Fluoroscopic Catheter-Tip Positioning During Internal Jugular TIVAD Placement in Breast Cancer: A Two-Center Retrospective Cohort Study

Abstract

Background/Objectives: Fluoroscopy permits direct assessment of catheter course and tip position during totally implantable venous access device (TIVAD) placement. We compared left- and right-sided internal jugular vein (IJV) port placement in breast cancer. Methods: This retrospective two-center cohort included 836 ultrasound- and fluoroscopy-guided IJV procedures performed during 2021–2024. The institutional optimal radiographic band was 20–40 mm below the carina; 10–20 and 40–45 mm were adjacent acceptable bands. Results: Left and right IJV access were used in 478 and 358 procedures. The imaging-defined reference lengths were 25.0 ± 0.5 and 22.2 ± 0.5 cm. First-pass target success was 70.3% and 77.1%, respectively. Guidewire-assisted repositioning (9.6% vs. 2.8%) and abnormal initial catheter course (7.9% vs. 2.0%) were more frequent on the left. Final tips were in the optimal band in 97.1% and 96.6%, and in the broader acceptable band in 99.4% on each side. Immediate complications comprised three pneumothoraces and six bleeding events. Among 823 patients with documented 90-day status, 45 had a first device-related event (12 mechanical, 18 thrombotic, 10 infectious, and 5 other). Conclusions: Left IJV placement involved a longer route and more intraprocedural correction, while final tip-position distributions were similar. Fluoroscopic assessment documented and guided the correction sequence.