• Elisa Granziera, Marco Scarpa, Angelo Ciccarese, Bogdan Filip, Matteo Cagol, Valentina Manfredi, Rita Alfieri, Connie Celentano, Sandra Cappellato, Carlo Castoro, and Muzio Meroni.
• Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy. marcoscarpa73@yahoo.it.
• Bmc Surg. 2014 Jan 1;14:27.

BackgroundThe aim of this study was to assess the efficacy and safety of totally implanted vascular devices (TIVAD) using different techniques of insertion.MethodsWe performed a retrospective study using a prospective collected database of 796 consecutive oncological patients in which TIVADs were inserted. We focused on early and late complications following different insertion techniques (surgical cutdown, blind and ultrasound guided percutaneous) according to different techniques.ResultsUltrasound guided technique was used in 646 cases, cephalic vein cutdown in 102 patients and percutaneous blind technique in 48 patients. The overall complication rate on insertion was 7.2% (57 of 796 cases). Early complications were less frequent using the ultrasound guided technique: arterial puncture (p = 0.009), technical failure (p = 0.009), access site change after first attempt (p = 0.002); pneumothorax occurred in 4 cases, all using the blind percutaneus technique. Late complications occurred in 49 cases (6.1%) which required TIVAD removal in 43 cases and included: sepsis (29 cases), thrombosis (3 cases), dislocation (7 cases), skin dehiscence (3 cases), and severe pain (1 case).ConclusionUltrasound guided technique is the safest option for TIVAD insertion, with the lowest rates of immediate complications.

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