A summary and analysis of 20 cases of total implantation venous access port via a left-sided approach based on a single surgeon's five years of experience

A summary and analysis of 20 cases of total implantation venous access port via a left-sided approach based on a single surgeon's five years of experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A summary and analysis of 20 cases of total implantation venous access port via a left-sided approach based on a single surgeon's five years of experience Shansong Gao, Ying He, Chenyue Wang, Shengling Xu, Dongjin Ling, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9401903/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Objective A review of 20 cases of total implantation venous access port (TIVAP) implantation via a left-sided approach provides valuable clinical experience and enables port placement physicians to assess the suitability of different approaches, thereby improving the feasibility and safety of port implantation. Methods The clinical data of 20 patients who underwent total venous access port implantation via a left-sided approach at the Department of Oncology and Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University from April 2019 to November 2023 were retrospectively analyzed. These data included patients' baseline characteristics, examination results, surgical procedures, perioperative conditions and long-term complications. Results The mean age of the 20 patients at the time of port placement was 57.7 years (range 41–79 years). The primary diseases were lung cancer, esophageal cancer, mediastinal malignancy, pancreatic cancer, rectal cancer, lymphoma, breast cancer, and colon cancer. The primary causes of left-sided port placement were venous compression (40%), followed by venous variations (30%), operative area-related factors (25%), and venous embolism (5%). Catheter obstruction occurred in one patient (5%), while no complications were observed in the remaining 19 patients (95%). The mean duration of port placement was 219 days (range: 25–690 days). Conclusion Left-sided TIVAP implantation is a safe and feasible alternative when right-sided access is contraindicated. Careful preoperative imaging evaluation and individualized access selection are essential to minimize complications. This case series provides practical guidance for port placement in complex clinical scenarios and may assist clinicians in selecting appropriate access routes. left approach totally implantable venous access port vascular malformation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The totally implantable venous access port (TIVAP) is a central venous device widely used for long-term chemotherapy and infusion therapy. It has been demonstrated to effectively reduce the incidence of damage to the vascular pathway, thereby enabling the direct delivery of potent drugs with high concentrations to the central vein, which avoids damage to peripheral blood vessels and tissues [ 1 , 2 ]. The TIVAP is administered via venous puncture, with the main access routes including the internal jugular vein, subclavian vein, cephalic vein and femoral vein. The right-sided approach is generally recommended for two main reasons: firstly, the anatomy on the left side is more complex, increasing procedural difficulty; secondly, the right internal jugular vein is usually larger, and the right cephalic vein is almost in a straight line with the superior vena cava. Therefore, there is no need to bend the catheter or guidewire excessively when placing a catheter in the right internal jugular vein, and there is a reduced probability of it inadvertently entering other venous channels. In contrast, the left internal jugular vein has a greater angle of intersection with the left cephalic trunk. Additionally, the majority of clinicians who place infusion ports utilize their right hand as their standard method of access. The majority of clinical cannulators are right-handed and thus relatively unfamiliar with left-sided internal jugular vein cannulation, which increases the difficulty of this procedure. The left pleura is situated at a greater level than the right pleura is, which renders it more susceptible to puncture during the development of pneumothorax. Furthermore, the angle formed between the left internal jugular vein and the subclavian vein is prone to be punctured during thoracic drainage catheter insertion, which may lead to leakage of the abdominal plexus [ 3 – 8 ]. However, certain patient-specific factors can contraindicate a right-sided approach. These include venous compression by tumor or lymph nodes, anatomical variations (e.g., stenosis or persistent left superior vena cava), local factors in the operative area (e.g., prior surgery, radiotherapy, or infection), and venous thrombosis [ 9 ]. Most patients can be assessed via the right approach; however, few complex cases require the left approach. These patients are often referred to clinicians who are inexperienced with the left approach and may even forego placement of the TIVAP because of failure of the right approach. A mature clinician should be able to face a variety of complex cases, master a variety of puncture access, and reasonably select individualized treatments according to the patient's situation. To date, there have been few studies on the left-sided approach for TIVAP placement, with the majority of studies focusing on the right side of the breast tumor. Only a small number of cases involving venous variations have been reported, and there is currently no systematic summary of the studies on the left side of breast tumors that cannot be placed on the right side for a variety of reasons. A retrospective analysis of 20 patients who were implanted with the TIVAP via the left approach was conducted on the basis of the five-year experience of a single surgeon. The analysis aimed to provide references and enrich the experience of clinical port placement practitioners by summarizing the reasons for choosing the left approach and its characteristics. This would help practitioners judge the choice of the appropriate approach and improve the feasibility and safety of clinical port placement. Methods In this study, 20 patients who underwent TIVAP implantation in the Department of Oncology and Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University were selected for analysis on the basis of the inclusion criteria. The clinical data of these patients were retrospectively analyzed, including the basic information of the patients, examination and tests, surgical modalities, and perioperative period. Additionally, the long-term complications and follow-up conditions of these patients were assessed through telephone follow-up. Ethical approval for the study was obtained from the Medical Ethics Committee of the First Affiliated Hospital of Nanchang University (IITS2024711). The First Affiliated Hospital of Nanchang University ethical institution confirms that the patient's informed consent form has been exempted. The data were analyzed via IBM SPSS Statistics 27.0.1. Results The present study offers a summary of the sex, age, primary disease, cause of left-sided access, length of stay in port, and complications observed in 20 patients, as detailed in Table 1 . Table 1 Clinical characteristics of the 20 patients undergoing left-sided TIVAP implantation. Patient Male/ female Age Primary disease Reason (left-sided approach) Duration with port(day) Complications 1 M 41 Esophageal cancer Venous variation 74 Normal 2 M 65 Rectal cancer Venous variation 113 Normal 3 W 41 Lung cancer Venous compression 393 Normal 4 M 60 Lung cancer Venous variation 331 Catheter occlusion 5 M 66 Lung cancer Operative area-related factors 78 Normal 6 M 55 Lung cancer Venous variation 112 Normal 7 W 59 Lymphoma Venous compression 116 Normal 8 W 41 Breast cancer Operative area-related factors 212 Normal 9 W 66 Carcinoma of the cardia Venous variation 212 Normal 10 M 58 Lung cancer Venous compression Missing Normal 11 M 63 Lung cancer Venous compression 25 Normal 12 M 46 Lung cancer Venous embolism 222 Normal 13 M 63 Lung cancer Venous compression 284 Normal 14 W 71 Esophageal cancer Venous variation 238 Normal 15 W 79 Esophageal cancer Venous compression 690 Normal 16 W 52 Malignant tumor of the mediastinum Operative area-related factors 247 Normal 17 M 55 Lung cancer Venous compression 226 Normal 18 W 61 Breast cancer Operative area-related factors 193 Normal 19 W 67 Lymphoma Venous compression 115 Normal 20 W 45 Colon cancer Operative area-related factors 279 Normal The 20 patients included 10 males and 10 females with a mean age of 57.7 (41–79) years at the time of port placement. The primary diseases were as follows: lung cancer (45%), esophageal cancer (15%), mediastinal malignancy (5%), pancreatic cancer (5%), rectal cancer (5%), lymphoma (5%), breast cancer (10%), and colon cancer (5%). The primary rationale for left-sided port placement was venous compression (40%), followed by venous variations (30%), operative area-related factors (25%), and venous embolism (5%). Further details can be found in Table 2 . One patient (5%) was complicated by catheter obstruction, whereas 19 patients (95%) did not experience any complications. The mean duration of port placement was 219 days (range: 25–690 days). Table 2 Distribution of reasons for selecting the left-sided approach. Reason N % Venous compression tumor 5 25% Lymph node 1 5% artery 2 10% Venous variation malformation 1 5% stricture 5 25% Operative area-related factors Scar on the body surface 1 5% radiotherapy 3 15% Secondary port purchase 1 5% Venous embolism thrombus 1 5% Discussion 1. Venous compression. The most common clinical reason for the placement of an infusion port via the left side is compression of the vein. This occurs when a tumor, lymph node or artery compresses, encases or encroaches on the vessel, resulting in damage to the lumen and a reduction in blood flow. 1.1 Tumor compression. Patients 3, 11, 17 and 19 had compressed tumors (Fig. 1 A, C(1)(2), D, E). Patients 3, 11 and 17 had lung malignancies, and patient 19 had lymphoma. 1.2 Lymph node compression. Patient 13 was characterized by lymph node compression (Fig. 1 F(1)(2)). Enlarged cervical and mediastinal lymph nodes may compress the vascular access point at the site of the infusion port. In Patient 13, an enlarged supraclavicular lymph node was observed to compress the internal jugular vein, resulting in the formation of stenosis within the internal jugular vein. It is advisable to refrain from puncturing this access at this juncture to prevent vascular injury. Furthermore, compressed vessels have the potential to narrow the lumen, increasing the risk of thrombosis [ 10 ]. In Patient 10, both the tumor and metastatic supraclavicular lymph nodes exerted compression forces (Figs. 1 B(2) and 1B(1)). 1.3 Arterial compression. Patients 7 and 15 presented with arterial compression of the internal jugular vein (Fig. 2 A). The right internal carotid artery exhibited tortuosity, compressing and deforming the right internal jugular vein to a degree that was almost wall-to-wall with the medial wall. This resulted in the artery being punctured with minimal difficulty during puncture of the vein, thereby increasing the risk of puncture. The right internal carotid artery was tortuous and spiralled upward. Given that the tortuous part of the artery was in close proximity to the right internal jugular vein and was throbbing quality, it was relatively straightforward to penetrate into the artery during puncture. Furthermore, the artery was repeatedly punctured during the procedure, resulting in arterial regurgitation. To prevent the formation of a hematoma at the puncture site, the right internal jugular vein approach was terminated, and the left approach was initiated instead. 2. Variation in veins Venous variations are also a common cause of intravenous infusion via the left lateral approach, which is subdivided into venous malformations and venous stenosis. 2.1 Venous malformations. Patient 1 had a venous malformation (Fig. 3 A) of the isolated permanent left superior vena cava (PLSVC), a congenital variant of the body vein. It is the most common thoracic venous malformation, with an incidence of 0.3% to 0.5% in the general population [ 11 – 13 ]. Approximately 10% of these PLSVCs are associated with right superior vena cava (SVC) agenesis, a condition known as isolated PLSVC [ 14 – 16 ]. This is an extremely rare venous malformation. In humans, the left superior vena cava originates in the left horn of the primitive venous sinus during the third week of embryonic life. As the left innominate vein develops in the embryo, the left jugular duct and the anterior main vein become occluded, and the left superior vena cava degenerates. Alternatively, if these structures do not degenerate, the left superior vena cava becomes permanent. In contrast, the right jugular duct and the anterior main vein develop to form the right superior vena cava. If the right jugular duct and the anterior main vein degenerate, the right superior vena cava is absent [ 17 , 18 ]. According to the anatomical features and mode of return of the superior vena cava, PLSVC is often classified into four types: Type I: (10%-20%) PLSVC flowing into the coronary sinus (CS) with the absence of the right superior vena cava; Type II: (50%-60%) bilateral SVCs (double superior vena cava) without traffic branches; Type III: (25%-30%) bilateral SVCs with traffic branches; and Type III: (25%-30%) bilateral SVCs with traffic branches; and Type III: (25%-30%) bilateral SVCs with traffic branches. bilateral SVCs with traffic branches; type IV: (10%-20%) PLSVC flowing directly into the left atrium without passing through the coronary sinus [ 19 ]. The present case is an isolated PLSVC, which belongs to PLSVC type I. Most patients with PLSVC are clinically asymptomatic and are typically identified incidentally during a physical examination with the use of a chest enhancement CT scan or during the placement of a central venous access device. Prior to implantation of the TIVAP, the patients were evaluated to ascertain their basic condition, and the puncture approach was selected accordingly. The vascular condition was evaluated via a CT scan of the patient, which revealed that the right cephalic arm vein flowed into the left superior vena cava through the innominate vein, the PLSVC flowed into the right atrium through the coronary sinus, and the anomalous left singular vein ascended in proximity to the descending aorta and flowed into the PLSVC. Additionally, Doppler ultrasound of the patient's heart revealed a dilated coronary sinus, a finding that has been corroborated by several studies. The presence of a permanent left superior vena cava in more than 75% of patients with coronary sinus dilatation has been documented in previous research [ 20 , 21 ]. Alerting patients with a dilated coronary sinus to the possibility of a permanent left superior vena cava is important. As port surgeons, it is our responsibility to assess our patients for venous access deformities before placing a TIVAP. This basic competency is essential to avoid serious complications such as vascular injury. 2.2 Venous stenosis. Patients 2, 4, 6, 9, and 14 presented evidence of venous stenosis, including right internal jugular vein stenosis (Fig. 3 B, C(1), D, E(2), and F) and unnamed vein stenosis (Fig. 3 E(1)). The presence of stenotic lesions represents a relative contraindication to TIVAP implantation, with the potential to increase the risk of catheter-related venous thrombosis following implantation [ 22 ]. When long-term placement of a central catheter is considered, the ratio between the catheter diameter and the vein diameter is crucial, as catheters have the potential to obstruct blood flow, which can subsequently lead to thrombosis. The risk of obstruction of blood flow depends on the size of the catheter and the vein. To reduce the risk of catheter-related venous thromboembolism, maintaining a catheter-to-vein diameter ratio of 45% or less is advisable. Therefore, clinicians encountering stenotic lesions when placing a central catheter should assess the degree of stenosis preoperatively, calculate the ratio of the catheter to the diameter of the vein, and attempt to avoid this access if the ratio is greater than 45%. 2.3 Factors associated with the operative area. The factors related to the operation area were classified as follows: radiotherapy (Fig. 4 A, B, C), body surface scarring (Fig. 4 D(1, 2)), secondary port placement (Fig. 4 E), skin breakage, skin infection, and tumors in the operation area. The patients who required radiotherapy were predominantly those with chest lesions. For example, patients 8 and 18 had right breast cancer, necessitating radiotherapy on the right side. Consequently, the chest wall on the lesion side was avoided, and the contralateral side was selected instead. In Patient 5, a right lung tumor had invaded the right rib cage, necessitating radiotherapy on the right side. Consequently, a left-sided approach was selected. In cases of surface scarring and secondary port placement, it is also important to consider the choice of approach. The condition of the local soft tissue of the skin of the port can impact the placement and stability of the port. In cases where there is surgical scarring of the skin of the chest wall, including secondary port placement, an alternative approach is typically advised, avoiding the side of the chest wall with poor local skin and soft tissue [ 23 , 24 ]. Patient 16 had right supraclavicular lymph node metastasis, a history of previous lymph node dissection on the right side of the neck, and surgical scarring of the skin, which rendered puncture and port placement inadvisable. In Patient 20, a second port was placed, as the initial port had punctured the right internal jugular vein. This poses a risk of embolism, as the thrombus from the original puncture can dislodge and travel through the vasculature, potentially causing complications [ 25 , 26 ]. Additionally, the initial port placement could affect the stability of the infusion port placement due to its proximity to the local soft tissue condition of the skin [ 22 ]. 3. Venous embolism In Patient 12, a filling defect of the right internal jugular vein (Fig. 5 A(1)(2)) was observed, which was deemed suspicious for venous thrombosis. The potential consequence of combining vascular access with a thrombus is that the thrombus may dislodge during puncture and tube placement, which may result in pulmonary embolism and other serious complications. This makes the placement of an infusion port an absolute contraindication[ 22 , 27 ]. To ensure the safety of the procedure, the left-sided approach was selected. It is imperative that the physician responsible for placing the port assesses the presence or absence of thrombus in the placed vascular access before proceeding with port placement. This ensures the prevention of serious complications that could arise from thrombus dislodgement [ 28 – 30 ]. Limitations and Future Directions This study has several limitations. The retrospective nature of the research, the small sample size, and the single-center design may affect the general applicability of the research results. Due to the lack of a matched control group for the right implantation surgery, it limits the comparative analysis of safety and efficacy results. The difference in follow-up time may lead to an underestimation of late complications (such as asymptomatic venous thrombosis). Future studies need to be multi-center, involving a larger sample size, and following a standardized follow-up protocol to verify our findings. Direct comparison of the surgical methods on the left and right sides among matched patients will help quantify the relative risks and benefits. Conclusion A comprehensive understanding of these blood vessels and surgical abnormalities is of great clinical significance for the implantation of central venous access devices. For patients with venous compression, anatomical abnormalities, surgical area-related contraindications, or suspected venous thrombosis, routine placement of the right TIVAP may increase the risk of vascular injury and catheter-related complications. In such cases, using the left approach TIVAP is a practical and safe alternative, provided that there is a comprehensive preoperative imaging assessment and appropriate professional technical support. This retrospective case series summarizes the indications and imaging features of left TIVAP implantation and demonstrates good safety results in long-term follow-up. This study emphasizes that mastering alternative access techniques is an important part of vascular access expertise, enabling the safe management of complex patients who were originally unable to receive this beneficial therapy. The results of this study provide practical references for clinical physicians performing TIVAP implantation and help improve individualized puncture selection and operational safety. Declarations Clinical trial number: not applicable Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Nanchang University (IITS2024711). The First Affiliated Hospital of Nanchang University ethical institution confirms that the patient's informed consent form has been exempted. The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and material The data used to support the findings of this study are available from the corresponding author upon request. Competing interests The authors declare that there are no conflicts of interest regarding the publication of this paper. Funding This is study is supported by the National Key R&D Program of China (No. 2023YFC2508604) and Jiangxi Provincial Department of Education Science and Technology Research Project Youth Project (190131). Authors’ Contributions • Study conception and design: Guowen Zou, Shansong Gao, Ying He • Acquisition of data: Shansong Gao, Xiaoming Liu, Chenyue Wang, • Analysis and interpretation of data: Shengling Xu, Ying He, Dongjin Ling, Bentong Yu • Drafting of manuscript: Guowen Zou, Shansong Gao, Ying He All authors given final approval of the version to be published. References Moss JG, et al. Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial. Lancet. 2021;398(10298):403–15. Fang S, et al. Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy. Patient Prefer Adherence. 2017;11:1197–204. Ge X, et al. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev. 2012;2012(3):CD004084. Ruesch S, Walder B, Tramer MR. Complications of central venous catheters: internal jugular versus subclavian access–a systematic review. Crit Care Med. 2002;30(2):454–60. Teichgraber UK, et al. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol. 2011;21(6):1224–32. Oner B, et al. Pneumothorax following ultrasound-guided jugular vein puncture for central venous access in interventional radiology: 4 years of experience. J Intensive Care Med. 2012;27(6):370–2. Aitken DR, Minton JP. The pinch-off sign: a warning of impending problems with permanent subclavian catheters. Am J Surg. 1984;148(5):633–6. Jadhav AP, Stahlheber C, Hofmann H. Traumatic chyle leak: a rare complication of left internal jugular venous cannulation. Am J Med Sci. 2011;341(3):238–9. Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40(8):2479–85. Sharp R, et al. Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study. BMJ Open. 2021;11(7):e045895. Van Walleghem J, Depuydt S, Schepers S. Insertion of a totally implantable venous access port in a patient with persistent left superior vena cava (PLSVC). Acta Chir Belg. 2018;118(1):68–71. Ichikawa T, et al. Persistent left superior vena cava with absent right superior vena cava in adults: CT and clinical findings. Jpn J Radiol. 2020;38(11):1046–51. Kang J, Liu B, Sun W. Two successful insertions of peripherally inserted central catheters in a patient with persistent left superior vena cava: A case report. Med (Baltim). 2019;98(38):e16988. Heye T, et al. Persistent left superior vena cava with absent right superior vena cava: morphological CT features and clinical implications. Int J Cardiol. 2007;116(3):e103–5. Ucar O, et al. Persistent left superior vena cava with absent right superior vena cava: a case report and review of the literature. Cardiovasc J Afr. 2010;21(3):164–6. Srivastava V, et al. Persistent left SVC with absent right SVC: a rare anomaly. J Card Surg. 2007;22(6):535–6. Bisoyi S, et al. Isolated persistent left superior vena cava: A case report and its clinical implications. Ann Card Anaesth. 2017;20(1):104–7. Sheikh AS, Mazhar S. Persistent left superior vena cava with absent right superior vena cava: review of the literature and clinical implications. Echocardiography. 2014;31(5):674–9. Minniti S, Visentini S, Procacci C. Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol. 2002;12(8):2040–55. Machevin-Surugue E, et al. Dilated coronary sinus in prenatal echocardiography; identification, associations and outcome. Prenat Diagn. 2002;22(10):898–902. Kim YG, et al. Impact of persistent left superior vena cava on radiofrequency catheter ablation in patients with atrial fibrillation. Europace. 2019;21(12):1824–32. Gorski LA et al. Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs, 2021. 44(1S Suppl 1): pp. S1-S224. Farrelly JS, Stitelman DH. Complications in pediatric enteral and vascular access. Semin Pediatr Surg. 2016;25(6):371–9. Ciofi Silva CL, et al. Site of catheter insertion in burn patients and infection: a systematic review. Burns. 2014;40(3):365–73. Linenberger ML. Catheter-related thrombosis: risks, diagnosis, and management. J Natl Compr Canc Netw. 2006;4(9):889–901. Verso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol. 2003;21(19):3665–75. Wang P, et al. Risk of VTE associated with PORTs and PICCs in cancer patients: A systematic review and meta-analysis. Thromb Res. 2022;213:34–42. Hu Z, et al. Risk assessment models for PICC-related venous thrombosis in adult patients with cancer: A network meta-analysis. Thromb Res. 2024;239:109030. Wang P, et al. Risk factors for peripherally inserted central catheter-related venous thrombosis in adult patients with cancer. Thromb J. 2024;22(1):6. Lu H, et al. The risk of venous thromboembolism associated with midline catheters compared with peripherally inserted central catheters: A systematic review and meta-analysis. Nurs Open. 2022;9(3):1873–82. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 28 Apr, 2026 Editor assigned by journal 16 Apr, 2026 Submission checks completed at journal 16 Apr, 2026 First submitted to journal 13 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9401903","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":632721259,"identity":"a5cc43e1-4f8f-42f7-a266-892cfe078b5f","order_by":0,"name":"Shansong Gao","email":"","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Shansong","middleName":"","lastName":"Gao","suffix":""},{"id":632721260,"identity":"7a253c65-6286-4449-9f9c-b0711464913c","order_by":1,"name":"Ying He","email":"","orcid":"","institution":"Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"He","suffix":""},{"id":632721262,"identity":"2f6676ae-d9b7-457d-a35e-5d76f597c263","order_by":2,"name":"Chenyue Wang","email":"","orcid":"","institution":"Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Chenyue","middleName":"","lastName":"Wang","suffix":""},{"id":632721263,"identity":"40f5afa7-009c-42ed-aaa1-a91659559010","order_by":3,"name":"Shengling Xu","email":"","orcid":"","institution":"Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Shengling","middleName":"","lastName":"Xu","suffix":""},{"id":632721265,"identity":"a62b5c11-baea-41e9-981b-f304076e18de","order_by":4,"name":"Dongjin Ling","email":"","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Dongjin","middleName":"","lastName":"Ling","suffix":""},{"id":632721268,"identity":"56301f2e-e525-4649-9b5e-b1ea86e0d3aa","order_by":5,"name":"Xiaoming Liu","email":"","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoming","middleName":"","lastName":"Liu","suffix":""},{"id":632721269,"identity":"aba98687-c2bc-4adb-9ac9-7f8a26c69073","order_by":6,"name":"Bentong Yu","email":"","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Bentong","middleName":"","lastName":"Yu","suffix":""},{"id":632721271,"identity":"edbcd03a-1ab4-4e31-a714-b19d09ad4e40","order_by":7,"name":"Guowen Zou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYFADZuaDDz5USMjJE6+FnS3ZcMYZC2PDBqK18POYSfO2VSQyHCCgUD4i+ZjExx11cgaHeYwNZ86TSGBsYH746AYeLYY30tIkZ55hMzY4zFb44OM2iTx2BjZj4xx8WmbkmN3mbeNJ3HCYebPhzG0SxYwNPGzSBLX8bZMAamEA+mWORGLDAQJa5CWAWhjbDIBaWIBaGojQYsDzLP1nb1uCseRhUCAfkzA2bCbgF/n25MMGP9vq5PjOHwZGZU2dnDx788PHeG05gCHEjEc52JYGAgpGwSgYBaNgFDAAAGcUS9QpHqOUAAAAAElFTkSuQmCC","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":true,"prefix":"","firstName":"Guowen","middleName":"","lastName":"Zou","suffix":""}],"badges":[],"createdAt":"2026-04-13 09:39:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9401903/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9401903/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108945502,"identity":"8975a287-ce9c-4968-9dd6-fc38258aafed","added_by":"auto","created_at":"2026-05-11 06:15:44","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":397723,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCT images show the situation of venous compression in the patients.\u003c/strong\u003e A. Patient 3: Right upper lung tumor with compression of the right accessory vein (red arrow). B(1). Patient 10: Right supraclavicular lymph node enlargement (yellow arrow) compressing the right internal jugular vein (red arrow). B(2). Patient 10: Right upper lung tumor (yellow arrow) and mediastinal lymph node enlargement (green arrow) compressing the superior vena cava (red arrow). C(1)-C(2). Patient 11: A tumor in the right upper lung (indicated by the yellow arrow) is accompanied by enlarged mediastinal lymph nodes (indicated by the green arrow) that have invaded the superior vena cava (indicated by the red arrow). D. Patient 17: A tumor in the right upper lung has invaded the superior vena cava (indicated by the red arrow). E. Patient 19: A lymphoma on the right side (indicated by the red arrow) is compressing the right brachiocephalic vein. F(1). Patient 13: Enlarged lymph nodes on the right supraclavicular region (indicated by the red arrow). F(2). Patient 13: Enlarged lymph nodes on the right supraclavicular region (indicated by the yellow arrow) have caused stenosis of the internal jugular vein (indicated by the red arrow).\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9401903/v1/5d8eb1eb7158bb55a19eda96.jpg"},{"id":108945500,"identity":"659312fa-1c58-451a-82a4-2be98ffec769","added_by":"auto","created_at":"2026-05-11 06:15:43","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":133619,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCT and 3D reconstruction images show the blocked condition of the right internal jugular vein due to arterial compression.\u003c/strong\u003eA (1). Patient 7: The twisted right internal carotid artery is compressing the right internal jugular vein. A (2) - A (3). 3D reconstruction images of the arterial (red) and venous (blue) systems and skeletal structure (white). A (4). The 3D reconstruction of the artery shows a malformation of the brachiocephalic trunk artery. B (1). The right internal jugular artery extends spirally upward, closely adjacent to the malformation of the right internal jugular vein. B (2). 3D reconstruction image of the vascular structures in the neck (arteries are red, veins are blue).\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9401903/v1/1a8cbb552a8e60f6168b62be.jpg"},{"id":108977536,"identity":"5cd8b350-24f6-4eab-b899-bfe3d39cbf6c","added_by":"auto","created_at":"2026-05-11 11:32:00","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":487828,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eImaging features of venous variations and stenosis.\u003c/strong\u003e A. Patient 1: isolated persistent malformation of the left superior vena cava (red arrow). B. Patient 2: elongated and narrowed right internal jugular vein (red arrow). C(1). Patient 4: central lung cancer in the left upper lobe with right internal jugular vein stenosis (red arrow). C(2). Patients in Group 2 and Group 4: right brachiocephalic vein lymph nodes compressed (red arrow). D. Patient 9: elongated and narrowed right internal jugular vein (red arrow). E(1)-E(2). Patient 6: elongated and narrowed right brachiocephalic vein (E1) and right internal jugular vein stenosis (E2) (red arrow). F. Patient 14: stenotic right internal jugular vein (red arrow) with right clavicular lymph node enlargement (yellow arrow).\u003c/p\u003e","description":"","filename":"figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9401903/v1/11e85d852630e304df8eb430.jpg"},{"id":108945499,"identity":"e8c7dc99-0a9e-47fd-89f8-625807fa9e03","added_by":"auto","created_at":"2026-05-11 06:15:43","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":89278,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRelevant factors incompatible with the right surgical approach.\u003c/strong\u003e A. Patient 5: Right upper lung tumor (red arrow), invading ribs (yellow arrow), requiring radiotherapy. B. Patient 8: Right breast cancer surgery followed by radiotherapy, with missing breast (red arrow). C. Patient 18: Right breast cancer with a huge mass on the chest wall (red arrow), requiring radiotherapy. D(1) - D(2). Patient 16: Preoperative right supraclavicular lymph node metastasis (red arrow). E. Patient 20: Postoperative image after secondary catheter implantation.\u003c/p\u003e","description":"","filename":"figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9401903/v1/e4594bc4a315e23949e993af.jpg"},{"id":108945503,"identity":"31e5056c-40a6-408e-8300-37e077c6b546","added_by":"auto","created_at":"2026-05-11 06:15:44","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":142913,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA(1)(2).\u003c/strong\u003e Patient 12 Suspected thrombus in the right internal jugular vein (indicated by the red arrow).\u003c/p\u003e","description":"","filename":"figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9401903/v1/ebc0ead95291a0871b4a619a.jpg"},{"id":108981041,"identity":"b6e2e60c-4900-4262-9d47-2315f4a366fe","added_by":"auto","created_at":"2026-05-11 12:13:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1553495,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9401903/v1/03f6f461-3138-41db-b1e3-c8f59c84609d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A summary and analysis of 20 cases of total implantation venous access port via a left-sided approach based on a single surgeon's five years of experience","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe totally implantable venous access port (TIVAP) is a central venous device widely used for long-term chemotherapy and infusion therapy. It has been demonstrated to effectively reduce the incidence of damage to the vascular pathway, thereby enabling the direct delivery of potent drugs with high concentrations to the central vein, which avoids damage to peripheral blood vessels and tissues [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The TIVAP is administered via venous puncture, with the main access routes including the internal jugular vein, subclavian vein, cephalic vein and femoral vein. The right-sided approach is generally recommended for two main reasons: firstly, the anatomy on the left side is more complex, increasing procedural difficulty; secondly, the right internal jugular vein is usually larger, and the right cephalic vein is almost in a straight line with the superior vena cava. Therefore, there is no need to bend the catheter or guidewire excessively when placing a catheter in the right internal jugular vein, and there is a reduced probability of it inadvertently entering other venous channels. In contrast, the left internal jugular vein has a greater angle of intersection with the left cephalic trunk. Additionally, the majority of clinicians who place infusion ports utilize their right hand as their standard method of access. The majority of clinical cannulators are right-handed and thus relatively unfamiliar with left-sided internal jugular vein cannulation, which increases the difficulty of this procedure. The left pleura is situated at a greater level than the right pleura is, which renders it more susceptible to puncture during the development of pneumothorax. Furthermore, the angle formed between the left internal jugular vein and the subclavian vein is prone to be punctured during thoracic drainage catheter insertion, which may lead to leakage of the abdominal plexus [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, certain patient-specific factors can contraindicate a right-sided approach. These include venous compression by tumor or lymph nodes, anatomical variations (e.g., stenosis or persistent left superior vena cava), local factors in the operative area (e.g., prior surgery, radiotherapy, or infection), and venous thrombosis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Most patients can be assessed via the right approach; however, few complex cases require the left approach. These patients are often referred to clinicians who are inexperienced with the left approach and may even forego placement of the TIVAP because of failure of the right approach. A mature clinician should be able to face a variety of complex cases, master a variety of puncture access, and reasonably select individualized treatments according to the patient's situation. To date, there have been few studies on the left-sided approach for TIVAP placement, with the majority of studies focusing on the right side of the breast tumor. Only a small number of cases involving venous variations have been reported, and there is currently no systematic summary of the studies on the left side of breast tumors that cannot be placed on the right side for a variety of reasons. A retrospective analysis of 20 patients who were implanted with the TIVAP via the left approach was conducted on the basis of the five-year experience of a single surgeon. The analysis aimed to provide references and enrich the experience of clinical port placement practitioners by summarizing the reasons for choosing the left approach and its characteristics. This would help practitioners judge the choice of the appropriate approach and improve the feasibility and safety of clinical port placement.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e In this study, 20 patients who underwent TIVAP implantation in the Department of Oncology and Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University were selected for analysis on the basis of the inclusion criteria. The clinical data of these patients were retrospectively analyzed, including the basic information of the patients, examination and tests, surgical modalities, and perioperative period. Additionally, the long-term complications and follow-up conditions of these patients were assessed through telephone follow-up. Ethical approval for the study was obtained from the Medical Ethics Committee of the First Affiliated Hospital of Nanchang University (IITS2024711). The First Affiliated Hospital of Nanchang University ethical institution confirms that the patient's informed consent form has been exempted.\u003c/p\u003e \u003cp\u003eThe data were analyzed via IBM SPSS Statistics 27.0.1.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe present study offers a summary of the sex, age, primary disease, cause of left-sided access, length of stay in port, and complications observed in 20 patients, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of the 20 patients undergoing left-sided TIVAP implantation.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale/ female\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrimary disease\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eReason\u003c/p\u003e \u003cp\u003e(left-sided approach)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDuration with port(day)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEsophageal cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous variation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRectal cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous variation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous compression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous variation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCatheter occlusion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOperative area-related factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous variation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous compression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBreast cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOperative area-related factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarcinoma of the cardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous variation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous compression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous compression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous embolism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous compression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEsophageal cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous variation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEsophageal cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous compression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e690\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMalignant tumor of the mediastinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOperative area-related factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLung cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous compression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBreast cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOperative area-related factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenous compression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColon cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOperative area-related factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe 20 patients included 10 males and 10 females with a mean age of 57.7 (41\u0026ndash;79) years at the time of port placement. The primary diseases were as follows: lung cancer (45%), esophageal cancer (15%), mediastinal malignancy (5%), pancreatic cancer (5%), rectal cancer (5%), lymphoma (5%), breast cancer (10%), and colon cancer (5%). The primary rationale for left-sided port placement was venous compression (40%), followed by venous variations (30%), operative area-related factors (25%), and venous embolism (5%). Further details can be found in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. One patient (5%) was complicated by catheter obstruction, whereas 19 patients (95%) did not experience any complications. The mean duration of port placement was 219 days (range: 25\u0026ndash;690 days).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of reasons for selecting the left-sided approach.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReason\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eVenous compression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eartery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVenous variation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emalformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003estricture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperative area-related factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScar on the body surface\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eradiotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary port purchase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVenous embolism\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ethrombus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003ch3\u003e1. Venous compression.\u003c/h3\u003e\n\u003cp\u003eThe most common clinical reason for the placement of an infusion port via the left side is compression of the vein. This occurs when a tumor, lymph node or artery compresses, encases or encroaches on the vessel, resulting in damage to the lumen and a reduction in blood flow.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Tumor compression.\u003c/h2\u003e \u003cp\u003ePatients 3, 11, 17 and 19 had compressed tumors (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA, C(1)(2), D, E). Patients 3, 11 and 17 had lung malignancies, and patient 19 had lymphoma.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Lymph node compression.\u003c/h2\u003e \u003cp\u003ePatient 13 was characterized by lymph node compression (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eF(1)(2)). Enlarged cervical and mediastinal lymph nodes may compress the vascular access point at the site of the infusion port. In Patient 13, an enlarged supraclavicular lymph node was observed to compress the internal jugular vein, resulting in the formation of stenosis within the internal jugular vein. It is advisable to refrain from puncturing this access at this juncture to prevent vascular injury. Furthermore, compressed vessels have the potential to narrow the lumen, increasing the risk of thrombosis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In Patient 10, both the tumor and metastatic supraclavicular lymph nodes exerted compression forces (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB(2) and 1B(1)).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Arterial compression.\u003c/h2\u003e \u003cp\u003ePatients 7 and 15 presented with arterial compression of the internal jugular vein (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). The right internal carotid artery exhibited tortuosity, compressing and deforming the right internal jugular vein to a degree that was almost wall-to-wall with the medial wall. This resulted in the artery being punctured with minimal difficulty during puncture of the vein, thereby increasing the risk of puncture. The right internal carotid artery was tortuous and spiralled upward. Given that the tortuous part of the artery was in close proximity to the right internal jugular vein and was throbbing quality, it was relatively straightforward to penetrate into the artery during puncture. Furthermore, the artery was repeatedly punctured during the procedure, resulting in arterial regurgitation. To prevent the formation of a hematoma at the puncture site, the right internal jugular vein approach was terminated, and the left approach was initiated instead.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2. Variation in veins\u003c/h3\u003e\n\u003cp\u003eVenous variations are also a common cause of intravenous infusion via the left lateral approach, which is subdivided into venous malformations and venous stenosis.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Venous malformations.\u003c/h2\u003e \u003cp\u003ePatient 1 had a venous malformation (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA) of the isolated permanent left superior vena cava (PLSVC), a congenital variant of the body vein. It is the most common thoracic venous malformation, with an incidence of 0.3% to 0.5% in the general population [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Approximately 10% of these PLSVCs are associated with right superior vena cava (SVC) agenesis, a condition known as isolated PLSVC [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This is an extremely rare venous malformation. In humans, the left superior vena cava originates in the left horn of the primitive venous sinus during the third week of embryonic life. As the left innominate vein develops in the embryo, the left jugular duct and the anterior main vein become occluded, and the left superior vena cava degenerates. Alternatively, if these structures do not degenerate, the left superior vena cava becomes permanent. In contrast, the right jugular duct and the anterior main vein develop to form the right superior vena cava. If the right jugular duct and the anterior main vein degenerate, the right superior vena cava is absent [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. According to the anatomical features and mode of return of the superior vena cava, PLSVC is often classified into four types: Type I: (10%-20%) PLSVC flowing into the coronary sinus (CS) with the absence of the right superior vena cava; Type II: (50%-60%) bilateral SVCs (double superior vena cava) without traffic branches; Type III: (25%-30%) bilateral SVCs with traffic branches; and Type III: (25%-30%) bilateral SVCs with traffic branches; and Type III: (25%-30%) bilateral SVCs with traffic branches. bilateral SVCs with traffic branches; type IV: (10%-20%) PLSVC flowing directly into the left atrium without passing through the coronary sinus [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The present case is an isolated PLSVC, which belongs to PLSVC type I. Most patients with PLSVC are clinically asymptomatic and are typically identified incidentally during a physical examination with the use of a chest enhancement CT scan or during the placement of a central venous access device. Prior to implantation of the TIVAP, the patients were evaluated to ascertain their basic condition, and the puncture approach was selected accordingly. The vascular condition was evaluated via a CT scan of the patient, which revealed that the right cephalic arm vein flowed into the left superior vena cava through the innominate vein, the PLSVC flowed into the right atrium through the coronary sinus, and the anomalous left singular vein ascended in proximity to the descending aorta and flowed into the PLSVC. Additionally, Doppler ultrasound of the patient's heart revealed a dilated coronary sinus, a finding that has been corroborated by several studies. The presence of a permanent left superior vena cava in more than 75% of patients with coronary sinus dilatation has been documented in previous research [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Alerting patients with a dilated coronary sinus to the possibility of a permanent left superior vena cava is important. As port surgeons, it is our responsibility to assess our patients for venous access deformities before placing a TIVAP. This basic competency is essential to avoid serious complications such as vascular injury.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Venous stenosis.\u003c/h2\u003e \u003cp\u003ePatients 2, 4, 6, 9, and 14 presented evidence of venous stenosis, including right internal jugular vein stenosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB, C(1), D, E(2), and F) and unnamed vein stenosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eE(1)). The presence of stenotic lesions represents a relative contraindication to TIVAP implantation, with the potential to increase the risk of catheter-related venous thrombosis following implantation [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. When long-term placement of a central catheter is considered, the ratio between the catheter diameter and the vein diameter is crucial, as catheters have the potential to obstruct blood flow, which can subsequently lead to thrombosis. The risk of obstruction of blood flow depends on the size of the catheter and the vein. To reduce the risk of catheter-related venous thromboembolism, maintaining a catheter-to-vein diameter ratio of 45% or less is advisable. Therefore, clinicians encountering stenotic lesions when placing a central catheter should assess the degree of stenosis preoperatively, calculate the ratio of the catheter to the diameter of the vein, and attempt to avoid this access if the ratio is greater than 45%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Factors associated with the operative area.\u003c/h2\u003e \u003cp\u003eThe factors related to the operation area were classified as follows: radiotherapy (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA, B, C), body surface scarring (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eD(1, 2)), secondary port placement (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eE), skin breakage, skin infection, and tumors in the operation area. The patients who required radiotherapy were predominantly those with chest lesions. For example, patients 8 and 18 had right breast cancer, necessitating radiotherapy on the right side. Consequently, the chest wall on the lesion side was avoided, and the contralateral side was selected instead. In Patient 5, a right lung tumor had invaded the right rib cage, necessitating radiotherapy on the right side. Consequently, a left-sided approach was selected. In cases of surface scarring and secondary port placement, it is also important to consider the choice of approach. The condition of the local soft tissue of the skin of the port can impact the placement and stability of the port. In cases where there is surgical scarring of the skin of the chest wall, including secondary port placement, an alternative approach is typically advised, avoiding the side of the chest wall with poor local skin and soft tissue [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Patient 16 had right supraclavicular lymph node metastasis, a history of previous lymph node dissection on the right side of the neck, and surgical scarring of the skin, which rendered puncture and port placement inadvisable. In Patient 20, a second port was placed, as the initial port had punctured the right internal jugular vein. This poses a risk of embolism, as the thrombus from the original puncture can dislodge and travel through the vasculature, potentially causing complications [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Additionally, the initial port placement could affect the stability of the infusion port placement due to its proximity to the local soft tissue condition of the skin [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e3. Venous embolism\u003c/h3\u003e\n\u003cp\u003eIn Patient 12, a filling defect of the right internal jugular vein (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA(1)(2)) was observed, which was deemed suspicious for venous thrombosis. The potential consequence of combining vascular access with a thrombus is that the thrombus may dislodge during puncture and tube placement, which may result in pulmonary embolism and other serious complications. This makes the placement of an infusion port an absolute contraindication[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. To ensure the safety of the procedure, the left-sided approach was selected. It is imperative that the physician responsible for placing the port assesses the presence or absence of thrombus in the placed vascular access before proceeding with port placement. This ensures the prevention of serious complications that could arise from thrombus dislodgement [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations and Future Directions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study has several limitations. The retrospective nature of the research, the small sample size, and the single-center design may affect the general applicability of the research results. Due to the lack of a matched control group for the right implantation surgery, it limits the comparative analysis of safety and efficacy results. The difference in follow-up time may lead to an underestimation of late complications (such as asymptomatic venous thrombosis). Future studies need to be multi-center, involving a larger sample size, and following a standardized follow-up protocol to verify our findings. Direct comparison of the surgical methods on the left and right sides among matched patients will help quantify the relative risks and benefits.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA comprehensive understanding of these blood vessels and surgical abnormalities is of great clinical significance for the implantation of central venous access devices. For patients with venous compression, anatomical abnormalities, surgical area-related contraindications, or suspected venous thrombosis, routine placement of the right TIVAP may increase the risk of vascular injury and catheter-related complications. In such cases, using the left approach TIVAP is a practical and safe alternative, provided that there is a comprehensive preoperative imaging assessment and appropriate professional technical support. This retrospective case series summarizes the indications and imaging features of left TIVAP implantation and demonstrates good safety results in long-term follow-up. This study emphasizes that mastering alternative access techniques is an important part of vascular access expertise, enabling the safe management of complex patients who were originally unable to receive this beneficial therapy. The results of this study provide practical references for clinical physicians performing TIVAP implantation and help improve individualized puncture selection and operational safety.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eClinical trial number:\u0026nbsp;not applicable\u003c/h3\u003e\n\u003ch3\u003eEthics approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eThis study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Nanchang University (IITS2024711). The First Affiliated Hospital of Nanchang University ethical institution confirms that the patient's informed consent form has been exempted. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to support the findings of this study are available from the corresponding author upon request.\u003cbr\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest regarding the publication of this paper.\u003cbr\u003e\u003cstrong\u003eFunding\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eThis is study is supported by the National Key R\u0026amp;D Program of China (No. 2023YFC2508604) and Jiangxi Provincial Department of Education Science and Technology Research Project Youth Project (190131).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e• Study conception and design: Guowen Zou, Shansong Gao, Ying He\u003c/p\u003e\n\u003cp\u003e• Acquisition of data: Shansong Gao, Xiaoming Liu, Chenyue Wang,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e• Analysis and interpretation of data: Shengling Xu, Ying He, Dongjin Ling, Bentong Yu\u003c/p\u003e\n\u003cp\u003e• Drafting of manuscript: Guowen Zou, Shansong Gao, Ying He\u003cbr\u003e\u0026nbsp;All authors given final approval of the version to be published.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMoss JG, et al. Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial. Lancet. 2021;398(10298):403\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFang S, et al. Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy. Patient Prefer Adherence. 2017;11:1197\u0026ndash;204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGe X, et al. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev. 2012;2012(3):CD004084.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuesch S, Walder B, Tramer MR. Complications of central venous catheters: internal jugular versus subclavian access\u0026ndash;a systematic review. Crit Care Med. 2002;30(2):454\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeichgraber UK, et al. Outcome analysis in 3,160 implantations of radiologically guided placements of totally implantable central venous port systems. Eur Radiol. 2011;21(6):1224\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOner B, et al. Pneumothorax following ultrasound-guided jugular vein puncture for central venous access in interventional radiology: 4 years of experience. J Intensive Care Med. 2012;27(6):370\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAitken DR, Minton JP. The pinch-off sign: a warning of impending problems with permanent subclavian catheters. Am J Surg. 1984;148(5):633\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJadhav AP, Stahlheber C, Hofmann H. Traumatic chyle leak: a rare complication of left internal jugular venous cannulation. Am J Med Sci. 2011;341(3):238\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012;40(8):2479\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharp R, et al. Catheter to vein ratio and risk of peripherally inserted central catheter (PICC)-associated thrombosis according to diagnostic group: a retrospective cohort study. BMJ Open. 2021;11(7):e045895.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Walleghem J, Depuydt S, Schepers S. Insertion of a totally implantable venous access port in a patient with persistent left superior vena cava (PLSVC). Acta Chir Belg. 2018;118(1):68\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIchikawa T, et al. Persistent left superior vena cava with absent right superior vena cava in adults: CT and clinical findings. Jpn J Radiol. 2020;38(11):1046\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKang J, Liu B, Sun W. Two successful insertions of peripherally inserted central catheters in a patient with persistent left superior vena cava: A case report. Med (Baltim). 2019;98(38):e16988.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeye T, et al. Persistent left superior vena cava with absent right superior vena cava: morphological CT features and clinical implications. Int J Cardiol. 2007;116(3):e103\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUcar O, et al. Persistent left superior vena cava with absent right superior vena cava: a case report and review of the literature. Cardiovasc J Afr. 2010;21(3):164\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSrivastava V, et al. Persistent left SVC with absent right SVC: a rare anomaly. J Card Surg. 2007;22(6):535\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBisoyi S, et al. Isolated persistent left superior vena cava: A case report and its clinical implications. Ann Card Anaesth. 2017;20(1):104\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheikh AS, Mazhar S. Persistent left superior vena cava with absent right superior vena cava: review of the literature and clinical implications. Echocardiography. 2014;31(5):674\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinniti S, Visentini S, Procacci C. Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol. 2002;12(8):2040\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMachevin-Surugue E, et al. Dilated coronary sinus in prenatal echocardiography; identification, associations and outcome. Prenat Diagn. 2002;22(10):898\u0026ndash;902.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim YG, et al. Impact of persistent left superior vena cava on radiofrequency catheter ablation in patients with atrial fibrillation. Europace. 2019;21(12):1824\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGorski LA et al. \u003cem\u003eInfusion Therapy Standards of Practice, 8th Edition.\u003c/em\u003e J Infus Nurs, 2021. 44(1S Suppl 1): pp. S1-S224.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarrelly JS, Stitelman DH. Complications in pediatric enteral and vascular access. Semin Pediatr Surg. 2016;25(6):371\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCiofi Silva CL, et al. Site of catheter insertion in burn patients and infection: a systematic review. Burns. 2014;40(3):365\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLinenberger ML. Catheter-related thrombosis: risks, diagnosis, and management. J Natl Compr Canc Netw. 2006;4(9):889\u0026ndash;901.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerso M, Agnelli G. Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. J Clin Oncol. 2003;21(19):3665\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang P, et al. Risk of VTE associated with PORTs and PICCs in cancer patients: A systematic review and meta-analysis. Thromb Res. 2022;213:34\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu Z, et al. Risk assessment models for PICC-related venous thrombosis in adult patients with cancer: A network meta-analysis. Thromb Res. 2024;239:109030.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang P, et al. Risk factors for peripherally inserted central catheter-related venous thrombosis in adult patients with cancer. Thromb J. 2024;22(1):6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu H, et al. The risk of venous thromboembolism associated with midline catheters compared with peripherally inserted central catheters: A systematic review and meta-analysis. Nurs Open. 2022;9(3):1873\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"left approach, totally implantable venous access port, vascular malformation","lastPublishedDoi":"10.21203/rs.3.rs-9401903/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9401903/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eA review of 20 cases of total implantation venous access port (TIVAP) implantation via a left-sided approach provides valuable clinical experience and enables port placement physicians to assess the suitability of different approaches, thereby improving the feasibility and safety of port implantation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe clinical data of 20 patients who underwent total venous access port implantation via a left-sided approach at the Department of Oncology and Department of Thoracic Surgery of the First Affiliated Hospital of Nanchang University from April 2019 to November 2023 were retrospectively analyzed. These data included patients' baseline characteristics, examination results, surgical procedures, perioperative conditions and long-term complications.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of the 20 patients at the time of port placement was 57.7 years (range 41\u0026ndash;79 years). The primary diseases were lung cancer, esophageal cancer, mediastinal malignancy, pancreatic cancer, rectal cancer, lymphoma, breast cancer, and colon cancer. The primary causes of left-sided port placement were venous compression (40%), followed by venous variations (30%), operative area-related factors (25%), and venous embolism (5%). Catheter obstruction occurred in one patient (5%), while no complications were observed in the remaining 19 patients (95%). The mean duration of port placement was 219 days (range: 25\u0026ndash;690 days).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eLeft-sided TIVAP implantation is a safe and feasible alternative when right-sided access is contraindicated. Careful preoperative imaging evaluation and individualized access selection are essential to minimize complications. This case series provides practical guidance for port placement in complex clinical scenarios and may assist clinicians in selecting appropriate access routes.\u003c/p\u003e","manuscriptTitle":"A summary and analysis of 20 cases of total implantation venous access port via a left-sided approach based on a single surgeon's five years of experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 06:15:38","doi":"10.21203/rs.3.rs-9401903/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-28T17:05:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-16T12:26:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-16T12:26:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2026-04-13T09:31:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d393d06a-74b4-48bb-898b-0380f2c7162a","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T06:15:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 06:15:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9401903","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9401903","identity":"rs-9401903","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}