Surgical Venous Cutdown for the Insertion of Totally Implantable Venous Access Devices

Abstract

Purpose:Stable insertion of totally implantable venous access devices (TIVADs) is mandatory for the administration of chemotherapy and parenteral nutrition. Subclavian venipuncture is the most popular route; however, perioperative complications occur in up to 12% of patients. We inserted TIVADs by surgical venous cutdown of the cephalic vein at the deltopectoral groove with the intention of a safe and stable implantation.Methods:We implanted TIVADs in 318 consecutive patients (331 cases) from January 2011 to December 2015. We retrospectively analyzed short- and long-term treatment outcomes and risk factors for primary failure of implantation and removal due to catheter-related complications.Results:The aim of implantation was chemotherapy in 198 cases, nutrition in 92 cases, and frequent intravenous drip in 41 case. Surgical venous cutdown was performed in 321 of 331 cases (97%); primary failure occurred in 42 cases (13.1%). Short-term complications occurred in 4 cases (1.2%), and there were no serious complications, such as pneumothorax. In the analysis of risk factors for primary failure, aim of implantation (chemotherapy versus nutrition versus frequent intravenous drip) was the only risk factor (P = 0.02). Removals occurred in 35 cases (11.5%). In the analysis of risk factors for removal due to complications, presence of infectious disease was identified as the only significant risk factor (P < 0.001).Conclusions:We confirmed the safety and efficacy of the cutdown method and clarified the risk factors for primary failure and removal. The cutdown method was safe and was not associated with serious complications; however, selective implantation was needed to achieve a high success rate.