Ultrasound-Guided Totally Implantable Venous Access: Comparison between Arm and Chest Ports in Solid Organ Cancer Patients

Abstract

Purpose: The purpose of this study was to evaluate the safety, technical feasibility, and complications of ultrasound-guided placement of totally implantable venous access ports (TIVAPs) in the arm compared to the chest for patients with cancer in a single center. Methods: We retrospectively identified 371 patients who underwent TIVAP implantation in the upper arm or chest between July 2018 and June 2019. Implantation via the upper arm (arm port) or the jugular vein (chest port) was performed under sonographic and fluoroscopic guidance after administering local anesthesia. Medical records were reviewed to determine technical success, complications, and the causes of port removal were analyzed. Results: In total, 371 devices were implanted, 252 in the upper arm (n = 252) and 119 in the upper chest wall (n = 119). The technical success rate was 100%. There were fewer complications observed in the arm port group compared to the chest port group (13 vs 23 patients; 5.2% vs 19.3%), which was statistically significant (P = 0.002). The chest port group developed more complications per 1000 catheter days and had a higher total complication rate than the arm port group (P < 0.001). Local infection with abscess and wound dehiscence were the most common cause of port removal. Multivariate analysis showed that the implantable port in the arm involved a less complicated procedure (P = 0.002). Conclusion: Implantation of TIVAPs in the upper arm is a safe and feasible procedure with a low rate of complications. TIVAPs in the upper arm may be a good alternative to TIVAPs in the chest.

Outcomes and complications of single-longitudinal incision technique for totally implantable venous access ports in the upper arm

“…For years, the chest has been the most popular and reliable access site for long-term indwelling TIVAPs; however, chest TIVAPs may not be suitable for patients' undergoing radiotherapy with chest wall involvement or those with chest wall skin lesions; meanwhile, many female patients experience discomforts such as "foreign body sensation", "bra inconvenience" when wearing seat belt or bag strap. Research shows that TIVAPs implanted in the upper arm have fewer complications, including local infections and wound dehiscence, compared to chest implants, making them a safer option for cancer patients [5][6][7][8].In recent years, many centers have used an upper arm venous port as an alternative to a chest port. In addition, a single incision technique for chest TIVAP has proven to be feasible and safe, with a high technical success rate and minimal complications, indicating that the single incision no-tunnel technique for upper arm port is a viable method [4,9].…”