Background: Given the limitations of ultrasound-guided totally implantable venous access ports (TIVAPs) placement in detecting venous abnormalities and predicting pinch-off syndrome, this study evaluates whether preoperative venography can improve surgical planning and reduce complications by identifying these anatomical risks prior to implantation.
Methods: The retrospective study analyzed 479 cancer patients undergoing TIVAP implantation from January 2019 to December 2021. Patients received either preoperative venography (n=252) or conventional ultrasound guidance (n=227) to guide surgical planning. The venography group underwent venous assessment using digital subtraction angiography (DSA), with surgical decisions based on identified venous abnormalities and pinch-off syndrome simulation tests. Primary outcomes were the concordance rate between planned and executed surgical procedures and intraoperative complications. Statistical comparisons used Chi-squared or Fisher’s exact tests, with significance set at P<0.05.
Results: Venous anomalies were detected in 18% (46/252) of venography patients, which were strongly associated with ipsilateral surgery or peripherally inserted central catheters (PICCs) placement (39.1% vs. 0.5%, P<0.001). The venography-guided group demonstrated significantly higher procedural concordance than the ultrasound-guided group (100% vs. 97%, P=0.005). Intraoperative complication rates were similar (2.8% vs. 2.6%, P>0.05). Pinch-off syndrome simulation tests in the venography group identified high-risk anatomy in five patients, allowing preventive surgical modifications; no postoperative pinch-off syndrome occurred in this group, compared to three cases (1.3%) in the ultrasound-guided group.
Conclusions: Preoperative venography has emerged as an indispensable tool in formulating judicious surgical strategies for the implantation of TIVAP, thereby preemptively mitigating unforeseen procedural alterations. Additionally, it affords a mechanism to assess the risk of pinch-off syndrome throughout the course of the procedure.
Reference:Yan J, Wang J, Yang B. Efficacy of preoperative venography in patients undergoing placement of totally implantable venous access ports. Quant Imaging Med Surg. 2026 May 1;16(5):381. doi: 10.21037/qims-2025-aw-2290. Epub 2026 Apr 12. PMID: 42147930; PMCID: PMC13178386.