Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies, University of Catania, Catania, Italy,
Ann Surg Oncol. 2010 Jun;17(6):1649-56. doi: 10.1245/s10434-010-1005-4. Epub 2010 Mar 5.
First implantation of a totally implantable venous access device (TIVAD) was performed in 1982 with surgical technique. Since then, these devices have permitted infusion of total parenteral nutrition, antibiotics, blood products, and, above all, they have definitively changed the quality of life of patients with cancer. However, with the increase of percutaneous procedures, we have assisted with a concomitant raise of immediate postprocedural life-threatening complications. The aim of this study was to review the literature during a 27-year period, with regard to the changes of incidence of immediate complications after percutaneous or surgical cutdown for TIVAD's implant.
An extensive search of relevant literature was carried out by using MEDLINE (PubMed) and Google Scholar. We gathered articles from 1982 to 2009 that quoted patient's number, type of pathology, specialist involved, number of devices implanted, site and technique of implantation (surgical cutdown or percutaneous technique), and immediate complications occurrence.
A total of 952 reports were screened, and finally only 45 articles addressing all inclusion criteria were used for the present study. A total of 11,430 TIVADs implanted in 11,381 patients were analyzed. Pneumothorax, hemothorax, arterial puncture, and hemoptysis developed only after percutaneous procedures. Atrial fibrillation, hematomas, and malpositioning were more frequent after percutaneous approach. The total amount of immediate complications in patients submitted to percutaneous implant was 4.5%, compared with 0.9% subsequent to cutdown technique.
Despite the increased use of percutaneous technique for TIVADs' implantation, surgical cutdown, because of its safety, remains the best approach to avoid possible fatal immediate complications.
1982 年，首例完全植入式静脉通路装置（TIVAD）采用外科技术进行植入。从那时起，这些装置允许输注全胃肠外营养、抗生素、血液制品，最重要的是，它们彻底改变了癌症患者的生活质量。然而，随着经皮操作的增加，我们也注意到随之而来的即刻危及生命的并发症发生率增加。本研究旨在回顾 27 年来经皮或外科切开植入 TIVAD 后即刻并发症发生率的变化。
通过使用 MEDLINE（PubMed）和 Google Scholar 进行广泛的文献检索。我们收集了 1982 年至 2009 年引用患者数量、病理类型、涉及的专家、植入装置数量、植入部位和技术（外科切开或经皮技术）以及即刻并发症发生情况的文章。
共筛选了 952 份报告，最终只有 45 篇符合所有纳入标准的文章用于本研究。共分析了 11381 例患者植入的 11430 个 TIVAD。气胸、血胸、动脉穿刺和咯血仅在经皮操作后发生。经皮入路后更容易发生心房颤动、血肿和定位不当。经皮植入患者即刻并发症的总发生率为 4.5%，而经切开技术的发生率为 0.9%。
尽管经皮技术在 TIVAD 植入中的应用增加，但由于其安全性，外科切开仍然是避免可能致命的即刻并发症的最佳方法。
