Immediate and long term complications of prolonged-venous-access devices (PVAD): a comparison between surgical cutdown and percutaneous techniques.

There is currently still no consensus regarding the best technique for implanting prolonged-venous-access devices (PVAD). One hundred ninety-six patients underwent surgical PVAD positioning using an all-surgical cutdown approach to the cephalic vein (CV). When surgical cannulation proved impossible, the patient was converted to percutaneous positioning. A retrospective analysis was performed on the difference between these two techniques. Among the 196 patients who underwent the surgical insertion of a PVAD, 23 (11.7%) were converted to percutaneous cannulation. For the surgical cannulation group, the median operating time was 35 minutes vs the 52.5 minutes needed for the percutaneous cannulation group. The median time of fluoroscopy amounted to eight seconds for the surgical cannulation group vs 18 seconds for the percutaneous cannulation group. Complications were observed in 23/196 patients (11.7%): 9/23 patients (39.1%) developed infections. Deep venous thrombosis was observed in 4/23 patients (17.4%). Pneumothorax and arterial hematoma developed in 5/23 patients (21.7%), all cases of percutaneous placement. PVAD malfunction was observed in 3/23 patients (13.0%). We concluded that surgical cutdown is faster than the percutaneous approach and safer for both patient and surgeon, involving a shorter time of exposure to radiation and reducing the risk of infection. --------------------------------------------------------------------------------