Totally implantable venous access devices - 20 years' experience of implantation in cystic fibrosis patients

Totally implantable venous access devices (TIVADs) are widely used to provide long-term, central venous access for antibiotic delivery in cystic fibrosis patients. However, few studies have demonstrated long-term follow-up with large cohorts. This is a retrospective review of TIVADs implanted in cystic fibrosis patients by vascular surgeons at a tertiary referral centre, using an open venous cut-down technique, from March 1986 to July 2006. The cephalic vein was preferentially chosen for line placement, in the deltopectoral groove, under fluoroscopic control. TIVAD performance (life-span or survival) and complications were evaluated. Data were extracted by review of a local database (data collated prospectively since 1986), with supplementation from electronic patient records and medical notes. In total 165 TIVADs in 109 patients (34 males, 75 females) were reviewed. Median survival was 1441 days (range, 6-4440 days). Cumulative patency was 146,072 catheter-days. No immediate intrathoracic complications (pneumothorax, haemothorax, nerve injury) occurred. There were 3 early and 82 late complications, namely: occlusion (33 TIVADs; median age 510 days), infection (23 TIVADs; median 376 days), leakage (16; median 283 days), pain or discomfort (6), venous thrombosis (5), extravasation/skin necrosis (1), vegetation in right atrium (1). Overall incidence of complications was 0.58 per 1000 catheter-days. This study concurs with others that TIVADs are safe and effective, with a favourable life-span in cystic fibrosis patients if well looked after in a specialist centre. Complications of infection, leakage and occlusion do occur. Using an open, venous cut-down technique with fluoroscopic control avoids any immediate intrathoracic complications.