices (TIVADs) are the percutaneous approach and surgical cutdown; however, the choice is still controversial. Hypothesis: The surgical cutdown approach may be beneficial to reduce the r ate of complications. Design: Retrospective review. Setting: A university hospital and a tertiary referral center. Patients: Patients undergoing a TIVAD implant at the First Surgical Clinic of the University of Catania in Catania, Italy, between January 1995 and De cember 1999, were considered for the study. All of the devices were implant ed in an operating room under fluoroscopic control. The vein of choice was the cephalic vein. When the cephalic vein was not suitable for implantation , the external jugular vein or the axillary vein and its branches were used . The percutaneous approach to the subclavian vein or internal jugular vein was considered a last resort to implant a catheter. Results: During the study period, 346 TIVADs were implanted in 344 patients . The procedure was performed with local anesthesia in 341 cases (98.5%), a nd only 2 patients (0.6%) required sedation for psychological reasons. Thre e patients (0.9%) had their TIVAD placed during a laparotomy. In 326 patien ts (94.2%), the devices were implanted in the cephalic vein. In the remaini ng cases, other veins were used with surgical cutdown. The mean time for th e procedure was 15 minutes. Percutaneous access was never used, and no earl y mechanical complications were recorded. Only 6 patients (1.8%) in our stu dy group had late complications (1 case of migration of the catheter, 2 cas es of infection, and 3 cases of withdrawal occlusion). The catheter life ra nged from 6 to 1487 days (mean time, 348 days). Conclusion: Our results confirm the safety, speed, and low cost of the open cutdown technique. This surgical procedure avoids both early and late comp lications that frequently occur with percutaneous access. Surgical cutdown should be considered the technique of choice to implant the TIVAD, especial ly in cancer patients.