Radiographic factor analysis of catheter malposition during totally implantable venous access port placement via the axillary vein

doi:10.13418/j.issn.1001-165x.2025.6.03

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Chinese Journal of Clinical Anatomy ›› 2025, Vol. 43 ›› Issue (6) : 640-644. DOI: 10.13418/j.issn.1001-165x.2025.6.03

Radiographic factor analysis of catheter malposition during totally implantable venous access port placement via the axillary vein

Chen Hao¹, Chen Lu²*, Zhang Yin¹*

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Abstract

Objective To investigate the incidence of catheter tip malposition during totally implantable venous access port (TIVAP) implantation via right axillary vein and analyze the correlation between preoperative magnetic resonance imaging (MRI)-measured vascular anatomical parameters and malposition, thereby providing evidence for preoperative risk assessment and precise intraoperative catheter placement. Methods 165 female breast cancer patients who underwent right axillary vein TIVAP implantation at the Department of Breast Surgery, Nanjing University Medical School Affiliated Drum Tower Hospital from May 2018 to December 2019 were enrolled in this retrospective study. Intracavitary electrocardiogram monitoring with P-wave localization was used to position the catheter tip in the operation. Patients were divided into a malposition group and a control group based on catheter malposition status. The diameters of the subclavian vein (A), internal jugular vein (B), and brachiocephalic vein (C), as well as subclavian/internal jugular vein angle (α angle) and subclavian/brachiocephalic vein angle (β angle) were measured preoperatively by MRI. Differences in imaging parameters between the two groups were compared, and their correlation with catheter malposition was analyzed. Results TIVAP implantation success rate was 100% (165/165), with an intraoperative catheter tip malposition rate of 14.5% (24/165), all occurring in ipsilateral internal jugular vein. Malposition group exhibited significantly larger internal jugular vein diameters (12.31±1.60) mm and α angles (100.8±7.7)° compared to control group (10.91±1.63) mm and (91.67±4.12)°, with statistically significant differences (P<0.05). There was no significant difference in parameters A, C, or β angle between two groups (P>0.05). Conclusions During the implantation of TIVAP via right axillary vein, the increased diameter of internal jugular vein and the widened angle between subclavian and internal jugular veins constitute significant risk factors for catheter tip malposition. Preoperative MRI-based quantitative measurements of venous anatomy can provide predictive guidance for intraoperative catheter trajectory, facilitating the identification of high-risk individuals for catheter malposition and enabling personalized catheterization strategies to enhance procedural safety and positioning accuracy.

Key words

Totally implantable venous access port; / / Catheter malposition; / / Axillary vein; / Magnetic resonance imaging; / / Anatomical parameters

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Chen Hao, Chen Lu, Zhang Yin. Radiographic factor analysis of catheter malposition during totally implantable venous access port placement via the axillary vein[J]. Chinese Journal of Clinical Anatomy. 2025, 43(6): 640-644 https://doi.org/10.13418/j.issn.1001-165x.2025.6.03

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