Increased Complication Rate of Ports Placed into the Subclavian versus Internal Jugular Vein
AbstractPurpose: Totally implantable venous access ports are commonly placed via subclavian or internal jugular (IJ) veins. The purpose of this study is to investigate the rate of radiographic abnormalities in clinically dysfunctional ports for subclavian versus IJ venous ports. Methods: This retrospective study included 152 ports in 150 patients placed by multiple operators in both surgery and interventional radiology departments. Contrast-based, fluoroscopically guided vascular access studies performed for clinically dysfunctional ports from January 2019 to September 2020 were included. The port studies were evaluated for subclavian versus IJ access and to determine if there were radiographic abnormalities present, including catheter fracture, fibrin sheath, or catheter malposition. Results: Of the 152 ports investigated, 30 were placed into the subclavian vein and 122 into the IJ vein. During vascular access checks, subclavian ports (n=23, 76.7%) demonstrated significantly more radiographic abnormalities compared to IJ ports (n=66, 54.1%, p=0.025). Of the dysfunctional ports with abnormal radiographic findings, subclavian ports were significantly more likely to have a major abnormality (n=15, 65.2%), defined as a malpositioned or fractured catheter, compared to IJ ports (n=21, 31.8%, p=0.005). The most common finding during vascular access checks for all ports investigated was no abnormality, with a well-functioning port and the catheter tip in an appropriate position (n=63; 41.4%). Conclusions: This study suggests that for patients undergoing implantable port evaluation, ports placed into the subclavian vein are more likely to demonstrate a radiographic abnormality, as well as having increased likelihood of catheter malposition or fracture, compared to those placed into the IJ vein. Additionally, this study suggests that a relatively high rate of clinically dysfunctional ports referred for IR port checks have no demonstrable abnormalities on fluoroscopic port evaluation.
Walser EM. Venous access ports: indications, implantation technique, follow-up, and complications. Cardiovasc Intervent Radiol. Aug 2012;35(4):751-64. doi:10.1007/s00270-011-0271-2
Araujo C, Silva JP, Antunes P, et al. A comparative study between two central veins for the introduction of totally implantable venous access devices in 1201 cancer patients. Eur J Surg Oncol. Feb 2008;34(2):222-6. doi:10.1016/j.ejso.2007.04.003
Machat S, Eisenhuber E, Pfarl G, et al. Complications of central venous port systems: a pictorial review. Insights Imaging. Aug 28 2019;10(1):86. doi:10.1186/s13244-019-0770-2
Nagasawa Y, Shimizu T, Sonoda H, et al. A comparison of outcomes and complications of totally implantable access port through the internal jugular vein versus the subclavian vein. Int Surg. Mar-Apr 2014;99(2):182-8. doi:10.9738/INTSURG-D-13-00185.1
Tsai YF, Ku YH, Chen SW, Huang WT, Lu CC, Tsao CJ. Right- and left-subclavian vein port-a-cath systems: comparison of complications. Eur Surg Res. 2012;49(2):66-72. doi:10.1159/000339308
Plumhans C, Mahnken AH, Ocklenburg C, et al. Jugular versus subclavian totally implantable access ports: catheter position, complications and intrainterventional pain perception. Eur J Radiol. Sep 2011;79(3):338-42. doi:10.1016/j.ejrad.2009.12.010
Chang DH, Mammadov K, Hickethier T, et al. Fibrin sheaths in central venous port catheters: treatment with low-dose, single injection of urokinase on an outpatient basis. Ther Clin Risk Manag. 2017;13:111-115. doi:10.2147/TCRM.S125130
Brady PS, Spence LD, Levitin A, Mickolich CT, Dolmatch BL. Efficacy of percutaneous fibrin sheath stripping in restoring patency of tunneled hemodialysis catheters. AJR Am J Roentgenol. Oct 1999;173(4):1023-7. doi:10.2214/ajr.173.4.10511171
Reddy AS, Lang EV, Cutts J, Loh S, Rosen MP. Fibrin sheath removal from central venous catheters: an internal snare manoeuvre. Nephrol Dial Transplant. Jun 2007;22(6):1762-5. doi:10.1093/ndt/gfm154
Gebauer B, Teichgraber UK, Podrabsky P, Werk M, Hanninen EL, Felix R. Radiological interventions for correction of central venous port catheter migrations. Cardiovasc Intervent Radiol. Jul-Aug 2007;30(4):668-74. doi:10.1007/s00270-007-9073-y
Mirza B, Vanek VW, Kupensky DT. Pinch-off syndrome: case report and collective review of the literature. Am Surg. Jul 2004;70(7):635-44.
Behrendt FF, Wingen M, Katoh M, Guenther RW, Buecker A. Evaluation of catheter loops in central venous port systems. Invest Radiol. Nov 2006;41(11):777-80. doi:10.1097/01.rli.0000239315.93244.8d
Sharma RP, Ree CJ, Ree A. Efficacy and safety of a single 2 mg dose or 4 mg double dose of alteplase for 50 occluded chest ports using a unique instillation technique. Int J Angiol. Fall 2008;17(3):125-8. doi:10.1055/s-0031-1278294
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