An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases
Introduction
Totally implantable central venous access devices (TICVAD) represent obvious problems in the administration of chemotherapy because of venous irritation and the need for multiple venipunctures. TICVAD is an important benefit for patients who need to receive chemotherapy. TICVAD are generally placed by the percutaneous subclavian vein approach. The cephalic vein cut-down approach is used infrequently in clinical practice due to technical limitation and a wide range of failure rates (8—62%) in the literature.1, 2, 3, 4, 5, 6, 7, 8
But complications are frequently observed in the percutaneous subclavian vein approach such as pneumothorax and arterial puncture. The major advantages of the cephalic vein cut-down approach compared to the percutaneous subclavian vein approach is the elimination of the risks of pneumothorax, hemothorax, and injury to the great vessels9 and direct observation of the adequacy of the vein. But comparative studies of the two methods is lacking. The aim of the present study was to analyse our experience of TICVAD implantation by two techniques to evaluate and determine which had lowest risk of technical problems.
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Materials and methods
From January 1998 to September 2003, we reviewed 1131 patients whom had received TICVAD implantation for chemotherapy by either technique. In 95.8% of the patients the tumours were solid and 4.2% had hematological diseases. Patients were divided into two groups, implantation of the catheter by cephalic vein cut-down (group A) by general surgeons and subclavian vein puncture with the Seldinger technique (group B) by vascular surgeons (Table 1). All implantations were performed by four surgeons
Statistical analysis
The software program Statistical Package for the Social Sciences (SPSS) for Windows (version 8.0) was utilized to analyse the data by the Student's t-test. A P value of less than 0.05 was considered statistically significant.
Results
In this retrospective study, the demographic data of both groups of patients are summarized in Table 1. Based on the Independent t-test, there were no statistically significant differences within the types of malignancy for either technique. Mean operative time was 43 min in group A (25—70 min) and 40 min in group B (25—60 min) (P>0.05). The failure rate of the cephalic vein cut-down was 12% (64/533). The cephalic vein was absent in 21 patients, too small in 39 patients, and iatrogenic injury in
Discussion
TICVAD have been widely used by the oncologists. They achieve safe and less painful vascular access, facilitate treatment of many medical disorders, and improve patients' quality of life by giving them unrestricted mobility and freedom in their activities. These devices can be implanted through either a surgical or percutaneous procedure. The cephalic vein cut-down is used infrequently due to the reported high failure rate and the requirement for surgical expertise. Two earlier cadaver-based
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