Increased Complication Rate of Ports Placed into the Subclavian versus Internal Jugular Vein

Abstract

Purpose: 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.