Right-Versus Left-Subclavian Central Venous Port for Patients with Malignant Tumor: A Retrospective Comparison of Adverse Events and Imaging Findings

Abstract

Purpose: The optimal side for placement of a central venous port (CVP) remains unclear. The authors aimed to compare adverse events (AEs) and imaging findings according to CVP placement via the right and left subclavian vein (SCV) in patients with malignant tumor (s).

Material and Methods: A total of 254 consecutive adult patients, who underwent CVP placement between January and August 2012, were included. Percutaneous ultrasound-guided access was attempted in the right SCV in 134 (59 men, 75 women; median age 61 years) and left SCV in 120 (58 men, 62 women; median age 61 years) patients. The primary tumor was colorectal (right, 17/ left, 71); upper gastrointestinal (33/7); bone and soft tissue (21/9); and others (63/33). A retrospective evaluation of technical success, AEs, and computed tomography findings was performed.

Results: Technical success was achieved in 99% of patients in both groups. Median procedure time was 30 min in both groups. There were no statistically significant differences in intraprocedural AEs. In postprocedural AEs during a median follow-up of 347 (right)/530 (left) days, CVP placement in the left SCV was associated with a significantly higher rate of catheter occlusion (right, 0%; left, 5.8%). Both symptomatic venous thrombosis (right, 0.7%; left, 4.2%) and image-confirmed venous thrombosis (right, 4.8%; left, 21.8%) occurred more frequently in the left-CVP group.

Conclusion: Left-CVP was associated with significantly higher rates of late AEs and venous thrombosis. Despite the inherent limitations of the retrospective study design and small sample size, re-evaluation of left-CVP may be required in patients with malignant tumor (s).