Characteristics of Symptomatic Axillary Vein Thrombosis After Placement of Totally Implanted Venous Access Port in Cancer Patients

Background: The incidence of venous thrombosis based on access route after implantation of the totally implanted venous access port (TIVAP) is controversial. Symptomatic TIVAP-related venous thrombosis remains relatively rare. However, characteristics of symptomatic axillary vein thrombosis after TIVAP implantation via access of the axillary vein has not been reported. Objectives: In this historical cohort study, the incidence and characteristics of venous thrombosis associated with TIVAP via the axillary vein in cancer patients were evaluated. Patients and Methods: A total of 4,773 TIVAPs were placed via the axillary vein in patients with various types of cancer between May 2012 and July 2018. Eighteen patients experienced symptomatic venous thrombosis associated with TIVAPs. Radiologic findings for venous thrombosis were evaluated using computed tomography (CT) including scans of the axillary vein. Medical records were retrospectively reviewed. Results: The prevalence of symptomatic thrombosis was 0.38% (18/4,773). The patients with symptomatic venous thrombosis included 14 males and four females. Among the 18 patients, the most common types of cancer were lung cancer (n = 7) and pancreatic cancer (n = 4), with the incidence rates of 0.79% (lung cancer, 7/882) and 1.58% (pancreatic cancer, 4/253), respectively. The median time between placement of the TIVAP and diagnosis of thrombosis was 35.5 days (range: 6 - 292 days). All symptomatic patients had thrombosis in the axillary vein on CT images. Symptoms were improved in all patients with treatment including removal of TIVAP at the time of diagnosis and following anticoagulation therapy. From the multiple binary logistic regression, pancreatic cancer and lung cancer were statistically significant risk factors of symptomatic axillary vein thrombosis. Conclusion: After insertion of TIVAPs through the axillary vein, symptomatic axillary vein thrombosis rarely developed. Pancreatic cancer and lung cancer were associated with the risk of symptomatic axillary vein thrombosis.