CardioVascular and Interventional Radiology

, Volume 34, Issue 6, pp 1222–1229 | Cite as

Subclavian Vein Versus Arm Vein for Totally Implantable Central Venous Port for Patients with Head and Neck Cancer: A Retrospective Comparative Analysis

  • Akio AkahaneEmail author
  • Miyuki Sone
  • Shigeru Ehara
  • Kenichi Kato
  • Ryoichi Tanaka
  • Tatsuhiko Nakasato
Clinical Investigation



This study was designed to compare central venous ports (CVP) from two different routes of venous access―the subclavian vein and arm vein―in terms of safety for patients with head and neck cancer (HNC).


Patients with HNC who underwent image-guided implantations of CVPs were retrospectively evaluated. All CVPs were implanted under local anesthesia. Primary outcome measurements were rates and types of adverse events (AEs). Secondary outcomes included technical success and rate and reason of CVP removal.


A total of 162 patients (subclavian port group, 47; arm port group, 115) were included in this study. Technical success was achieved in all patients. The median follow-up period was 94 (range, 1–891) days. Two patients in the subclavian port group experienced periprocedural complications. Postprocedural AEs were observed in 8.5 and 22.6% of the subclavian port and arm port group patients, respectively (P = 0.044). Phlebitis and system occlusions were observed only in the arm port group. The rate of infection was not significantly different between the two groups. The CVP was removed in 34 and 39.1% of the subclavian port and arm port patients, respectively.


Both subclavian and arm CVPs are feasible in patients with HNC. AEs were more frequent in the arm port group; thus, the arm port is not recommended as the first choice for patients with HNC. However, further experience is needed to improve the placement technique and the maintenance of CVPs and a prospective analysis is warranted.


Central venous port Venous access Subclavian vein Arm vein 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Adelstein DJ, Li Y, Adams GL et al (2003) An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 21(1):92–98PubMedCrossRefGoogle Scholar
  2. 2.
    Forastiere AA, Goepfert H, Maor M et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349(22):2091–2098PubMedCrossRefGoogle Scholar
  3. 3.
    Brizel DM (1998) Radiotherapy and concurrent chemotherapy for the treatment of locally advanced head and neck squamous cell carcinoma. Semin Radiat Oncol 8(4):237–246PubMedCrossRefGoogle Scholar
  4. 4.
    Bodner LJ, Nosher JL, Patel KM et al (2000) Peripheral venous access ports: outcomes analysis in 109 patients. Cardiovasc Intervent Radiol 23(3):187–193PubMedCrossRefGoogle Scholar
  5. 5.
    Kock HJ, Pietsch M, Krause U et al (1998) Implantable vascular access systems: experience in 1500 patients with totally implanted central venous port systems. World J Surg 22(1):12–16PubMedCrossRefGoogle Scholar
  6. 6.
    Lorch H, Zwaan M, Kagel C et al (2001) Central venous access ports placed by interventional radiologists: experience with 125 consecutive patients. Cardiovasc Intervent Radiol 24(3):180–184PubMedCrossRefGoogle Scholar
  7. 7.
    Kuriakose P, Colon-Otero G, Paz-Fumagalli R (2002) Risk of deep venous thrombosis associated with chest versus arm central venous subcutaneous port catheters: a 5-year single-institution retrospective study. J Vasc Interv Radiol 13(2 Pt 1):179–184PubMedCrossRefGoogle Scholar
  8. 8.
    Vardy J, Engelhardt K, Cox K et al (2004) Long-term outcome of radiological-guided insertion of implanted central venous access port devices (CVAPD) for the delivery of chemotherapy in cancer patients: institutional experience and review of the literature. Br J Cancer 91(6):1045–1049PubMedGoogle Scholar
  9. 9.
    Biffi R, de Braud F, Orsi F et al (1998) Totally implantable central venous access ports for long-term chemotherapy. A prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days. Ann Oncol 9(7):767–773PubMedCrossRefGoogle Scholar
  10. 10.
    Marcy PY, Chamorey E, Amoretti N et al (2008) A comparison between distal and proximal port device insertion in head and neck cancer. Eur J Surg Oncol 34(11):1262–1269PubMedCrossRefGoogle Scholar
  11. 11.
    Sacks D, McClenny TE, Cardella JF et al (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14(9 Pt 2):S199–S202PubMedGoogle Scholar
  12. 12.
    O’Grady NP, Alexander M, Dellinger EP et al (2002) Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 23(12):759–769PubMedCrossRefGoogle Scholar
  13. 13.
    Groeger JS, Lucas AB, Thaler HT et al (1993) Infectious morbidity associated with long-term use of venous access devices in patients with cancer. Ann Intern Med 119(12):1168–1174PubMedGoogle Scholar
  14. 14.
    Trotti A, Colevas AD, Setser A et al (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13(3):176–181PubMedCrossRefGoogle Scholar
  15. 15.
    Marcy PY, Figl A, Amoretti N et al (2010) Arm port implantation in cancer patients. Int J Clin Oncol 15(3):328–330PubMedCrossRefGoogle Scholar
  16. 16.
    Aitken DR, Minton JP (1984) The “pinch-off sign”: a warning of impending problems with permanent subclavian catheters. Am J Surg 148(5):633–636PubMedCrossRefGoogle Scholar
  17. 17.
    Hata Y, Morita S, Morita Y et al (1998) Peripheral insertion of a central venous access device under fluoroscopic guidance using a peripherally accessed system (PAS) port in the forearm. Cardiovasc Intervent Radiol 21(3):230–233PubMedCrossRefGoogle Scholar
  18. 18.
    Marcy PY, Magne N, Castadot P et al (2007) Is radiologic placement of an arm port mandatory in oncology patients? Analysis of a large bi-institutional experience. Cancer 110(10):2331–2338PubMedCrossRefGoogle Scholar
  19. 19.
    Lameris JS, Post PJ, Zonderland HM, Gerritsen PG, Kappers-Klunne MC, Schutte HE (1990) Percutaneous placement of Hickman catheters: comparison of sonographically guided and blind techniques. AJR Am J Roentgenol 155(5):1097–1099PubMedGoogle Scholar
  20. 20.
    Sakamoto N, Arai Y, Takeuchi Y et al (2010) Ultrasound-guided radiological placement of central venous port via the subclavian vein: a retrospective analysis of 500 cases at a single institute. Cardiovasc Intervent Radiol 33(5):989–994CrossRefGoogle Scholar
  21. 21.
    Biffi R, De Braud F, Orsi F et al (2001) A randomized, prospective trial of central venous ports connected to standard open-ended or Groshong catheters in adult oncology patients. Cancer 92(5):1204–1212PubMedCrossRefGoogle Scholar
  22. 22.
    Kawamura J, Nagayama S, Nomura A et al (2008) Long-term outcomes of peripheral arm ports implanted in patients with colorectal cancer. Int J Clin Oncol 13(4):349–354PubMedCrossRefGoogle Scholar
  23. 23.
    Starkhammar H, Bengtsson M, Morales O (1992) Fibrin sleeve formation after long term brachial catheterisation with an implantable port device. A prospective venographic study. Eur J Surg 158(9):481–484PubMedGoogle Scholar
  24. 24.
    Biffi R, Martinelli G, Pozzi S et al (1999) Totally implantable central venous access ports for high-dose chemotherapy administration and autologous stem cell transplantation: analysis of overall and septic complications in 68 cases using a single type of device. Bone Marrow Transpl 24(1):89–93CrossRefGoogle Scholar
  25. 25.
    McGee DC, Gould MK (2003) Preventing complications of central venous catheterization. N Engl J Med 348(12):1123–1133PubMedCrossRefGoogle Scholar
  26. 26.
    Imberti D, Di Nisio M, Donati MB et al (2009) Treatment of venous thromboembolism in patients with cancer: guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res 124(5):e32–4025PubMedCrossRefGoogle Scholar
  27. 27.
    Yildizeli B, Lacin T, Batirel HF et al (2004) Complications and management of long-term central venous access catheters and ports. J Vasc Access 5(4):174–178PubMedGoogle Scholar
  28. 28.
    Muscedere G, Bennett JD, Lee TY et al (1998) Complications of radiologically placed central venous ports and Hickman catheters in patients with AIDS. Can Assoc Radiol J 49(2):84–89PubMedGoogle Scholar
  29. 29.
    Huang WT, Chen TY, Su WC et al (2004) Implantable venous port-related infections in cancer patients. Support Care Cancer 12(3):197–201PubMedCrossRefGoogle Scholar
  30. 30.
    Johansson E, Bjorkholm M, Bjorvell H et al (2004) Totally implantable subcutaneous port system versus central venous catheter placed before induction chemotherapy in patients with acute leukaemia-a randomized study. Support Care Cancer 12(2):99–105PubMedCrossRefGoogle Scholar
  31. 31.
    Sadoyama G, Gontijo Filho PP (2003) Comparison between the jugular and subclavian vein as insertion site for central venous catheters: microbiological aspects and risk factors for colonization and infection. Braz J Infect Dis 7(2):142–148PubMedCrossRefGoogle Scholar
  32. 32.
    Merrer J, De Jonghe B, Golliot F et al (2001) Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 286(6):700–707PubMedCrossRefGoogle Scholar
  33. 33.
    Foley MJ (1995) Radiologic placement of long-term central venous peripheral access system ports (PAS Port): results in 150 patients. J Vasc Interv Radiol 6(2):255–262PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Akio Akahane
    • 1
    Email author
  • Miyuki Sone
    • 1
  • Shigeru Ehara
    • 1
  • Kenichi Kato
    • 1
  • Ryoichi Tanaka
    • 1
  • Tatsuhiko Nakasato
    • 1
  1. 1.Department of RadiologyIwate Medical University School of MedicineMoriokaJapan

Personalised recommendations