title: External jugular vein cutdown approach, as a useful alternative, supports the choice of the cephalic vein for totally implantable access device placement.
abstract: BACKGROUND
  Cephalic vein (CV) cut down for totally implantable venous access device (TIVAD) placement has been accepted as an alternative to the percutaneous subclavian vein approach. The aim of this retrospective study was to validate the external jugular vein (EJV) cut-down approach when the CV is not feasible.
  
  
  METHODS
  Patients receiving a TIVAD from January 1995 to December 2003 were included in this study. Age, sex, surgical technique, disease, device used, length of the procedure, and morbidity were considered.
  
  
  RESULTS
  A total of 427 TIVADs were placed in 425 patients: 253 men (59.5%) and 172 women (40.5%) aged 31 to 79 years. Of 425 patients, 5 were excluded; 420 underwent a CV cut down on the first attempt, and 391 (93.1%) procedures were successful. Among the final 29 patients, 20 (68.96%) underwent a TIVAD placement through the ipsilateral EJV cut-down approach. In the remaining nine patients (31.04%), TIVAD placement was performed through the ipsilateral internal jugular vein in four cases, via the ipsilateral axillary vein in three cases, and through the ipsilateral coracobrachial vein in the other cases. No immediate postoperative complications were detected in any of the patients.
  
  
  CONCLUSIONS
  TIVAD placement by the CV cut-down approach is safe and fast, and its success rate is very high. By avoiding the immediate complications associated with the percutaneous approach, the EJV cut down has to be considered a valid, safe, and suitable alternative when the CV is not feasible.
authors.affiliation: Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, Via Messina, 829, 95126 Catania, Italy. idicarlo@unict.it
authors.forename: Isidoro
authors.initials: I
authors.lastname: Di Carlo
authors.forename: Francesco
authors.initials: F
authors.lastname: Barbagallo
authors.forename: Adriana
authors.initials: A
authors.lastname: Toro
authors.forename: Maria
authors.initials: M
authors.lastname: Sofia
authors.forename: Rosario
authors.initials: R
authors.lastname: Lombardo
authors.forename: Stefano
authors.initials: S
authors.lastname: Cordio
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D016748:Venous Cutdown / Q000379:methods*