Ultrasound-guided axillary vein versus internal jugular vein access for totally implantable venous access ports in breast cancer: a retrospective comparison of patient-reported outcomes

TL;DR

Using ultrasound to guide implantation of venous access ports in breast cancer patients through the axillary vein improves comfort and satisfaction without increasing complications.

Contribution

The study demonstrates that axillary vein access for venous ports in breast cancer patients improves patient-reported outcomes compared to the standard internal jugular approach.

Findings

Axillary vein access improved early postoperative comfort with a higher rate of no discomfort (72.5% vs. 59.4%).

Axillary vein access resulted in better cosmetic outcomes (93.1% vs. 67.9%) and higher patient satisfaction at 6 months.

Axillary vein access was an independent predictor of comfort, cosmetic outcomes, and satisfaction in multivariable analysis.

Abstract

Patient-centered venous access is critical in breast cancer supportive care. While the tunnel-less axillary vein (AxV) approach for totally implantable venous access port (TIVAP) implantation may improve patient experience, comparative evidence on patient-reported outcomes (PROs) against the standard internal jugular vein (IJV) approach remains limited.

This single-center retrospective cohort study compared ultrasound-guided IJV (n = 106) versus AxV (n = 102) TIVAP implantation in breast cancer patients (September 2020–February 2025). Primary outcomes included postoperative comfort (assessed at 1 day) and cosmetic outcome and satisfaction (assessed at 6 months). Complications were monitored for 6 months. Group comparisons utilized chi-square/Fisher’s exact tests. To control for potential confounders, multivariable logistic regression analyses were performed, adjusting for age, body mass index, and implantation side. Complications were monitored for 6 months.

The AxV approach significantly enhanced early postoperative comfort, with a higher rate of no discomfort (Grade 0: 72.5% vs. 59.4%, p = 0.032). At 6 months, the AxV approach demonstrated superior, favorable cosmetic outcomes (Grades 1–2: 93.1% vs. 67.9%, p < 0.001) and higher overall satisfaction (94.1% vs. 85.8%, p = 0.039). Multivariable analysis confirmed the AxV approach as an independent predictor for ideal comfort [adjusted odds ratio (aOR) = 4.48, p = 0.0002], favorable cosmetic outcome (aOR = 6.22, p < 0.001), and overall satisfaction (aOR = 3.07, p = 0.033). More AxV patients would choose the port again (83.3% vs. 72.6%, p = 0.045). The overall complication rates were comparable between groups [4.8%, 0.269/1,000 central line-days (CD) vs. 4.9%, 0.279/1,000 CD; p = 0.957].

For breast cancer patients, the ultrasound-guided AxV approach for TIVAP provides superior early postoperative comfort, long-term cosmetic results, and patient satisfaction without increasing early complication risks, representing a significant patient-centered advancement in venous access.

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