Material and Methods: This retrospective single-center, single-operator study included 1,224 consecutive adult patients who underwent TIVAP implantation between June 2022 and January 2026. Patients with clinical conditions limiting cervical or pectoral access were classified as the restrictedaccess group (n = 115), while the remaining patients comprised the standard-access group (n = 1,109). Primary outcomes were revision and catheter malposition. Logistic regression analyses were performed
Results: Left-sided access (12.2% vs 1.4%, p < 0.001) and subclavian vein use (47.0% vs 20.2%, p < 0.001) were significantly more frequent in the restricted-access group. Revision rates (4.3% vs 3.7%, p = 0.612) and catheter malposition rates (1.7% vs 0.7%, p = 0.240) did not differ significantly between groups. Restricted-access status was not independently associated with revision (OR 1.08, 95% CI 0.38-3.01, p = 0.887) or malposition (OR 0.86, 95% CI 0.15-4.70, p = 0.861). Subclavian vein use was associated with catheter malposition (OR 34.84, 95% CI 4.31-281.2, p = 0.001).
Conclusions: No statistically significant increase in revision or catheter malposition risk was observed in patients with clinical conditions restricting guideline-preferred access planning. When applied within a standardized procedural framework, alternative venous access strategies may be feasible according to
