Researchers analyzed safety outcomes and asymptomatic catheter-related thrombosis across 475 breast cancer patients undergoing totally implantable venous access port implantations.
Totally implantable venous access ports provide long-term intravenous access for patients requiring chemotherapy, parenteral nutrition, or repeated blood product administration, offering advantages such as a lower infection risk and improved comfort compared to conventional catheters. To evaluate the comparative safety of different insertion routes, retrospective data were analyzed from 475 breast cancer patients who underwent port implantation at Shanghai Integrated Traditional Chinese and Western Medicine Hospital between January 2022 and December 2025 under the institutional review board approval number 2026-025-1, with the requirement for informed consent waived due to the study design.
Implantation Routes and Catheter-Related Thrombosis Analysis
Patients in the retrospective review were categorized by their specific venous access route: 161 individuals received internal jugular vein access, 138 underwent subclavian vein placement, and 176 utilized the axillary vein approach. All procedures were executed under local anesthesia by two experienced vascular surgeons utilizing power-injectable implantable port systems and compatible accessories from BARD, specifically the PowerPort 8806061. Continuous real-time ultrasound guidance directed venous punctures and catheter advancements, while intraoperative fluoroscopy verified catheter tip positions at the junction of the lower third of the superior vena cava and the right atrium.
My cousin, who was very close to my age got diagnosed with cancer, and it freaked me out. I noticed a lump around my breast. And I started panicking. I had just arrived to Shanghai from Korea. I hadn’t even started my job, as I arrived early, and so I didn’t have my insurance.…
— https://x.com/zapatas_mom/status/2024518752742854763
Among the entire cohort of 475 patients, 234 completed their planned anticancer treatment during the study period and subsequently underwent port-removal evaluation. These individuals received pre-removal D-dimer testing and vascular ultrasonography according to institutional clinical workflows to assess asymptomatic catheter-related thrombosis. The remaining 241 patients continued requiring venous access for ongoing treatment or follow-up, and were therefore excluded from the pre-removal thrombosis evaluation.
Biomarker Findings and Exploratory Risk-Stratification Framework
Catheter-related thrombosis remains a frequent complication of port placement, with a substantial proportion of events remaining asymptomatic until detected via imaging. While D-dimer serves as a standard screening biomarker, the study noted that D-dimer alone is insufficient to exclude thrombosis. For descriptive comparisons in the study’s data, an elevated D-dimer level was defined using the institutional laboratory upper reference limit of 0.243 micrograms per milliliter, whereas the exploratory four-scenario risk-stratification framework utilized a receiver operating characteristic-derived cutoff of 0.251 micrograms per milliliter.
The exploratory framework combined D-dimer results with vascular ultrasonography findings to characterize heterogeneous pre-removal thrombotic risk profiles. Because of the retrospective design and limited number of thrombotic events, the research team emphasized that this combined framework requires prospective validation before any clinical application can be considered.