title: Routine chest X-ray is not mandatory after fluoroscopy-guided totally implantable venous access device insertion.
abstract: BACKGROUND
  The aim of this study is to determine whether systematic postoperative chest X-ray is required after totally implantable venous access port device (TIVAD) placement under fluoroscopic control.
  
  
  METHODS
  A retrospective chart review of all consecutive patients with fluoroscopy-guided TIVAD insertion from July 10, 2009 to April 16, 2012 was conducted at the Geneva University Hospitals (n = 927). Patients with an available postoperative chest X-ray were included, regardless of approach (open or percutaneous) and venous access site (subclavian, cephalic, jugular, etc.). Exclusion criteria were incomplete data and preexisting pneumothorax or hemothorax.
  
  
  RESULTS
  Eight hundred ninety-one patients were included. First-intention venous cutdown was performed in 878 patients (98.5%), with success rates of 79.4% and 88.2% when targeting the left and right cephalic veins, respectively. Percutaneous access was the chosen first-intention procedure for 12 patients (1.3%). Eight-hundred thirty-six (93.8%) insertions were performed only by the open approach and 53 (5.9%) implantations required at least one venous puncture. Two implantations were performed using previous central venous accesses. Immediate complications associated with TIVAD placement and detected on the postoperative chest X-ray consisted of 1 asymptomatic pneumothorax, 1 symptomatic hemothorax, and 2 malpositions of the catheter. One additional pneumothorax was discovered during the first night after TIVAD insertion in a patient who became symptomatic.
  
  
  CONCLUSIONS
  The very low incidence of immediate complications detected by postprocedural chest X-ray suggests that such a control is not mandatory as a routine method after fluoroscopy-guided TIVAD insertion mainly performed by venous cutdown. X-ray should be performed only in cases of clinical suspicion.
authors.affiliation: Division of Visceral and Transplantation Surgery, University Hospitals of Geneva, Switzerland. Electronic address: theodoros.thomopoulos@hcuge.ch.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Thomopoulos
authors.affiliation: Division of Visceral and Transplantation Surgery, University Hospitals of Geneva, Switzerland.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Meyer
authors.affiliation: Division of Visceral and Transplantation Surgery, University Hospitals of Geneva, Switzerland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Staszewicz
authors.affiliation: Division of Radiology, University Hospitals of Geneva, Switzerland.
authors.forename: Ilias
authors.initials: I
authors.lastname: Bagetakos
authors.affiliation: Division of Radiology, University Hospitals of Geneva, Switzerland.
authors.forename: Max
authors.initials: M
authors.lastname: Scheffler
authors.affiliation: Division of Visceral and Transplantation Surgery, University Hospitals of Geneva, Switzerland.
authors.forename: Antoine
authors.initials: A
authors.lastname: Lomessy
authors.affiliation: Division of Visceral and Transplantation Surgery, University Hospitals of Geneva, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
authors.affiliation: Division of Radiology, University Hospitals of Geneva, Switzerland.
authors.forename: Christoph D
authors.initials: CD
authors.lastname: Becker
authors.affiliation: Division of Visceral and Transplantation Surgery, University Hospitals of Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D005260:Female; D005471:Fluoroscopy; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D018579:Patient Selection; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012307:Risk Factors; D016748:Venous Cutdown