Abstract No. 188 Incidence of abnormalities and association with accessed vein on radiographic port evaluation

Abstract

Totally implantable venous access ports are commonly placed via subclavian or internal jugular (IJ) veins. The purpose of this retrospective study is to investigate the rate of post-implantation, radiographic abnormalities in clinically dysfunctional ports for subclavian versus IJ venous ports. This retrospective study included 109 ports in 107 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 1, 2019, to July 31, 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, and catheter malposition. Of the 109 ports investigated, 27 were inserted via the subclavian vein and the remaining 82 via the IJ vein. The most common indications for port study referral were unspecified (n = 41, 37.6%), poor aspiration (n = 39; 35.8%), difficulty accessing (n = 12; 11.0%), and pain and/or swelling at the port site (n = 9; 8.3%). During vascular access checks, 20 of the 27 subclavian ports (74.1%) demonstrated radiographic abnormality compared to 42 of the 82 IJ ports (51.2%), which was significantly different using Chi-Squared testing (P = 0.038). The two most common findings during vascular access checks were well-functioning port with catheter tip in appropriate position (n = 47; 43.1%) and poorly aspirating port with fibrin sheath, but catheter tip in appropriate position (n = 37, 33.9%). Of the dysfunctional ports with abnormal radiographic findings, subclavian ports were significantly (P = 0.029) more likely to have a major abnormality (n = 12, 60.0%), defined as a malpositioned or fractured catheter, compared to IJ ports (n = 13, 31.0%). This study suggests that for patients undergoing implantable port evaluation, ports placed via 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 via IJ vein. Additionally, this study suggests that a relatively high rate of clinically dysfunctional ports referred for port check will have no demonstrable abnormalities on fluoroscopic port evaluation.