Abstract
BackgroundTotally implantable venous access devices can be implanted both by percutaneous approaches and by surgical approaches with cephalic vein or external jugular vein cut-down techniques that are related to low intraoperative complication rates. The authors report a prospective evaluation of 83 consecutive external jugular vein cut-down approaches for totally implantable venous access devices implantation.MethodsEighty three consecutive patients (28 M, 55 F, mean age 54.2) suffering from solid tumors (58) or hematologic diseases (25) were consecutively submitted to totally implantable venous access devices insertion through external jugular vein cut-down approach (75 on right side, 8 on left side).ResultsAll devices were surgically implanted; no instances of intraoperative complications were detected. After a minimum follow-up of 150 days, only one case of wound hematoma and one case of device malfunction due to incorrect catheter angulation were noted.Postoperative patient satisfaction was evaluated by the use of specific questionnaire that demonstrated a good satisfaction and compliance (92.8 %) of patients with implanted devices.ConclusionsDespite the lack of controlled studies comparing external jugular vein cut-down approach vs other approaches, this approach should be considered as a tool for long-term central vein catheters positioning, both as an alternative and for primary approach.
Highlights
Implantable venous access devices can be implanted both by percutaneous approaches and by surgical approaches with cephalic vein or external jugular vein cut-down techniques that are related to low intraoperative complication rates
The authors report a prospective evaluation of 83 consecutive external jugular vein (EJV) cut-down (EJV-CD) approach procedures for Totally implantable venous access devices (TIVADs) implantation, evaluating success rates, intraoperative and postoperative complications, and patient satisfaction
EJV approach represents an effective way for accessing the central venous system, reducing severe complications related to deep vein puncture: pneumothorax, hemothorax, arterial or nerve injuries, and deep venous thrombosis [7,8,9,10,11,12], and it is currently used for many kinds of central venous catheters especially in pediatric patients [13,14,15,16,17], reporting low complication rates and higher success rates, even in emergency and intensive care settings [18,19,20,21,22]
Summary
Implantable venous access devices can be implanted both by percutaneous approaches and by surgical approaches with cephalic vein or external jugular vein cut-down techniques that are related to low intraoperative complication rates. The authors report a prospective evaluation of 83 consecutive external jugular vein cut-down approaches for totally implantable venous access devices implantation. Implantable venous access devices (TIVADs) are usually inserted and utilized in case of long-term therapies and nutritional support in oncologic patients [1, 2]. These devices can typically be implanted through different ways. Cephalic vein cut-down (CVCD) technique appears to be effective and not affected by these severe complications [3,4,5] but is reported to fail in 6–30 % of cases, mainly due to anatomic variations in cephalic vein course
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