Totally Implantable Venous Access Devices: Study of 1,613 Patients and Complication Management

Objectives: Totally implantable venous access devices (TIVADs) are crucial for treating patients with malignancy. However, reaching the intravenous route is rendered difficult owing to the consequences of chemotherapy. This retrospective study aimed to investigate the early and late complications associated with percutaneous insertion and TIVAD use.
Methods: A total of 1,647 TIVAD procedures in 1,613 patients between 2010 and 2023 were retrospectively analyzed. All TIVADs were placed in the cardiovascular surgeon operating room under sedation. A C-arm fluoroscopy machine and ultrasound were used during the procedure.
Results: A total of 1,613 patients were included in the study, of which 1,085 were males and 528 were females. The mean age of these patients was 49.8±19.2 (16–86) years. At the right side, 1,403 devices were implanted (791 right subclavian vein and 612 right internal jugular vein), while 210 were implanted at the left side (128 left subclavian vein and 82 left internal jugular vein). During the study period, 285 early and 142 late complications were detected. TIVAD insertions were performed successfully, with no recorded deaths.
Conclusion: This study revealed that TIVADs are relatively safe procedures. Majority of the early complications are related to the implantation technique, whereas late complications are associated with catheter fatigue or the use of inlabrate. These complications can be prevented by adhering to rules of the procedure and employing the appropriate technique. Although C-arm fluoroscopy is crucial for these procedures, a risk of accumulated radiation exposure exists but can be reduced with utmost care.