Efficacy of preoperative venography in patients undergoing placement of totally implantable venous access ports.

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.