Highlights

  • Larger, arm port polyurethane catheters have more potential for:

    ○ Venous thrombosis

    ○ Multivessel venous thrombosis

    ○ Access vein occlusive thrombosis

  • Arm port venous thrombosis is more frequent than suspected and is asymptomatic

Abstract

Background: Venous thrombosis is a possible complication of vein port insertion. A randomized cohort of 211 oncology patients receiving either a power injectable or nonpower injectable implanted arm port were prospectively assessed for complication-related removal. Because the outcome of venous thrombus occurred more frequently in power injectable port recipients, this analysis further investigates thrombus characteristics by port type among patients who underwent Doppler ultrasound within 3 months of port implantation.

Methods: Patients were randomized to receive 1 of 2 totally implanted venous access devices (TIVADs), either a nonpower injectable Cook TIVAD with a 5F catheter or a power injectable AngioDynamics TIVAD with a 6.6F catheter. Patients were scheduled to have an ipsilateral arm, subclavian region, and base of neck venous Doppler ultrasound 3 months after port implantation, or sooner, if clinically indicated.

Results: By 3 months postimplantation, 140 patients had undergone ultrasound. Two ultrasounds were performed earlier than at 3 months to investigate clinically suspected venous thrombosis. Twenty-one of these 140 patients (15.0%) developed venous thrombosis, 2 symptomatic and 19 asymptomatic. Among those receiving an ultrasound, 15 cases of venous thrombosis were identified among those with the larger, power injectable, polyurethane catheter (n = 76, 19.7%) and 6 among those with the smaller, nonpower injectable, silicone catheter (n = 67, 9.0%, P = 0.08). The former also had a higher frequency of access vein occlusive thrombus.

Conclusions: Thrombosis is concerning among patients with arm TIVADs, is often unrecognized, and warrants further investigation. Access may be compromised for those with more thrombogenic ports.

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