The Experts below are selected from a list of 201 Experts worldwide ranked by ideXlab platform
Christian Toso - One of the best experts on this subject based on the ideXlab platform.
-
ultrasound based prediction of cephalic vein Cutdown success prior to totally implantable Venous access device placement
Journal of vascular surgery. Venous and lymphatic disorders, 2019Co-Authors: Wojciech Staszewicz, Surennaidoo P Naiken, Andre Mennet, Jeremy Meyer, Marc Philip Righini, Philippe Morel, Christian TosoAbstract:Abstract Background Surgical Venous Cutdown 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 Cutdown failure for TIVAD insertion. Methods Ultrasound and operative reports of a cohort of patients undergoing TIVAD insertion by cephalic vein Cutdown 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 Cutdown 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 Cutdown. Preoperative ultrasound examination constitutes an efficient tool for choosing the most appropriate surgical approach and improving patient comfort.
-
systematic review and meta analysis of percutaneous subclavian vein puncture versus surgical Venous Cutdown for the insertion of a totally implantable Venous access device
British Journal of Surgery, 2014Co-Authors: Lorenzo A Orci, Wojciech Staszewicz, Philippe Morel, Raphael P H Meier, Christian TosoAbstract:Totally implantable Venous access devices (TIVADs) are commonly used in patients with cancer. Although several methods of implantation have been described, there is not enough evidence to support the use of a specific technique on a daily basis. The objective of this study was systematically to assess the literature comparing percutaneous subclavian vein puncture with surgical Venous Cutdown.
-
Routine chest X-ray is not mandatory after fluoroscopy-guided totally implantable Venous access device insertion
Annals of vascular surgery, 2013Co-Authors: Theodoros Thomopoulos, Wojciech Staszewicz, Jeremy Meyer, Christian Toso, Ilias Bagetakos, Max Scheffler, Antoine Paul Lomessy, Christoph D. Becker, Philippe MorelAbstract:Background The aim of this study is to determine whether systematic postoperative chest X-ray is required after totally implantable Venous access port device (TIVAD) placement under fluoroscopic control. Methods A retrospective chart review of all consecutive patients with fluoroscopy-guided TIVAD insertion from July 10, 2009 to April 16, 2012 was conducted at the Geneva University Hospitals ( n = 927). Patients with an available postoperative chest X-ray were included, regardless of approach (open or percutaneous) and Venous access site (subclavian, cephalic, jugular, etc.). Exclusion criteria were incomplete data and preexisting pneumothorax or hemothorax. Results Eight hundred ninety-one patients were included. First-intention Venous Cutdown was performed in 878 patients (98.5%), with success rates of 79.4% and 88.2% when targeting the left and right cephalic veins, respectively. Percutaneous access was the chosen first-intention procedure for 12 patients (1.3%). Eight-hundred thirty-six (93.8%) insertions were performed only by the open approach and 53 (5.9%) implantations required at least one Venous puncture. Two implantations were performed using previous central Venous accesses. Immediate complications associated with TIVAD placement and detected on the postoperative chest X-ray consisted of 1 asymptomatic pneumothorax, 1 symptomatic hemothorax, and 2 malpositions of the catheter. One additional pneumothorax was discovered during the first night after TIVAD insertion in a patient who became symptomatic. Conclusions The very low incidence of immediate complications detected by postprocedural chest X-ray suggests that such a control is not mandatory as a routine method after fluoroscopy-guided TIVAD insertion mainly performed by Venous Cutdown. X-ray should be performed only in cases of clinical suspicion.
-
Systematic review and meta‐analysis of percutaneous subclavian vein puncture versus surgical Venous Cutdown for the insertion of a totally implantable Venous access device
The British journal of surgery, 2013Co-Authors: Lorenzo A Orci, Wojciech Staszewicz, Philippe Morel, Raphael P H Meier, Christian TosoAbstract:Totally implantable Venous access devices (TIVADs) are commonly used in patients with cancer. Although several methods of implantation have been described, there is not enough evidence to support the use of a specific technique on a daily basis. The objective of this study was systematically to assess the literature comparing percutaneous subclavian vein puncture with surgical Venous Cutdown.
Wojciech Staszewicz - One of the best experts on this subject based on the ideXlab platform.
-
ultrasound based prediction of cephalic vein Cutdown success prior to totally implantable Venous access device placement
Journal of vascular surgery. Venous and lymphatic disorders, 2019Co-Authors: Wojciech Staszewicz, Surennaidoo P Naiken, Andre Mennet, Jeremy Meyer, Marc Philip Righini, Philippe Morel, Christian TosoAbstract:Abstract Background Surgical Venous Cutdown 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 Cutdown failure for TIVAD insertion. Methods Ultrasound and operative reports of a cohort of patients undergoing TIVAD insertion by cephalic vein Cutdown 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 Cutdown 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 Cutdown. Preoperative ultrasound examination constitutes an efficient tool for choosing the most appropriate surgical approach and improving patient comfort.
-
systematic review and meta analysis of percutaneous subclavian vein puncture versus surgical Venous Cutdown for the insertion of a totally implantable Venous access device
British Journal of Surgery, 2014Co-Authors: Lorenzo A Orci, Wojciech Staszewicz, Philippe Morel, Raphael P H Meier, Christian TosoAbstract:Totally implantable Venous access devices (TIVADs) are commonly used in patients with cancer. Although several methods of implantation have been described, there is not enough evidence to support the use of a specific technique on a daily basis. The objective of this study was systematically to assess the literature comparing percutaneous subclavian vein puncture with surgical Venous Cutdown.
-
Routine chest X-ray is not mandatory after fluoroscopy-guided totally implantable Venous access device insertion
Annals of vascular surgery, 2013Co-Authors: Theodoros Thomopoulos, Wojciech Staszewicz, Jeremy Meyer, Christian Toso, Ilias Bagetakos, Max Scheffler, Antoine Paul Lomessy, Christoph D. Becker, Philippe MorelAbstract:Background The aim of this study is to determine whether systematic postoperative chest X-ray is required after totally implantable Venous access port device (TIVAD) placement under fluoroscopic control. Methods A retrospective chart review of all consecutive patients with fluoroscopy-guided TIVAD insertion from July 10, 2009 to April 16, 2012 was conducted at the Geneva University Hospitals ( n = 927). Patients with an available postoperative chest X-ray were included, regardless of approach (open or percutaneous) and Venous access site (subclavian, cephalic, jugular, etc.). Exclusion criteria were incomplete data and preexisting pneumothorax or hemothorax. Results Eight hundred ninety-one patients were included. First-intention Venous Cutdown was performed in 878 patients (98.5%), with success rates of 79.4% and 88.2% when targeting the left and right cephalic veins, respectively. Percutaneous access was the chosen first-intention procedure for 12 patients (1.3%). Eight-hundred thirty-six (93.8%) insertions were performed only by the open approach and 53 (5.9%) implantations required at least one Venous puncture. Two implantations were performed using previous central Venous accesses. Immediate complications associated with TIVAD placement and detected on the postoperative chest X-ray consisted of 1 asymptomatic pneumothorax, 1 symptomatic hemothorax, and 2 malpositions of the catheter. One additional pneumothorax was discovered during the first night after TIVAD insertion in a patient who became symptomatic. Conclusions The very low incidence of immediate complications detected by postprocedural chest X-ray suggests that such a control is not mandatory as a routine method after fluoroscopy-guided TIVAD insertion mainly performed by Venous Cutdown. X-ray should be performed only in cases of clinical suspicion.
-
Systematic review and meta‐analysis of percutaneous subclavian vein puncture versus surgical Venous Cutdown for the insertion of a totally implantable Venous access device
The British journal of surgery, 2013Co-Authors: Lorenzo A Orci, Wojciech Staszewicz, Philippe Morel, Raphael P H Meier, Christian TosoAbstract:Totally implantable Venous access devices (TIVADs) are commonly used in patients with cancer. Although several methods of implantation have been described, there is not enough evidence to support the use of a specific technique on a daily basis. The objective of this study was systematically to assess the literature comparing percutaneous subclavian vein puncture with surgical Venous Cutdown.
Philippe Morel - One of the best experts on this subject based on the ideXlab platform.
-
ultrasound based prediction of cephalic vein Cutdown success prior to totally implantable Venous access device placement
Journal of vascular surgery. Venous and lymphatic disorders, 2019Co-Authors: Wojciech Staszewicz, Surennaidoo P Naiken, Andre Mennet, Jeremy Meyer, Marc Philip Righini, Philippe Morel, Christian TosoAbstract:Abstract Background Surgical Venous Cutdown 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 Cutdown failure for TIVAD insertion. Methods Ultrasound and operative reports of a cohort of patients undergoing TIVAD insertion by cephalic vein Cutdown 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 Cutdown 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 Cutdown. Preoperative ultrasound examination constitutes an efficient tool for choosing the most appropriate surgical approach and improving patient comfort.
-
systematic review and meta analysis of percutaneous subclavian vein puncture versus surgical Venous Cutdown for the insertion of a totally implantable Venous access device
British Journal of Surgery, 2014Co-Authors: Lorenzo A Orci, Wojciech Staszewicz, Philippe Morel, Raphael P H Meier, Christian TosoAbstract:Totally implantable Venous access devices (TIVADs) are commonly used in patients with cancer. Although several methods of implantation have been described, there is not enough evidence to support the use of a specific technique on a daily basis. The objective of this study was systematically to assess the literature comparing percutaneous subclavian vein puncture with surgical Venous Cutdown.
-
Routine chest X-ray is not mandatory after fluoroscopy-guided totally implantable Venous access device insertion
Annals of vascular surgery, 2013Co-Authors: Theodoros Thomopoulos, Wojciech Staszewicz, Jeremy Meyer, Christian Toso, Ilias Bagetakos, Max Scheffler, Antoine Paul Lomessy, Christoph D. Becker, Philippe MorelAbstract:Background The aim of this study is to determine whether systematic postoperative chest X-ray is required after totally implantable Venous access port device (TIVAD) placement under fluoroscopic control. Methods A retrospective chart review of all consecutive patients with fluoroscopy-guided TIVAD insertion from July 10, 2009 to April 16, 2012 was conducted at the Geneva University Hospitals ( n = 927). Patients with an available postoperative chest X-ray were included, regardless of approach (open or percutaneous) and Venous access site (subclavian, cephalic, jugular, etc.). Exclusion criteria were incomplete data and preexisting pneumothorax or hemothorax. Results Eight hundred ninety-one patients were included. First-intention Venous Cutdown was performed in 878 patients (98.5%), with success rates of 79.4% and 88.2% when targeting the left and right cephalic veins, respectively. Percutaneous access was the chosen first-intention procedure for 12 patients (1.3%). Eight-hundred thirty-six (93.8%) insertions were performed only by the open approach and 53 (5.9%) implantations required at least one Venous puncture. Two implantations were performed using previous central Venous accesses. Immediate complications associated with TIVAD placement and detected on the postoperative chest X-ray consisted of 1 asymptomatic pneumothorax, 1 symptomatic hemothorax, and 2 malpositions of the catheter. One additional pneumothorax was discovered during the first night after TIVAD insertion in a patient who became symptomatic. Conclusions The very low incidence of immediate complications detected by postprocedural chest X-ray suggests that such a control is not mandatory as a routine method after fluoroscopy-guided TIVAD insertion mainly performed by Venous Cutdown. X-ray should be performed only in cases of clinical suspicion.
-
Systematic review and meta‐analysis of percutaneous subclavian vein puncture versus surgical Venous Cutdown for the insertion of a totally implantable Venous access device
The British journal of surgery, 2013Co-Authors: Lorenzo A Orci, Wojciech Staszewicz, Philippe Morel, Raphael P H Meier, Christian TosoAbstract:Totally implantable Venous access devices (TIVADs) are commonly used in patients with cancer. Although several methods of implantation have been described, there is not enough evidence to support the use of a specific technique on a daily basis. The objective of this study was systematically to assess the literature comparing percutaneous subclavian vein puncture with surgical Venous Cutdown.
Lorenzo A Orci - One of the best experts on this subject based on the ideXlab platform.
-
systematic review and meta analysis of percutaneous subclavian vein puncture versus surgical Venous Cutdown for the insertion of a totally implantable Venous access device
British Journal of Surgery, 2014Co-Authors: Lorenzo A Orci, Wojciech Staszewicz, Philippe Morel, Raphael P H Meier, Christian TosoAbstract:Totally implantable Venous access devices (TIVADs) are commonly used in patients with cancer. Although several methods of implantation have been described, there is not enough evidence to support the use of a specific technique on a daily basis. The objective of this study was systematically to assess the literature comparing percutaneous subclavian vein puncture with surgical Venous Cutdown.
-
Systematic review and meta‐analysis of percutaneous subclavian vein puncture versus surgical Venous Cutdown for the insertion of a totally implantable Venous access device
The British journal of surgery, 2013Co-Authors: Lorenzo A Orci, Wojciech Staszewicz, Philippe Morel, Raphael P H Meier, Christian TosoAbstract:Totally implantable Venous access devices (TIVADs) are commonly used in patients with cancer. Although several methods of implantation have been described, there is not enough evidence to support the use of a specific technique on a daily basis. The objective of this study was systematically to assess the literature comparing percutaneous subclavian vein puncture with surgical Venous Cutdown.
Mieke L Van Driel - One of the best experts on this subject based on the ideXlab platform.
-
Venous Cutdown versus the seldinger technique for placement of totally implantable Venous access ports
Cochrane Database of Systematic Reviews, 2016Co-Authors: Charlie Chiatsong Hsu, Gigi Nga Chi Kwan, Hannah Evansbarns, John A Rophael, Mieke L Van DrielAbstract:Background Totally implantable Venous access ports (TIVAPs) provide patients with a safe and permanent Venous access, for instance in the administration of chemotherapy for oncology patients. There are several methods for TIVAP placement, and the optimal evidence-based method is unclear. Objectives To compare the efficacy and safety of three commonly used techniques for implanting TIVAPs: the Venous Cutdown technique, the Seldinger technique, and the modified Seldinger technique. This review includes studies that use Doppler or real-time two-dimensional ultrasonography for locating the vein in the Seldinger technique. Search methods The Cochrane Vascular Trials Search Co-ordinator searched the Cochrane Vascular Specialised Register (last searched August 2015) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 7), as well as clinical trials registers. Selection criteria We included randomised or quasi-randomised controlled clinical trials that randomly allocated people requiring TIVAP to the Venous Cutdown, Seldinger, or modified Seldinger technique. Two review authors independently assessed studies for inclusion eligibility, with a third review author checking excluded studies. Data collection and analysis Two review authors independently extracted data. We assessed all studies for risk of bias. We assessed heterogeneity using Chi2 statistic and variance (I2statistic) methods. Dichotomous outcomes, summarised as odds ratio (OR) with 95% confidence interval (CI), were: primary implantation success, complications (in particular infection), pneumothorax, and catheter complications. We conducted separate analyses to assess the two access veins, subclavian and internal jugular (IJ) vein, in the Seldinger technique versus the Venous Cutdown technique. We used both intention-to-treat (ITT) and on-treatment analyses and pooled data using a fixed-effect model. Main results We included nine studies with a total of 1253 participants in the review. Five studies compared Seldinger technique (subclavian vein access) with Venous Cutdown technique (cephalic vein access). Two studies compared Seldinger (IJ vein) versus Venous Cutdown (cephalic vein). One study compared the modified Seldinger technique (cephalic vein) with the Venous Cutdown (cephalic vein), and one study compared the Seldinger (subclavian vein) versus the Seldinger (IJ vein) technique. Seldinger technique (subclavian or IJ vein access) versus Venous Cutdown (cephalic vein): We included seven trials with 1006 participants for analysis. Both ITT (OR 0.40; 95% CI 0.25 to 0.65) and on-treatment analysis (OR 0.59; 95% CI 0.36 to 0.98) showed that the Seldinger technique for implantation of TIVAP had a higher success rate compared with the Venous Cutdown technique. We found no difference between overall peri- and postoperative complication rates: ITT (OR 1.16; 95% CI 0.76 to 1.75) and on-treatment analysis (OR 0.93; 95% CI 0.62 to 1.40). In the Seldinger group, the majority of the trials reported use of the subclavian vein for Venous access, with only a limited number of trials utilising the IJ vein for access. When individual complication rates of infection, pneumothorax, and catheter complications were analysed, the Seldinger technique (subclavian vein access) was associated with a higher rate of catheter complications compared to the Venous Cutdown technique: ITT (OR 6.77; 95% CI 2.31 to 19.79) and on-treatment analysis (OR 6.62; 95% CI 2.24 to 19.58). There was no difference in incidence of infections, pneumothorax, and other complications between the groups. Modified Seldinger technique (cephalic vein) versus Venous Cutdown (cephalic vein): We identified one trial with 164 participants. ITT analysis showed no difference in primary implantation success rate between the modified Seldinger technique (69/82, 84%) and the Venous Cutdown technique (66/82, 80%), P = 0.686. We observed no differences in the peri- or postoperative complication rates. Seldinger (subclavian vein access) versus Seldinger (IJ vein access): We identified one trial with 83 participants. The primary success rate was 84% (37/44) for Seldinger (subclavian vein) versus 74% (29/39) for the Seldinger (IJ vein). There was a higher overall complication rate in the subclavian group (48%) compared to the jugular group (23%), P = 0.02. However, when specific complications were compared individually, we found no differences between the groups. The overall quality of the trials included in this review was moderate. The methods used for randomisation were inadequate in four of the nine included studies, but sensitivity analysis excluding these trials did not alter the outcome. The nature of the interventions, either Venous Cutdown or Seldinger techniques, meant that it was not feasible to blind the participant or personnel, therefore we judged this to be at low risk of bias. The majority of participants in the included trials were oncology patients at tertiary centres, and the outcomes were applicable to the typical clinical scenario. For all outcomes, when comparing Venous Cutdown and Seldinger technique, serious imprecision was evident by wide confidence intervals in the included trials. The quality of the overall evidence was therefore downgraded from high to moderate. Due to the limited number of included studies we were unable to assess publication bias. Authors' conclusions Moderate-quality evidence showed that the Seldinger technique has a higher primary implantation success rate compared with the Venous Cutdown technique. The majority of trials using the Seldinger technique used the subclavian vein for Venous access, and only a few trials reported the use of the internal jugular vein for Venous access. Moderate-quality evidence showed no difference in the overall complication rate between the Seldinger and Venous Cutdown techniques. However, when the Seldinger technique with subclavian vein access was compared with the Venous Cutdown group, there was a higher reported incidence of catheter complications. The rates of pneumothorax and infection did not differ between the Seldinger and Venous Cutdown group. We identified only one trial for each of the comparisons modified Seldinger technique (cephalic vein) versus Venous Cutdown (cephalic vein) and Seldinger (subclavian vein access) versus Seldinger (IJ vein access), thus a definitive conclusion cannot be drawn for these comparisons and further research is recommended.
-
The Cochrane Library - Venous Cutdown versus the Seldinger technique for placement of totally implantable Venous access ports.
Cochrane Database of Systematic Reviews, 2016Co-Authors: Charlie Chiatsong Hsu, Gigi Nga Chi Kwan, John A Rophael, Hannah Evans-barns, Mieke L Van DrielAbstract:Background Totally implantable Venous access ports (TIVAPs) provide patients with a safe and permanent Venous access, for instance in the administration of chemotherapy for oncology patients. There are several methods for TIVAP placement, and the optimal evidence-based method is unclear. Objectives To compare the efficacy and safety of three commonly used techniques for implanting TIVAPs: the Venous Cutdown technique, the Seldinger technique, and the modified Seldinger technique. This review includes studies that use Doppler or real-time two-dimensional ultrasonography for locating the vein in the Seldinger technique. Search methods The Cochrane Vascular Trials Search Co-ordinator searched the Cochrane Vascular Specialised Register (last searched August 2015) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 7), as well as clinical trials registers. Selection criteria We included randomised or quasi-randomised controlled clinical trials that randomly allocated people requiring TIVAP to the Venous Cutdown, Seldinger, or modified Seldinger technique. Two review authors independently assessed studies for inclusion eligibility, with a third review author checking excluded studies. Data collection and analysis Two review authors independently extracted data. We assessed all studies for risk of bias. We assessed heterogeneity using Chi2 statistic and variance (I2statistic) methods. Dichotomous outcomes, summarised as odds ratio (OR) with 95% confidence interval (CI), were: primary implantation success, complications (in particular infection), pneumothorax, and catheter complications. We conducted separate analyses to assess the two access veins, subclavian and internal jugular (IJ) vein, in the Seldinger technique versus the Venous Cutdown technique. We used both intention-to-treat (ITT) and on-treatment analyses and pooled data using a fixed-effect model. Main results We included nine studies with a total of 1253 participants in the review. Five studies compared Seldinger technique (subclavian vein access) with Venous Cutdown technique (cephalic vein access). Two studies compared Seldinger (IJ vein) versus Venous Cutdown (cephalic vein). One study compared the modified Seldinger technique (cephalic vein) with the Venous Cutdown (cephalic vein), and one study compared the Seldinger (subclavian vein) versus the Seldinger (IJ vein) technique. Seldinger technique (subclavian or IJ vein access) versus Venous Cutdown (cephalic vein): We included seven trials with 1006 participants for analysis. Both ITT (OR 0.40; 95% CI 0.25 to 0.65) and on-treatment analysis (OR 0.59; 95% CI 0.36 to 0.98) showed that the Seldinger technique for implantation of TIVAP had a higher success rate compared with the Venous Cutdown technique. We found no difference between overall peri- and postoperative complication rates: ITT (OR 1.16; 95% CI 0.76 to 1.75) and on-treatment analysis (OR 0.93; 95% CI 0.62 to 1.40). In the Seldinger group, the majority of the trials reported use of the subclavian vein for Venous access, with only a limited number of trials utilising the IJ vein for access. When individual complication rates of infection, pneumothorax, and catheter complications were analysed, the Seldinger technique (subclavian vein access) was associated with a higher rate of catheter complications compared to the Venous Cutdown technique: ITT (OR 6.77; 95% CI 2.31 to 19.79) and on-treatment analysis (OR 6.62; 95% CI 2.24 to 19.58). There was no difference in incidence of infections, pneumothorax, and other complications between the groups. Modified Seldinger technique (cephalic vein) versus Venous Cutdown (cephalic vein): We identified one trial with 164 participants. ITT analysis showed no difference in primary implantation success rate between the modified Seldinger technique (69/82, 84%) and the Venous Cutdown technique (66/82, 80%), P = 0.686. We observed no differences in the peri- or postoperative complication rates. Seldinger (subclavian vein access) versus Seldinger (IJ vein access): We identified one trial with 83 participants. The primary success rate was 84% (37/44) for Seldinger (subclavian vein) versus 74% (29/39) for the Seldinger (IJ vein). There was a higher overall complication rate in the subclavian group (48%) compared to the jugular group (23%), P = 0.02. However, when specific complications were compared individually, we found no differences between the groups. The overall quality of the trials included in this review was moderate. The methods used for randomisation were inadequate in four of the nine included studies, but sensitivity analysis excluding these trials did not alter the outcome. The nature of the interventions, either Venous Cutdown or Seldinger techniques, meant that it was not feasible to blind the participant or personnel, therefore we judged this to be at low risk of bias. The majority of participants in the included trials were oncology patients at tertiary centres, and the outcomes were applicable to the typical clinical scenario. For all outcomes, when comparing Venous Cutdown and Seldinger technique, serious imprecision was evident by wide confidence intervals in the included trials. The quality of the overall evidence was therefore downgraded from high to moderate. Due to the limited number of included studies we were unable to assess publication bias. Authors' conclusions Moderate-quality evidence showed that the Seldinger technique has a higher primary implantation success rate compared with the Venous Cutdown technique. The majority of trials using the Seldinger technique used the subclavian vein for Venous access, and only a few trials reported the use of the internal jugular vein for Venous access. Moderate-quality evidence showed no difference in the overall complication rate between the Seldinger and Venous Cutdown techniques. However, when the Seldinger technique with subclavian vein access was compared with the Venous Cutdown group, there was a higher reported incidence of catheter complications. The rates of pneumothorax and infection did not differ between the Seldinger and Venous Cutdown group. We identified only one trial for each of the comparisons modified Seldinger technique (cephalic vein) versus Venous Cutdown (cephalic vein) and Seldinger (subclavian vein access) versus Seldinger (IJ vein access), thus a definitive conclusion cannot be drawn for these comparisons and further research is recommended.
