Abstract:
Background: Catheter malposition is a recognized complication of totally implantable venous access ports (TIVAPs). Removal or reimplantation may be unnecessarily invasive when the catheter remains patent, whereas untreated malposition may cause thrombosis, dysfunction, or infusion-related complications. Evidence regarding pigtail catheter repositioning remains limited. This study reviews 39 cases of TIVAP catheter malposition treated using a transfemoral pigtail catheter technique.
Methods: This retrospective case series included 39 patients with imaging-confirmed TIVAP catheter malposition treated between September 2018 and October 2025. Eligible catheters were patent and functional without occlusion; patients with catheter dysfunction or those managed using other repositioning methods were excluded. Under fluoroscopic guidance, a 5-F pigtail catheter was introduced through the femoral vein to redirect the catheter tip into the intended central venous position.
Results: The right internal jugular vein was the most common malposition site (25/39, 64.1%). Initial technical success was achieved in all patients, with a mean procedure duration of 13.64±5.02 minutes. No immediate procedure-related complications were documented. Recurrent malposition occurred in 2 patients during a mean follow-up of 3.9±3.7 months (range, 2-14 months).
Conclusions: Fluoroscopy-guided transfemoral pigtail catheter repositioning is technically feasible for selected patients with a functioning, non-occluded malpositioned TIVAP and may avoid immediate catheter replacement or surgical revision.
Reference:Yang Z, Ma Y, Zhang J, Ma Y, Yin M, Wang L, Li C, Wu G. Fluoroscopy-guided transfemoral pigtail catheter repositioning of malpositioned totally implantable venous access port catheters: a retrospective single-center study. Quant Imaging Med Surg. 2026 Nov 1;16(11):889. doi: 10.21037/qims-2026-0991. Epub 2026 Sep 30. PMID: 42997951; PMCID: PMC13743304.