Choice of Venous Sites. Surgical Implant/Technique

Abstract

Totally implantable venous access devices (TIVADs) can be positioned using a surgical or percutaneous technique. The surgical technique using the cephalic vein is the only approach able to avoid immediate fatal complications. Many different venous sites using the surgical technique have been described, including the external jugular vein, the internal jugular vein, the axillary vein, the saphenous vein, the gonadal vein and the inferior vena cava. The cephalic vein is generally used because it is easy to identify, but when it is unavailable due to hypoplasia or fibrosis, an external jugular vein cutdown approach can be useful. The internal jugular vein is used in patients when the cephalic vein or external jugular vein are unsuitable because of multiple previous lines, recent line-related infection, chemotherapy or thrombosis or in patients having tissue compromised by previous surgery, metastases, open wounds or previous radiation on the anterior chest wall. If the cephalic vein is not useful and the external jugular veins are unavailable, the axillary vein may be preferred especially in overweight subjects. When the superior central venous routes are not available, the most common technique used to obtain central venous access to the inferior vena cava is the inguinal approach using the saphenous vein or the gonadal vein.