Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy.

Since the first implant of totally implantable venous access device (TIVAD), performed by Niederhuber and colleague in 1982, the systems have increasingly been used in the field of oncology. We analyzed the clinical reviews and complications of TIVAD in an effort to achieve optimal management. We retrospectively studied 442 cases with TIVAD device at our hospital and we report the results. Four hundred and forty-two TIVAD were placed in the right subclavian vein in 345 cases, the left subclavian vein in 93 cases, the right jugular vein in 2 cases, the left jugular vein in 1 case, and the right femoral vein in 1 case. The immediate complications were 28 cases in malposition of the catheter, 10 cases of arterial puncture, and 2 cases of pneumothorax. The late complications were 3 cases of pocket infection, 2 cases of catheter related to sepsis, 3 cases of catheter obstruction, 2 cases of SVC thrombosis, and 1 case of catheter fracture (pinch-off syndrome: Hinke grade 3). There were no other early or late complications. The low rate of complications in the study confirms the safety and convenience of using TIVAD in patients undergoing prolonged chemotherapy. Yet because infection, thrombosis and catheter fracture are the most common long-term complications of TIVAD, early diagnosis and management of these problems can prevent severe complications.