Cephalic Vein Cut-Down Method for Totally Implantable Venous Access Ports: A Single-Institution Experience

Abstract

The widespread use of chemotherapies has increased the need for totally implantable venous access ports (TIVAPs). Previously, the subclavian puncture approach with the landmark technique was the most used implantation method; however, it has been related to early complications, such as pneumothorax, hemothorax, and arterial puncture. Therefore, a safer implantation method is required. This study aimed to assess the safety and efficacy of the cephalic vein cut-down method used in our institution. Patients who underwent TIVAPs implantation using the cephalic vein cut-down method as the first choice between January 1, 2018, and December 31, 2020, were included in this study. We retrospectively evaluated the technical success rates, operation times, and early complications. This study included 221 adult patients (men, 129; women, 92), with a mean age of 68±11 years. The mean body mass index (BMI) was 21±4 kg/m2. A total of 213 patients (96.4%) had malignant tumors that required chemotherapy. The mean postoperative follow-up period was 659±442 days (range, 5-1698 days). A total of 127 patients (57.5%) died during the follow-up period. The technical success rate was 86.4% (191/221). There were 30 failures, 24 of which were converted to the subclavian vein puncture approach. The mean operation time was 53±21 minutes. Early complications were observed in 4 (1.8%) patients, corresponding to an incidence of 0.028 complications/1,000 catheter-days. One patient had an unintended arterial puncture; however, it was not a result of the cephalic vein cut-down method, but a secondary result of the subclavian vein puncture. No complications of pneumothorax, hemothorax, or arterial puncture was observed with the cephalic vein cut-down method. This study showed that the cephalic vein cut-down method for TIVAPs had an acceptable success rate and fewer early complications than the conventional puncture techniques.