Zeyang Fan

Background/Objectives: Fluoroscopy permits direct assessment of catheter course and tip position during totally implantable venous access device (TIVAD) placement. We compared left- and right-sided internal jugular vein (IJV) port placement in breast cancer. Methods: This retrospective two-center cohort included 836 ultrasound- and fluoroscopy-guided IJV procedures performed during 2021–2024. The institutional optimal radiographic band was 20–40 mm below the carina; 10–20 and 40–45 mm were adjacent acceptable bands. Results: Left and right IJV access were used in 478 and 358 procedures. The imaging-defined reference lengths were 25.0 ± 0.5 and 22.2 ± 0.5 cm. First-pass target success was 70.3% and 77.1%, respectively. Guidewire-assisted repositioning (9.6% vs. 2.8%) and abnormal initial catheter course (7.9% vs. 2.0%) were more frequent on the left. Final tips were in the optimal band in 97.1% and 96.6%, and in the broader acceptable band in 99.4% on each side. Immediate complications comprised three pneumothoraces and six bleeding events. Among 823 patients with documented 90-day status, 45 had a first device-related event (12 mechanical, 18 thrombotic, 10 infectious, and 5 other). Conclusions: Left IJV placement involved a longer route and more intraprocedural correction, while final tip-position distributions were similar. Fluoroscopic assessment documented and guided the correction sequence.

Background: Retained totally implantable venous access ports (TIVAPs) pose a clinical management challenge after completion of intravenous anticancer therapy, particularly when future treatment needs remain uncertain. We aimed to characterize longitudinal post-treatment TIVAP trajectories after a day-90 conditional landmark, with elective removal prespecified as the primary first event. Methods: This retrospective cohort study included patients who were alive and event-free, retained the original TIVAP, had no documented TIVAP-related indication requiring removal, and had documented clinical and TIVAP status at day 90. Elective removal was the primary event; TIVAP reactivation, complication-related removal, and network-documented death were competing events. Results: Among 1406 patients, the 12-month cumulative incidence was 34.3% (95% confidence interval [CI], 31.4–37.1) for elective removal, 10.1% (95% CI, 8.2–11.9) for reactivation, 4.1% (95% CI, 3.0–5.3) for complication-related removal, and 1.0% (95% CI, 0.5–1.6) for network-documented death. During 1164.9 patient-years, 9978 maintenance-related patient-date encounters were recorded. In the assessed subcohort (n = 1319), 69.2% of assessments indicated willingness to choose a TIVAP again for similar future treatment, 64.4% indicated willingness to recommend TIVAP use, and 26.0% recorded a preference for earlier removal. Conclusions: Retained TIVAPs followed heterogeneous post-treatment courses, including elective removal, subsequent reuse, and continued retention requiring maintenance. These findings describe observed management patterns; they do not establish the comparative effectiveness of retention versus removal or identify an optimal removal time, and they support a prospective evaluation of structured reassessment pathways.

Background: Evidence on tissue adhesive for skin closure after totally implantable venous access port (TIVAP) implantation is limited. We evaluated whether alpha‐n‐butyl cyanoacrylate applied after subcutaneous tension‐reducing sutures was associated with fewer clinically relevant early wound complications and lower postoperative care burden. Methods: This retrospective propensity score‐matched cohort study included 2118 analysis‐eligible TIVAP implantations performed from July 2024 to March 2026 after exclusion of four records with implausible anthropometric values. The adhesive group underwent tension‐reducing subcutaneous closure followed by cyanoacrylate sealing; the control group underwent conventional intradermal continuous suturing. The primary outcome was clinically relevant wound complication within 21 ± 3 days, excluding mild erythema without antibiotics and dressing frequency. One‐to‐one nearest‐neighbour propensity score matching without replacement was performed using age, sex, body mass index, comorbidities, laboratory indices, tumour type, port indication and puncture side. Results: After matching, 972 pairs were retained with good covariate balance (maximum absolute standardised mean difference, 0.046). The primary outcome occurred in 101/972 patients (10.4%) in the adhesive group and 173/972 (17.8%) in the suture group (absolute risk reduction, 7.4 percentage points; number needed to treat, 14; odds ratio, 0.54; 95% confidence interval, 0.41–0.70; p < 0.001). Adhesive‐assisted closure was associated with fewer wound dehiscence events, secondary closure or incision reopening, antibiotic‐requiring wound infections, port‐use delay and unplanned wound visits. Mild erythema without antibiotics was more frequent with adhesive‐assisted closure (12.8% vs. 4.8%). Closure time was shorter in the adhesive group (3.7 ± 0.7 vs. 8.0 ± 1.2 min; p < 0.001). Conclusion: Adhesive‐assisted closure after TIVAP implantation was associated with fewer objective early wound complications and reduced postoperative care burden. Mild erythema should be reported separately from infection or wound failure.

To compare the long-term outcomes of combined transarterial chemoembolization and radiofrequency ablation (TACE-RFA) with radiofrequency ablation (RFA) monotherapy for small (≤3 cm) hepatocellular ...