Left-sided yoffa technique: a safe and optimized approach for totally implantable venous access device (TIVAD) placement.

BACKGROUND

Totally implantable venous access devices (TIVADs) are essential for the long-term management of oncology patients. Although access via the right internal jugular vein is usually preferred due to its favorable anatomy, left-sided access becomes necessary in certain cases (anatomical variations, previous surgeries, or thromboses) by employing the supraclavicular Yoffa technique.

METHODS

We describe a standardized and optimized approach using the Yoffa technique for left-sided TIVAD placement. Our protocol details patient positioning, venous puncture, guidewire insertion, subcutaneous tunneling, and port chamber implantation. This retrospective study included 719 patients, of which 216 underwent the left-sided approach.

RESULTS

The left-sided technique was successfully performed with low rates of early complications (pneumothorax 0.42%, hematoma 1.25%, arterial puncture 0.42%) and late complications (catheter-associated thrombosis 0.42%, port pocket infection 1.39%, catheter migration 0.14%) comparable to those obtained with the right-sided approach (503 patients, 69.95%). The main indications for the left-sided approach included right-sided obstruction, previous surgical or radiation history, and failed right-sided access (Rupp SM and Apfelbaum JL Anesth Analg 85(4):741-746) (1997); McGee DC and Gould MK. N Engl J Med 348(12):1123-1133 (2003); Souadka et al PLoS ONE 15(11):e0242727 (2020).

CONCLUSION

The left-sided Yoffa technique offers a safe and effective alternative for TIVAD placement when right-sided access is contraindicated or difficult. Its supraclavicular approach minimizes the risk of complications (pneumothorax, arterial puncture) and ensures an optimal catheter trajectory toward the superior vena cava.