Key result
Surgical cut-down for TIVAD implantation resulted in a 1.1% immediate complication rate compared to 2.8% with the percutaneous technique, avoiding potentially fatal complications like pneumothorax.
Why the study?
Even though totally implantable venous access devices (TIVADs) have been used for decades, immediate complications still occur, prompting a review of placement techniques to evaluate their aetiology.
Does the surgical cut-down technique prevent immediate complications compared to the percutaneous technique in patients receiving TIVAD implants?
Systematic Review (n=17,496)
Does the surgical cut-down technique prevent immediate complications compared to the percutaneous technique in patients receiving TIVAD implants?
Absolute Event Rate: 1.1% vs 2.8%
The surgical cut-down technique for TIVAD implantation eliminates the risk of potentially fatal immediate complications such as pneumothorax and accidental arterial puncture that are associated with the percutaneous approach.
Highlights need for technique standardization to minimize immediate TIVAD complications; leaves open optimal approach pending prospective trials.
AIM: Even though TIVADs have been implanted for a long time, immediate complications are still occurring. The aim of this work was to review different techniques of placing TIVAD implants to evaluate the aetiology of immediate complications. METHODS: A systematic literature review was performed using the PubMed, Cochrane and Google Scholar databases in accordance with the PRISMA guidelines. The patient numbers, number of implanted devices, specialists involved, implant techniques, implant sites and immediate complication onsets were studied. RESULTS: Of the 1256 manuscripts reviewed, 36 were eligible for inclusion in the study, for a total of 17,388 patients with equivalent TIVAD implantation. A total of 2745 patients (15.8%) were treated with a surgical technique and 14,643 patients (84.2%) were treated with a percutaneous technique. Of the 2745 devices (15.8%) implanted by a surgical technique, 1721 devices (62.7%) were placed in the cephalic vein (CFV). Of the 14,643 implants (84.2%) placed with a percutaneous technique, 5784 devices (39.5%) were placed in the internal jugular vein (IJV), and 5321 devices (36.3%) were placed in the subclavian vein (SCV). The number of immediate complications in patients undergoing surgical techniques was 32 (1.2%) HMMs. In patients treated with a percutaneous technique, the number of total complications were 333 (2.8%): 71 PNX (0.5%), 2 HMT (0.01%), 175 accidental artery punctures AAP (1.2%) and 85 HMM (0.6%). No mortality was reported with either technique. CONCLUSION: The percutaneous approach is currently the most commonly used technique to implant a TIVAD, but despite specialist's best efforts, immediate complications are still occurring. Surgical cut-down, 40 years after the first implant, is still the only technique that can avoid all of the immediate complications that can be fatal.
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Toro et al. (2021) conducted a systematic review in Patients requiring totally implantable venous access devices (TIVAD) (n=17,496). Surgical cut-down technique vs. Percutaneous technique was evaluated on Immediate complications (pneumothorax, haemothorax, accidental arterial puncture, haematoma). Surgical cut-down for TIVAD implantation resulted in a 1.1% immediate complication rate compared to 2.8% with the percutaneous technique, avoiding potentially fatal complications like pneumothorax.
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