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lüll Totally implantable venous access devices - 20 years experience of implantation in cystic fibrosis patients Royle TJ; Davies RE; Gannon MXAnn R Coll Surg Engl 2008[Nov]; 90 (8): 679-84INTRODUCTION: 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. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.|Adolescent[MESH]|Adult[MESH]|Blood Vessel Prosthesis Implantation/statistics & numerical data[MESH]|Catheters, Indwelling/statistics & numerical data[MESH]|Cohort Studies[MESH]|Cystic Fibrosis/*drug therapy[MESH]|Graft Occlusion, Vascular/etiology[MESH]|Humans[MESH]|Long-Term Care[MESH]|Middle Aged[MESH]|Prosthesis-Related Infections/etiology[MESH]|Retrospective Studies[MESH]|Young Adult[MESH] |