title: Totally implantable venous access devices implanted surgically: a retrospective study on early and late complications.
abstract: 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.
  
  
  OBJECTIVE
  The surgical cutdown approach may be beneficial to reduce the rate of complications.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  A university hospital and a tertiary referral center.
  
  
  METHODS
  Patients undergoing a TIVAD implant at the First Surgical Clinic of the University of Catania in Catania, Italy, between January 1995 and December 1999, were considered for the study. All of the devices were implanted 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%), and only 2 patients (0.6%) required sedation for psychological reasons. Three patients (0.9%) had their TIVAD placed during a laparotomy. In 326 patients (94.2%), the devices were implanted in the cephalic vein. In the remaining cases, other veins were used with surgical cutdown. The mean time for the procedure was 15 minutes. Percutaneous access was never used, and no early mechanical complications were recorded. Only 6 patients (1.8%) in our study group had late complications (1 case of migration of the catheter, 2 cases of infection, and 3 cases of withdrawal occlusion). The catheter life ranged from 6 to 1487 days (mean time, 348 days).
  
  
  CONCLUSIONS
  Our results confirm the safety, speed, and low cost of the open cutdown technique. This surgical procedure avoids both early and late complications that frequently occur with percutaneous access. Surgical cutdown should be considered the technique of choice to implant the TIVAD, especially in cancer patients.
authors.affiliation: Firrst Surgical Clinic, University of Catania, Italy. idicarlo@mbox.unict.it
authors.forename: I
authors.initials: I
authors.lastname: Di Carlo
authors.forename: S
authors.initials: S
authors.lastname: Cordio
authors.forename: G
authors.initials: G
authors.lastname: La Greca
authors.forename: G
authors.initials: G
authors.lastname: Privitera
authors.forename: D
authors.initials: D
authors.lastname: Russello
authors.forename: S
authors.initials: S
authors.lastname: Puleo
authors.forename: F
authors.initials: F
authors.lastname: Latteri
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D000075202:Contraindications; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016748:Venous Cutdown / Q000379:methods
chemical_list: D000970:Antineoplastic Agents