Percutaneous versus Cut-Down Technique for Indwelling Port Placement

Area of Science:

• Oncology
• Vascular Surgery
• Medical Devices

Background:

• The optimal method for inserting totally implantable venous access devices (TIVADs) remains debated.
• Surgical cut-down of the cephalic vein and percutaneous catheterization of the subclavian vein are common approaches.

Purpose of the Study:

• To compare the safety and efficacy of surgical cut-down versus percutaneous placement of TIVADs in oncologic patients.
• To evaluate implantation failure rates and postoperative complications within 30 days.

Main Methods:

• A single-institution retrospective cohort study involving 14 surgeons and 442 oncologic patients.
• Data collected on implantation success, 30-day postoperative complications, and operative time.
• Multivariate logistic regression analysis was used to identify predictors of complications.

Main Results:

• The overall 30-day complication rate was 5.2% (5.7% percutaneous vs. 4.6% cut-down), with no significant difference between techniques.
• Implantation failure occurred in 6.5% of percutaneous cases versus 14.4% of cephalic cut-down cases (adjusted OR = 2.387).
• Median operative time was significantly shorter for cephalic cut-down (37.5 min) compared to percutaneous placement (46 min).

Conclusions:

• Both percutaneous and cephalic cut-down techniques are safe and effective for TIVAD implantation.
• Cephalic cut-down is associated with shorter operative times but a higher likelihood of implantation failure.
• Surgeons should be proficient in both methods due to the potential for implantation failure with either approach.