Bouazizi Yassine El, Bouazizi Amine El, Mouatassim Zakaria El, Lahnaoui Oumayma, Majbar Mohammed Anass, Souadka Abdelilah, Souadka Amine
Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.
Equipe de recherche en Oncologie Translationnelle (EROT). Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco.
Langenbecks Arch Surg. 2025 Nov 10;411(1):6. doi: 10.1007/s00423-025-03908-0.
Totally implantable venous access devices (TIVADs) are essential for the long-term management of oncology patients. Although access via the right internal jugular vein is usually preferred due to its favorable anatomy, left-sided access becomes necessary in certain cases (anatomical variations, previous surgeries, or thromboses) by employing the supraclavicular Yoffa technique.
We describe a standardized and optimized approach using the Yoffa technique for left-sided TIVAD placement. Our protocol details patient positioning, venous puncture, guidewire insertion, subcutaneous tunneling, and port chamber implantation. This retrospective study included 719 patients, of which 216 underwent the left-sided approach.
The left-sided technique was successfully performed with low rates of early complications (pneumothorax 0.42%, hematoma 1.25%, arterial puncture 0.42%) and late complications (catheter-associated thrombosis 0.42%, port pocket infection 1.39%, catheter migration 0.14%) comparable to those obtained with the right-sided approach (503 patients, 69.95%). The main indications for the left-sided approach included right-sided obstruction, previous surgical or radiation history, and failed right-sided access (Rupp SM and Apfelbaum JL Anesth Analg 85(4):741-746) (1997); McGee DC and Gould MK. N Engl J Med 348(12):1123-1133 (2003); Souadka et al PLoS ONE 15(11):e0242727 (2020).
The left-sided Yoffa technique offers a safe and effective alternative for TIVAD placement when right-sided access is contraindicated or difficult. Its supraclavicular approach minimizes the risk of complications (pneumothorax, arterial puncture) and ensures an optimal catheter trajectory toward the superior vena cava.
全植入式静脉通路装置（TIVADs）对于肿瘤患者的长期治疗至关重要。尽管由于右侧颈内静脉解剖结构有利，通常更倾向于通过该静脉进行穿刺，但在某些情况下（解剖变异、既往手术或血栓形成），采用锁骨上约法（Yoffa）技术进行左侧穿刺是必要的。
我们描述了一种使用约法技术进行左侧TIVAD植入的标准化和优化方法。我们的方案详细说明了患者体位、静脉穿刺、导丝插入、皮下隧道制作以及端口腔植入。这项回顾性研究包括719例患者，其中216例采用左侧入路。
左侧技术成功实施，早期并发症（气胸0.42%，血肿1.25%，动脉穿刺0.42%）和晚期并发症（导管相关血栓形成0.42%，端口袋感染1.39%，导管移位0.14%）发生率较低，与右侧入路（503例患者，69.95%）相当。左侧入路的主要适应证包括右侧梗阻、既往手术或放疗史以及右侧穿刺失败（Rupp SM和Apfelbaum JL，《麻醉与镇痛》85(4):741 - 746）（1997年）；McGee DC和Gould MK，《新英格兰医学杂志》348(12):1123 - 1133（2003年）；Souadka等人，《公共科学图书馆·综合》15(11):e0242727（2020年）。
当右侧穿刺禁忌或困难时，左侧约法技术为TIVAD植入提供了一种安全有效的替代方法。其锁骨上入路可将并发症（气胸、动脉穿刺）风险降至最低，并确保导管向上腔静脉的最佳走行。
