title: External jugular vein approach for TIVAD implantation: first choice or only an alternative? A review of the literature.
abstract: OBJECTIVE
  Totally implantable venous access devices (TIVADs) can be implanted by percutaneous approach (to the subclavian or internal jugular vein) or by surgical approach, through cephalic vein or external jugular vein (EJV). The authors present a review of the literature about EJV approach for TIVAD implantation.
  
  
  METHODS
  A review of articles indexed in MEDLINE (PubMed) and Cochrane Central Register on "EJV access," "EJV cut-down," and "TIVADs" was performed, even matching the terms.We gathered articles from papers quoting patient number, specialist involved, number of devices implanted, site and technique of implantation and complications.
  
  
  RESULTS
  A total of 1,308 TIVAD implantations through EJV have been reported, with a success rate ranging from 73.7% to 100% and a complication rate up to 13%. Only in 4 on 10 series reported (with more than 15 procedures) the EJV approach was the first choice, while in the other 6 series this approach was the alternative after failure of other approaches.
  
  
  CONCLUSIONS
  Despite the lack of consistent series and prospective studies comparing EJV with other approaches, data present in the literature may support the evidence that EJV approach for TIVAD implantation is safe and effective, and may be considered as the first approach in selected patients.
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome - Italy.
authors.forename: Olga
authors.initials: O
authors.lastname: Iorio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallaro
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D004867:Equipment Design; D006801:Humans; D007601:Jugular Veins; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors