Is there a difference in catheter-related thrombosis between left- and right-sided arm ports and chest ports?

Totally Implantable Venous Access Ports (TIVAPs) are long-term subcutaneous venous infusion devices widely used in patients requiring prolonged venous therapy, particularly those with cancer. The choice of left- vs. right-sided implantation during TIVAP implantation is a key clinical decision, as anatomical and hemodynamic differences between sides may influence the risk of catheter-related thrombosis (CRT). However, existing literature remains controversial regarding the association between implantation side and CRT incidence. This meta-analysis aims to systematically evaluate the impact of left- vs. right-sided TIVAP implantation on CRT risk, providing evidence-based support for clinical prevention strategies.

Literature searches were conducted in PubMed, Web of Science, Embase, Cochrane Library, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Database to identify studies investigating the effect of left- vs. right-sided TIVAP implantation on CRT incidence. The search spanned from database inception to October 2025. Two independent researchers screened literature, extracted data, and assessed the risk of bias of the included studies. A meta-analysis was conducted using RevMan 5.3 software.

A total of 21 studies involving 10,778 patients were included. Meta-analysis revealed no statistically significant difference in CRT incidence between left- and right-sided chest ports [OR = 1.28, 95%CI (0.97-1.68), P = 0.08] or arm port [OR = 1.19,95% CI (0.86-1.66), P = 0.29].

Current evidence indicates no overall difference in CRT incidence between left- and right-sided TIVAPs. However, the observed sample size-dependent association suggests that left-sided implantation may carry a slightly higher CRT risk in large cohorts. Clinicians may select the implantation side based on individual patient characteristics. However, large-sample, multi-center randomized controlled trials are needed to further validate these findings, particularly given the observed sample size-dependent differences.