Determination of optimal catheter insertion depth in totally implantable venous access ports via three-dimensional reconstruction of cervicothoracic veins: a cross-sectional retrospective analysis

Precise positioning of the catheter tip at the cavoatrial junction (CAJ) is critical for totally implantable venous access port (TIVAP) safety; however, it remains technically challenging. Here, we propose a novel preoperative method using non-contrast chest computed tomography (CT)-based three-dimensional (3D) reconstruction to predict insertion depth. In this retrospective matched-pairs study, 50 female patients with breast cancer who underwent right/left jugular TIVAP placement were analyzed. The vascular centerline of the cervicothoracic vein from the clavicular to the right inferior pulmonary vein was reconstructed using 3D Slicer. The predicted catheter depth was compared with intracavitary electrocardiogram (IC-ECG) using signed (ΔL) and absolute distance (|ΔL|). The optimal depth was radiographically confirmed at 2.4 vertebral body units below the carina. There was no significant difference in ΔL between the two methods (-0.49 cm vs. -0.82 cm, p = 0.056). The 3D reconstruction achieved significantly smaller |ΔL| values than IC-ECG (0.70 cm vs. 1.00 cm, p = 0.007), while the 3D reconstruction ΔL showed no correlations with anthropometric factors (p > 0.05). Non-contrast chest CT 3D reconstruction shows greater accuracy in preoperative depth prediction compared to IC-ECG. It may thus be a preferential alternative when intraoperative guidance is unavailable.