Complication-related Removal of Central Venous Ports: Comparison of Subclavian and Upper Arm Approaches

To compare overall and cause-specific complication-related central venous port removal, particularly infection-related removal and catheter fracture, and time-to-event outcomes between the subclavian and upper arm approaches.

This retrospective study included 1,195 patients who underwent ultrasound-guided central venous port implantation via the subclavian (n = 706) or upper arm (n = 489) approach between 2012 and 2021. Comparative analyses were restricted to a maximum of 5 years after implantation. A total of 621,902 catheter-days were analyzed. The evaluated outcomes were overall complication-related central venous port removal and cause-specific removals, including infection-related removal, catheter fracture, malposition, occlusion, leakage, and venous thrombosis. Crude incidence rate ratios were estimated using Poisson regression, adjusted incidence rate ratios using a negative binomial model, and removal-free survival using Kaplan-Meier analysis.

Within 5 years, complication-related removals occurred in 50 patients (7.1%) in the subclavian group and 41 (8.4%) in the upper arm group. Crude incidence rates were 0.131 and 0.171 per 1,000 catheter-days, respectively (crude incidence rate ratio, 0.77; 95% confidence interval, 0.51-1.16; p = 0.211). Adjusted analysis showed no significant difference between approaches (adjusted incidence rate ratio, 1.09; 95% confidence interval, 0.59-2.00; p = 0.786). Infection-related removal was more frequent in the upper arm group (crude incidence rate ratio, 0.55; 95% confidence interval, 0.34-0.91; p = 0.020). Catheter fractures occurred only in the subclavian group (12/706, 1.7%; 0.031 per 1,000 catheter-days). Overall, removal-free survival did not differ significantly (p = 0.234), whereas infection-free and fracture-free survival differed significantly.

Overall complication-related removal rates were similar between the approaches, but complication profiles differed.