title: Increased use of percutaneous technique for totally implantable venous access devices. Is it real progress? A 27-year comprehensive review on early complications.
abstract: BACKGROUND
  First implantation of a totally implantable venous access device (TIVAD) was performed in 1982 with surgical technique. Since then, these devices have permitted infusion of total parenteral nutrition, antibiotics, blood products, and, above all, they have definitively changed the quality of life of patients with cancer. However, with the increase of percutaneous procedures, we have assisted with a concomitant raise of immediate postprocedural life-threatening complications. The aim of this study was to review the literature during a 27-year period, with regard to the changes of incidence of immediate complications after percutaneous or surgical cutdown for TIVAD's implant.
  
  
  METHODS
  An extensive search of relevant literature was carried out by using MEDLINE (PubMed) and Google Scholar. We gathered articles from 1982 to 2009 that quoted patient's number, type of pathology, specialist involved, number of devices implanted, site and technique of implantation (surgical cutdown or percutaneous technique), and immediate complications occurrence.
  
  
  RESULTS
  A total of 952 reports were screened, and finally only 45 articles addressing all inclusion criteria were used for the present study. A total of 11,430 TIVADs implanted in 11,381 patients were analyzed. Pneumothorax, hemothorax, arterial puncture, and hemoptysis developed only after percutaneous procedures. Atrial fibrillation, hematomas, and malpositioning were more frequent after percutaneous approach. The total amount of immediate complications in patients submitted to percutaneous implant was 4.5%, compared with 0.9% subsequent to cutdown technique.
  
  
  CONCLUSIONS
  Despite the increased use of percutaneous technique for TIVADs' implantation, surgical cutdown, because of its safety, remains the best approach to avoid possible fatal immediate complications.
authors.affiliation: Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies, University of Catania, Catania, Italy, idicarlo@unict.it
authors.forename: Isidoro
authors.initials: I
authors.lastname: Di Carlo
authors.forename: Elia
authors.initials: E
authors.lastname: Pulvirenti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Mannino
authors.forename: Adriana
authors.initials: A
authors.lastname: Toro
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D001158:Arteries / Q000293:injuries; D001281:Atrial Fibrillation / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000706:statistics & numerical data; D002408:Catheters, Indwelling / Q000009:adverse effects; D006406:Hematoma / Q000209:etiology; D006469:Hemoptysis / Q000209:etiology; D006491:Hemothorax / Q000209:etiology; D006801:Humans; D015994:Incidence; D015918:Infusion Pumps, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008134:Long-Term Care; D009369:Neoplasms / Q000188:drug therapy; D011030:Pneumothorax / Q000209:etiology; D011788:Quality of Life
chemical_list: D000970:Antineoplastic Agents