Difficult removal of totally implantable venous access devices in adult patients: Incidence, risk factors, and management

Shohei Chatani, Ryota Tsukii, Kyohei Nagasawa, Takaaki Hasegawa, Shinichi Murata, Mina Kato, Hidekazu Yamaura, Hiroaki Onaya, Keitaro Matsuo, Yoshiyuki Watanabe, Yoshitaka Inaba

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Totally implantable venous access devices (TIVADs) have played an important role of medical oncology practice. However, operators sometimes encounter considerable difficulty when removing TIVADs. This study aimed to investigate the incidence of difficult TIVAD removal, determine associated risk factors, and investigate interventional radiology (IR) approaches to difficult removal. Methods: A total of 514 TIVAD removal procedures performed in a single-center between January 2014 and May 2021 were retrospectively analyzed to determine incidence of difficult removal and associated risk factors. IR approaches applied in difficult removal cases were also reviewed. Results: The incidence of difficult removal was 7.4% (38/514). In univariable analysis, indwelling duration, silicone catheter, and subcutaneous leakage of fluid were identified as significant risk factors for difficult removal. Multivariable analysis showed that indwelling duration per year (odds ratio (OR), 1.46; 95% confidence interval (CI), 1.28–1.67; p < 0.01) and subcutaneous leakage of fluid (OR, 6.04; 95% CI, 2.45–14.91; p < 0.01) were significantly associated with difficult removal. In the 38 difficult removal cases, 32 TIVADs could be removed using more dissection and traction than the standard removal method. In the other 6, TIVADs were successfully removed by using several IR techniques, including insertion of a guide wire (n = 1), dissection using an introducer sheath (n = 2), pushing with a dilator (n = 1), and pulling with a snare (n = 2). Conclusion: Difficult TIVAD removal is uncommon. However, operators should expect it when removing long indwelling TIVADs and those with subcutaneous leakage. IR approaches to difficult removal are minimally invasive and can be useful.

Original languageEnglish
Pages (from-to)1150-1157
Number of pages8
JournalJournal of Vascular Access
Issue number5
Publication statusPublished - 09-2023
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Nephrology


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