Axillary versus Jugular Vein for Totally Implanted Port-A-Cath, Randomized, Controlled Trial

Background

To compare the safety and efficacy of the internal jugular vein and the axillary vein access points for port-a-cath (PORT) implantation in cancer patients undergoing systemic intravenous treatments.

Methods

The study was conducted at the AC Camargo Cancer Center in São Paulo, Brazil. Between April 2017 and June 2021, a total of 240 patients were initially recruited, of whom 213 were included in the final analysis of the study. Participants were randomly assigned to either the axillary or jugular access groups. The PORT placement was facilitated using ultrasound and radioscopy guidance. The study's primary objective was to assess the total complication rate, which was analyzed following both intention-to-treat and per-protocol principles.

Results

The overall complication rates for both access points were low and not significantly different. However, there was a higher tendency toward thrombosis in the axillary group, leading to the PORT removal in 4 patients.

Conclusion

Although axillary vein access offers certain advantages, such as a single incision and elimination of the need for a subcutaneous tunnel, our findings suggest that internal jugular vein access may often be a more practical choice due to its larger diameter, superficial location, and straight trajectory to the right atrium for the right jugular. Therefore, despite axillary vein access serving as a viable alternative, internal jugular vein access might be a more suitable choice, especially for patients at a higher risk of thrombosis.