TIVAD implantation for chemotherapy: retrospective comparison between US-guided vein puncture vs. surgical vein cutdown on more than 3000 procedures

Totally implantable venous access devices (TIVADs) are widely used for long-term therapies, including chemotherapy. Given the potential for serious complications, it is crucial to determine the safest implantation technique with the lowest risk profile. This bicentric, retrospective study aims to compare the surgical vein cut-down approach with ultrasound-guided percutaneous vein puncture in terms of procedural success, complication rates, and operative efficiency. A retrospective analysis was conducted on 3373 patients who underwent TIVAD implantation at two centers. Patients were divided into two groups: group A (N.=1846) underwent TIVAD placement via cephalic or external jugular vein cut-down, while group B (N.=1527) underwent ultrasound-guided puncture of the internal jugular or subclavian vein. The two techniques were compared based on operative time, success rate, need for conversion, and complication incidence. In Group A, the cephalic vein was used in 1733 cases, while the external jugular vein was used in 133 cases. No conversions to percutaneous access or contralateral approaches were required. In group B, TIVADs were implanted via the subclavian vein in 1490 patients and the internal jugular vein in 172 patients. The mean operative time was comparable between the two groups (32.6±11.3 minutes in group A vs. 34.2±12.5 minutes in group B; P not significant). However, the 30-day complication rate was significantly lower in group A (3.8%) compared to group B (5.7%; P<0.05). This bicentric retrospective study suggests that the surgical cut-down approach for TIVAD implantation via peripheral veins is associated with a high success rate and a lower short-term complication rate compared to percutaneous techniques. However, given the retrospective design and potential center-specific factors, further prospective, multicentric studies are needed to confirm these findings and determine the optimal approach in different clinical settings.