In the presence of contraindications to the use of arm veins, the port will be implanted using veins in the cervico-thoracic region, either in the supra-clavicular area (ultrasound cannulation of the brachio-cephalic, internal jugular, or subclavian vein) or in the infra-clavicular area (ultrasound cannulation of the axillary vein). In both cases, it is preferable to pocket the reservoir in the infra-clavicular area above the pectoral muscle fascia.
The ultrasound guided approach to the axillary vein is preferable as a first choice, since it allows to minimize the tunneling and to create the pocket of the reservoir in the same point where the vein is cannulated. Compared to the ultrasound-guided approach to supra-clavicular veins, the use of axillary for chest ports has considerable advantages:
- tunneling over the clavicle is avoided, which results in greater catheter stability and a better aesthetic result
- only one incision is made, which results in less traumatism and a better aesthetic result.
Interestingly the pinch-off syndrome (a complication exclusively linked to the placement of catheters by 'blind' puncture of the subclavian vein via an infra-clavicular approach) is impossible when the infra-clavicular access to the axillary vein is performed by ultrasound guidance.