A

Single-Incision Technique for Placement of

Implantable Venous Access Ports via the Axillary
Vein
RFS Journal Primer

Quick Summary
BOTTOM LINE

The single-incision technique for placing ports via the axillary vein is a feasible and safe procedure
with high technical success and low risk of complications.

MAJOR POINTS

Conventional techniques for placing catheters use two incisions to create a subcutaneous tunnel
with several associated drawbacks.

To overcome the disadvantages associated with the conventional technique, a single-incision

technique to access the IVJ via an infraclavicular incision is proposed.

Potential advantages include cosmetic beneFits, reduction of post-procedural discomfort, and easier
placement in patients with tracheostomies

Potential drawbacks include limited subcutaneous tunnel length, a potentially inaccessible IVJ, and
difFiculty advancing devices.

CRITICISM

Port pocket location was not randomized because this was a retrospective review.

Patient follow-up and CT imaging were inconsistent, and follow-up period was generally short.

Comparison to a control group, port placement using the traditional two incision technique, was not
made.

Study design
IRB-approved retrospective study

216 patients with a variety of underlying malignancies who underwent port

placement for long-term chemotherapy administration.

Time range: May 2012 to October 2012

INCLUSION CRITERIA

Ports placed via a single-incision technique by the same interventional radiologist

Patients with malignancies requiring port placement for chemotherapy

administration

Access possible via axillary vein (*preferred, not absolute)

EXCLUSION CRITERIA

Patients with high body mass index

Patients with pendulous breasts

Purpose

To evaluate the technical feasibility and safety of a single-incision technique for placement of
implantable venous access ports via the axillary vein

Interven7on

Ports were placed in 112 men and 104 women with a mean age of
58.2 years

Ports were placed via the left axillary vein in 172 patients and via the
right axillary vein in 44 patients
The most common reason for placing a right-sided port was
left-sided breast cancer (n=25)

A single vertical incision without subcutaneous tunneling was made

Axillary vein was then punctured under US guidance, typically 3 cm

lateral to the junction of the axillary vein and the clavicle and directed
medially

Procedure details were retrospectively reviewed, including:

Technical success rate
Final location of the micropuncture needle tip
Procedure time
Fluoroscopy time
Complications - identiFied according to Society of Interventional
Radiology criteria

Outcome

All procedures using single-incision technique were successful, with a mean Fluoroscopy time
of 0.65 minutes and mean procedure time of nearly 14 minutes.

The most common Final needle tip location was overlapping the First rib on Fluoroscopic
imaging

On CT scan, the entry points into the vein was the axillary vein in 161 patients and the
subclavian vein in 31 patients.

Most common problem encountered was advancement of the wire or catheter into unintended
veins, which occurred in 33 patients

1 major and 2 minor complications occurred

Major thrombosis of the axillary vein
Minor hematoma formation after puncture of the axillary artery

Credits

SUMMARY BY:

Justin Shafa, MSIV
The George Washington University School of Medicine and Health
Sciences

FULL CITATION:
Seo T, Song M, Kang E, Lee C, Yong H, Doo K. Clinical Study: A Single-Incision Technique for Placement of Implantable Venous Access Ports
via the Axillary Vein. Journal Of Vascular And Interven4onal Radiology [serial online]. September 1, 2014;25:1439-1446. Available from:
ScienceDirect, Ipswich, MA.

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