Ultrasound-based prediction of cephalic vein cut down success prior to totally implantable venous access device placement

Abstract Background Surgical venous cut down is a method for totally implantable venous access device (TIVAD) insertion. The main drawback of this technique is its higher failure rate when compared with the percutaneous approach, which is mostly related to anatomic variations of the cephalic vein. The aim of this study was to assess preoperative ultrasound imaging as a tool to predict cephalic vein cut down failure for TIVAD insertion. Methods Ultrasound and operative reports of a cohort of patients undergoing TIVAD insertion by cephalic vein cut down were reviewed. Ultrasound venous (vein visibility, diameter, length, subcutaneous depth, vein path, and subclavian junction visibility) and patient variables were tested by logistic regression as predictors of TIVAD insertion failure. Results One hundred sixty consecutive patients underwent cephalic vein cut down for attempted TIVAD insertion. An inability to visualize the vein on the preoperative ultrasound examination (odds ratio, 4.39; 95% confidence interval, 1.57-12.30; P  Conclusions Preoperative ultrasound examination allows identifying patients at risk of failure of TIVAD insertion by cephalic vein cut down. Preoperative ultrasound examination constitutes an efficient tool for choosing the most appropriate surgical approach and improving patient comfort.