Use of totally inplantable venous systems in long-term infusional therapy

Totally implantable vascular devices for long term venous access compares favourably with classical methods of vascular access. Between October 1988 and December 1993 we implanted 59 of these devices in 58 patients, in the Institute of Clinical Surgery of the University of Modena. The catheters were introduced with the cutdown technique in to the superior vena cava, via the internal jugular vein. The total complication rate was 15.2%. In 5 patients (8.5%) the system was removed: in 3 for subcutaneous pocket infection, in 1 for thrombosis of the left brachio-cephalic vein and in 1 for migration of the catheter into the pulmonary artery. Four (6.8%) complications didn't require the removal of the catheter: 1 case of cardiac arrhythmia, 1 of wound dehiscence, 1 of fever above 380 and 1 of drug extravasation around the reservoir. Routine use of intraoperative radiography or radioscopy should be performed to avoid malposition of the system. Patient acceptance is excellent. Implantable vascular devices provide a convenient route for administering chemotherapy and intravenous therapy in chronically ill patients; they are safe and reliable with adequate management.