Department of Interventional Radiology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Provinece, China.
Department of Interventional Radiology, TaiCang First People's Hospital, Taicang, China.
J Cancer Res Ther. 2020;16(7):1575-1581. doi: 10.4103/jcrt.JCRT_1082_19.
The background of this study was to explore the success rate and early complications concerning the implantation of totally implantable venous access devices (TIVADs) by percutaneous venipuncture and management strategies for early complications.
This was a retrospective study of 1923 patients who received TIVAD implantation by percutaneous venipuncture (mostly via the supraclavicular route). The percutaneous access sites were internal jugular vein (810 patients; right/left: 158/652) or proximal right internal jugular vein, brachiocephalic vein, and proximal subclavian vein (1113 patients). Success rates and early complications related to TIVAD placement techniques were summarized, and strategies for managing complications were also analyzed.
In 627 patients, TIVAD implantation was first performed by interventional radiologists using a "blind" approach relying on anatomical landmarks, having a 91.9% success rate. In contrast, there was a 100% success rate among the remaining 1296 patients who received ultrasound-guided implantation, a difference which was statistically significant (P < 0.05). Ultrasound-guided implantation was also successful for the 51 patients for whom the first attempt failed using the blind technique. Further, we found that the incidence of early complications was 5.41% (104/1923) and that the occurrence of immediate complications was significantly higher in the blind technique group compared to the ultrasound-guided group (37 vs. 12; P < 0.05).
It is safe and feasible to implant TIVADs by supraclavicular venipuncture. Ultrasound guidance combined with X-ray monitoring during operation significantly improves the surgery success rate and reduces the risk of early complications. Unclear anatomical landmarks and vascular variation are the main factors affecting success using a blind (nonguided) technique.
本研究旨在探讨经皮穿刺置管完全植入式静脉输液港（TIVAD）的成功率及早期并发症，并总结早期并发症的处理策略。
回顾性分析 1923 例经皮穿刺（多采用锁骨下入路）行 TIVAD 植入术患者的临床资料。经皮穿刺入路：颈内静脉（810 例；右/左侧：158/652 例）或右颈内静脉近段、头臂静脉及锁骨下静脉近端（1113 例）。总结 TIVAD 置管技术的成功率及与置管技术相关的早期并发症，并分析并发症的处理策略。
627 例患者采用盲穿法（依靠解剖标志定位），由介入放射科医师首次操作，成功率为 91.9%；其余 1296 例患者采用超声引导下置管，成功率为 100%，差异有统计学意义（P<0.05）。对于盲穿法首次失败的 51 例患者，超声引导下均成功置管。此外，我们发现早期并发症发生率为 5.41%（104/1923），盲穿组早期并发症的发生率明显高于超声引导组（37 例比 12 例；P<0.05）。
锁骨下静脉穿刺置管 TIVAD 安全可行，超声联合 X 线透视引导下操作可显著提高手术成功率，降低早期并发症风险。盲目（非引导）置管技术受解剖标志不清晰、血管变异等因素影响，是导致置管失败的主要原因。
