Upper-Extremity Deep Vein Thrombosis in Patients With Breast Cancer With Chest Versus Arm Central Venous Port Catheters

Abstract

Most of the patients undergoing treatment for cancer require placement of a totally implantable venous access device to facilitate safe delivery of chemotherapy. However, implantable ports also increase the risk of deep vein thrombosis and related complications in this high-risk population. The objective of this study was to assess the incidence of upper-extremity deep vein thrombosis (UEDVT) in patients with breast cancer to determine whether the risk of UEDVT was higher with chest versus arm ports, as well as to determine the importance of previously reported risk factors predisposing to UEDVT in the setting of active cancer. We retrospectively reviewed the medical records of 297 women with breast cancer who had ports placed in our institution between the dates of December 1, 2010, and December 31, 2016. The primary outcome was the development of radiologically confirmed UEDVT ipsilateral to the implanted port. Overall, 17 of 297 study subjects (5.7%) were found to have UEDVT. There was 1 documented case of associated pulmonary embolism. Fourteen (9.5%) of 147 subjects with arm ports experienced UEDVT compared with only 3 (2.0%) of 150 subjects with chest ports (P = .0056). Thus, implantation of arm ports as opposed to chest ports may be associated with a higher rate of UEDVT in patients with breast cancer.

PICC-PORT totally implantable vascular access device in breast cancer patients undergoing chemotherapy

“…3,4 As is the case with breast cancer patients, arm ports in patients who have head and neck tumours and a tracheostomy can potentially reduce infections since the access site in these latter patients is far from tracheal secretions that might facilitate cutaneous bacterial overgrowth increasing the risk of TIVAD pocket infections. [5][6][7][8] Despite these advantages, there are some concerns about a higher incidence of complications in patients with arm port devices as compared to chest ports. 2 Catheter occlusion, upper extremity deep vein thrombosis (UEDVT), skin dehiscence and needle dislocation with drug extravasation are reportedly responsible for the removal of the device in 4%-17% of patients.…”

“…2 Catheter occlusion, upper extremity deep vein thrombosis (UEDVT), skin dehiscence and needle dislocation with drug extravasation are reportedly responsible for the removal of the device in 4%-17% of patients. [6][7][8] In order to evaluate the possibility of reducing the incidence of arm TIVAD failures, the authors introduced a technical variation to the standard method of arm port placement named the peripherally inserted central catheter (PICC)-PORT technique. It consists of a percutaneous venous access through the basilic or brachial veins, which is always performed under ultrasound guidance using the micro-Seldinger technique that allows the venous catheter to be inserted in the proximal third of the upper arm, close to the axilla.…”

Risk of venous thromboembolism associated with totally implantable venous access ports in cancer patients: A systematic review and meta‐analysis

“…Additionally, compared with Hickman catheters, we also detect a trend for lower risk of VTE in the TIVAP groups (OR = 0.75, 95% CI: 0.37-1.50), but the result was not significant (P = .413). The results were Preferred venous access site Upper-extremity vein 7,19,20,25,30,31,41,42,59,64,67,69,91 3 .029…”

“…Retrospective 7,19,20,25,30,31,33,38,39,41,42,45,50,52,54,56,57,59,61,64 Port sites Chest ports 19,24,31,33,34,36,38,39,42,48,[50][51][52][53][54]57,61,64,68,[73][74][75][76] .702…”

“…Peripheral ports 7,19,20,25,30,31,41,42,59,64,67,69 7,8,20,24,25,30,31,34,36,38,39,41,42,45,48,[50][51][52][53][54]56 2. .381…”