Subclavian vein puncture vs. surgical cut-down to the cephalic vein for insertion of totally implantable venous access ports

Abstract

Totally implantable venous access ports (TIAP) are commonly used in oncology, but which insertion modality should be preferred is still discussed controversially. We present a retrospective survey of the two main approaches for central venous cannulation from a single surgical department. All TIAP procedures between January 2004 and December 2010 were included. Direct puncture of the subclavian vein (DP) represented the standard approach for port insertion until 2007, when surgical cut-down to the cephalic vein (CD) was introduced as a reliable alternative at our department. Primary success rate, procedure time and postoperative complications within 30 days were analysed. In 301 (64.9 %) cases, DP was performed, and CD was done 163 times. Primary success rate for DP and CD was 94.4 and 87.1 %, respectively (p = 0.012). Mean procedure time was significantly longer in the CD group (38 vs. 32 min; p = 0.008). On routine postoperative chest X-ray, pneumothoraces were seen only following DP (10/301; 3.3 %), twice (2/301; 0.7 %) necessitating drainage. Early port infection (n = 6), haematoma (n = 2) and inadvertent arterial placement (n = 1) were seen following DP only. Complication rate for DP and CD procedures accounted for 7 and 1.2 %, respectively (p = 0.006). Surgical CD is associated with a minimal risk for (severe) early complications and should be favoured over DP for TIAP implantation even if it takes longer and is associated with a lower primary success rate