Comparative outcomes of axillary, jugular, and subclavian venous access for totally implantable venous access port implantation: a 335-case single-center retrospective study

Totally implantable venous access ports (TIVAP) are essential for long-term intravenous access in cancer patients receiving chemotherapy. Controversies persist regarding the optimal venous access route. This study aimed to compare procedural outcomes and complication profiles of axillary, jugular, and subclavian approaches as implemented in routine institutional practice. This retrospective study included 335 cancer patients who underwent TIVAP implantation at a single center between February 2021 and December 2022. Ultrasound plus electrocardiogram (ECG) guidance was used for the axillary vein (AxV, n = 51) and internal jugular vein (IJV, n = 84) approaches, whereas the subclavian vein approach (SCV, n = 200) was performed under ECG guidance alone without routine ultrasound. Outcomes assessed included operative time, overall complication rates, and individual complication profiles. Categorical outcomes were compared using Fisher’s exact test; continuous variables were compared using one-way ANOVA and the Kruskal-Wallis test. Analysis of covariance (ANCOVA) was performed to adjust operative time for BMI. Exact binomial 95% confidence intervals (CIs) were calculated for all complication rates. The three groups were comparable with respect to age ( p = 0.231) and sex distribution ( p = 0.184), but differed significantly in body mass index (BMI: SCV 22.54 ± 3.31, AxV 22.07 ± 2.52, IJV 23.68 ± 3.78 kg/m²; ANOVA p = 0.013). The mean operative time was significantly shorter for the AxV group (27.39 ± 4.75 min) compared with both the SCV (33.75 ± 2.77 min) and IJV (37.49 ± 9.59 min) groups (one-way ANOVA p < 0.001; all pairwise post-hoc p < 0.001). After adjustment for BMI, the AxV advantage persisted (BMI-adjusted means: SCV 33.8, AxV 27.6, IJV 37.2 min; p < 0.001). The overall complication rate was 8.0% (16/200; 95% CI: 4.6%–12.7%) in the SCV group, 3.9% (2/51; 95% CI: 0.5%–13.5%) in the AxV group, and 2.4% (2/84; 95% CI: 0.3%–8.3%) in the IJV group. These differences did not reach statistical significance (Fisher’s exact p = 0.18). In this single-center descriptive comparison, the ultrasound- and ECG-guided axillary vein approach was associated with significantly shorter operative times compared to the subclavian and jugular approaches. Complication rates were numerically lower in the AxV group, but the differences were not statistically significant. The comparison was confounded by the use of different imaging guidance modalities and non-overlapping enrollment periods across groups. These hypothesis-generating findings support the need for prospective studies with standardized guidance protocols.