Implantation of Venous Access Devices for Chemotherapy via Anatomical Landmarks Versus Technology-Assisted Devices: A Multicenter Study

Introduction:The global incidence of cancer has significantly increased, resulting in the expanded use of innovative systemic treatments that require implantable vascular access devices, thus increasing the frequency of device implantation. These implants are associated with low complication rates, good patient tolerance, and a relatively short learning curve for both surgeons and radiologists. Additionally, other treatments, such as prolonged antibiotic therapies and chronic parenteral nutrition, have also benefited from these devices. However, various factors, such as individual patient characteristics, anatomical variations, underlying pathologies, and the surgeon's traditional approach, continue to present challenges in their implementation.Methods:This retrospective, multicenter cohort study analyzed oncology patients indicated for intravenous chemotherapy, with data collected from four institutions in Bogotá between June 1, 2016, and December 31, 2021. A total of 867 patients with diagnoses of hematolymphoid, gastric, colon, pancreatic, or breast cancer were included, excluding those with hypercoagulability syndrome, arrhythmias, or pacemaker use at the time of implantation. The data were systematically recorded via the REDCap® application. Quantitative variables were analyzed via descriptive statistics, whereas categorical data were analyzed via the chi-square test and Fisher's exact test. Continuous variables were assessed with t tests and Mann‒Whitney U tests. Kaplan‒Meier survival models were used to analyze the time to complications based on the catheter insertion technique, and the anatomical reference point (ARP) technique was compared with the technology-assisted (TA) insertion technique. The incidence of complications was calculated using the relative risk (RR) with a significance level of p < 0.05.Results:A total of 3,308 clinical records of patients undergoing totally implantable venous access device (TIVAD) implantation were reviewed, and 867 individuals who met the inclusion criteria were selected: 464 (53.5%) in the technology-assisted (TA) group and 403 (46.5%) in the anatomical reference point (ARP) group, with equivalent sociodemographic characteristics. The statistically significant findings included the presence of hematomas as a complication (p < 0.001) and the use of prophylactic antibiotics (RR 2.56) and fluoroscopy to assess catheter positioning (RR 2.15), both of which are associated with a higher complication rate at 90 days post-operation. Additionally, a surgical time greater than or equal to 30 minutes was associated with a trend toward greater incidence of complications, although this difference did not reach statistical significance (RR 4.24). No significant differences were found between implantation techniques based on anatomical reference points (ARPs) and those based on technology-assisted (TA) methods in terms of complication rates.Conclusions:The implantation of TIVADs in oncology patients with different primary cancers is safe and feasible. Although this study provides a clear definition of the advantages of different techniques, future research using controlled clinical trials is recommended to validate our findings and definitively determine the optimal TIVAD insertion technique.