An alternative technique for totally implantable central venous access devices. A retrospective study of 1311 cases

Long‐term complications in totally implantable venous access devices: Randomized study comparing subclavian and internal jugular vein puncture

“…Silicone catheters have a tendency to undergo embolism when they break, because the material is malleable and light. There are several descriptions in the literature of the incidence of catheter fracture and embolism [8,10,12,15,18,27,33]. However, the exact cause of catheter disconnection and subsequent embolization has not been clearly explained.…”

“…When the puncture technique is used, the internal jugular vein, subclavian vein, or femoral vein may be chosen [4][5][6][7][8][9]. While some authors have used the puncture technique either in the internal jugular vein or subclavian vein [4,10,11], others have preferably performed the puncture in the subclavian vein in both adult and pediatric patients [5,6,10,12,13].…”

Totally Implantable Venous Access Devices – 20 Years' Experience of Implantation in Cystic Fibrosis Patients

“…In this cohort, if the vein was too under-sized or thrombosed, the surgeon performed an open dissection of asuitable alternative vein such as the external jugular,a sd escribed by Di Carlo et al 6 Other veins used were the internal jugular,subclavian, basilic, and long saphenous (at the groin). The principals teps of the open approach (cephalic vein) are well documentede lsewhere 7,9 and surgeons at Heartlands Hospital essentially use this standard technique.…”

“…It is well known that 'pinch-off' syndrome can lead to fracture of catheters. 4,9,14,15 'Pinch-off' is thought to occur when acatheter is inserted into the subclavian vein too medially via ap ercutaneous Seldinger approach and becomes compressed between the first rib, clavicle and costoclavicular ligament. All TIVADs in this cohort were inserted by open cut-down; af ew were placed directly in the subclavianvein, but into the middle or lateral third, well away from thec ostoclavicular ligament.…”

“…Some studies have compared percutaneous and open techniques, [4][5][6][7][8][9] others specifically discussing TIVADs in cystic fibrosis patients. [10][11][12] However,f ew such studies have demonstrated long-term follow-up with large cohorts.…”