Ultrasound-guided vein puncture versus surgical cut-down technique in totally implantable venous access devices (tivads):.

Totally implantable venous access devices (TIVADs) consist of a central venous catheter (made of silicone rubber or polyurethane) and a subcutaneously-implanted injection port made of titanium or plastic, providing a simple, safe, and permanent means of accessing the vascular system for intravenous delivery of drugs and fluids.1,2 The main advantages of these systems are to preserve peripheral vessels and to allow the patient unrestricted mobility and freedom in choice of activities.3 This situation has led to increasing use of these systems, particularly for long-term oncologic therapies.4–6 TIVADs can usually be implanted through 2 different ways: subclavian or external jugular vein puncture, by Seldinger technique, eventually under ultrasound (US) guidance; or surgical approach by vein cut-down (VCD) technique.11–14 TIVADs insertion can be accompanied by intraoperative or early postoperative severe complications, such as pneumothorax, hemothorax, arterial, or brachial plexus injuries, deep venous thrombosis and pinch-off syndrome, which seem to be more frequent in cases of direct vein puncture than during surgical approach.7–10,15–18 A recent meta-analysis showed a similar success rate and operating time, as well as complication rates, when comparing vein puncture and surgical approach, even if serious complications such as pneumothorax were higher after vein puncture.19 The authors present a comparative prospective study evaluating both VCD and US-guided Seldinger technique for TIVAD implantation, focusing on surgical outcome, intra and postoperative complications in 298 consecutive patients with a minimum follow-up of 180 days.