医学
外科
头静脉
经皮
腋静脉
锁骨下静脉
植入
颈内静脉
导管
静脉
局部麻醉
镇静
静脉通路
血栓形成
作者
Isidoro Di Carlo,S. Cordio,Gaetano La Greca,Giuseppe Privitera,Domenico Russello,Stefano Puleo,Ferdinando Latteri
出处
期刊:Archives of Surgery
[American Medical Association]
日期:2001-09-01
卷期号:136 (9): 1050-1050
被引量:140
标识
DOI:10.1001/archsurg.136.9.1050
摘要
The techniques used for the implantation of totally implantable venous access devices (TIVADs) are the percutaneous approach and surgical cutdown; however, the choice is still controversial.The surgical cutdown approach may be beneficial to reduce the rate of complications.Retrospective review.A university hospital and a tertiary referral center.Patients undergoing a TIVAD implant at the First Surgical Clinic of the University of Catania in Catania, Italy, between January 1995 and December 1999, were considered for the study. All of the devices were implanted in an operating room under fluoroscopic control. The vein of choice was the cephalic vein. When the cephalic vein was not suitable for implantation, the external jugular vein or the axillary vein and its branches were used. The percutaneous approach to the subclavian vein or internal jugular vein was considered a last resort to implant a catheter.During the study period, 346 TIVADs were implanted in 344 patients. The procedure was performed with local anesthesia in 341 cases (98.5%), and only 2 patients (0.6%) required sedation for psychological reasons. Three patients (0.9%) had their TIVAD placed during a laparotomy. In 326 patients (94.2%), the devices were implanted in the cephalic vein. In the remaining cases, other veins were used with surgical cutdown. The mean time for the procedure was 15 minutes. Percutaneous access was never used, and no early mechanical complications were recorded. Only 6 patients (1.8%) in our study group had late complications (1 case of migration of the catheter, 2 cases of infection, and 3 cases of withdrawal occlusion). The catheter life ranged from 6 to 1487 days (mean time, 348 days).Our results confirm the safety, speed, and low cost of the open cutdown technique. This surgical procedure avoids both early and late complications that frequently occur with percutaneous access. Surgical cutdown should be considered the technique of choice to implant the TIVAD, especially in cancer patients.
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