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

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