Catheter spatial configuration and biological factors predict fibrin sheath–related dysfunction in totally implantable venous access ports
Abstract
BackgroundFibrin sheath formation is a major cause of totally implantable venous access port (TIVAP) dysfunction, but tools for early risk assessment remain limited.ObjectivesTo develop and validate an interpretable model for early post-implantation risk stratification and explore the hemodynamic context of catheter spatial predictors.MethodsThis single-center retrospective study included 507 patients divided into training, internal testing, and temporal validation cohorts. Demographic, laboratory, and catheter spatial variables were assessed. Nine predictors were selected using univariable logistic regression, Boruta, and least absolute shrinkage and selection operator (LASSO) regression. Eight machine-learning models were compared for discrimination, calibration, and clinical utility. The final model was interpreted using SHapley Additive Explanations (SHAP), and computational fluid dynamics (CFD) was performed in representative cases.ResultsXGBoost-linear showed stable discrimination, with areas under the curve of 0.891 in the internal testing cohort and 0.904 in the temporal validation cohort. SHAP analysis identified catheter spatial parameters as the leading predictors, while coagulation and inflammatory indices provided complementary information. In the two representative cases, hemodynamic disturbances were observed near venous curvature, confluence, and catheter–wall contact regions, with heterogeneous wall-based indices in the lower superior vena cava (SVC) above the right atrium (RA). A simplified six-variable model retained comparable performance in temporal validation (area under the curve, 0.893) and was implemented as an interactive web-based tool.ConclusionThe model may support interpretable early risk stratification and closer catheter-function monitoring, subject to prospective multicenter validation. Exploratory CFD analysis in two representative cases provided preliminary hemodynamic context for the model-identified spatial predictors.
Related
- Radiofrequency ablation with a conventional solid tip catheter in contact with an implantable cardioverter-defibrillator coil causing inadvertent ventricular fibrillation.
- Analgesic Effectiveness of Ultrasound-Guided PECS II Block in Implantable Venous Port Catheter Placement: A Retrospective Comparative Study
- Fluoroscopy-guided transfemoral pigtail catheter repositioning of malpositioned totally implantable venous access port catheters: a retrospective single-center study.
- Comparative safety outcomes of three venous access routes for totally implantable venous access port placement and exploratory assessment of pre-removal catheter-related thrombosis in breast cancer patients
- Metabolic Dysfunction-Associated Steatotic Liver Disease and Atrial Fibrillation Recurrence After Catheter Ablation: A Systematic Review and Meta-Analysis
BibTeX
@article{wu2026catheter,
title = {{Catheter spatial configuration and biological factors predict fibrin sheath–related dysfunction in totally implantable venous access ports}},
author = {Chenkai Wu and Yuxiao Zong and Yunyuan Bao and Xiaohu Yang and Hui Zhao and Cong Chen and Suming Zhao and Weiwei Gu},
journal = {Frontiers in Oncology},
year = {2026},
month = nov,
doi = {10.3389/fonc.2026.1990440},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1990440},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Catheter spatial configuration and biological factors predict fibrin sheath–related dysfunction in totally implantable venous access ports
AU - Chenkai Wu
AU - Yuxiao Zong
AU - Yunyuan Bao
AU - Xiaohu Yang
AU - Hui Zhao
AU - Cong Chen
AU - Suming Zhao
AU - Weiwei Gu
PY - 2026
DA - 2026/11/02
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1990440
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1990440
AB - BackgroundFibrin sheath formation is a major cause of totally implantable venous access port (TIVAP) dysfunction, but tools for early risk assessment remain limited.ObjectivesTo develop and validate an interpretable model for early post-implantation risk stratification and explore the hemodynamic context of catheter spatial predictors.MethodsThis single-center retrospective study included 507 patients divided into training, internal testing, and temporal validation cohorts. Demographic, laboratory, and catheter spatial variables were assessed. Nine predictors were selected using univariable logistic regression, Boruta, and least absolute shrinkage and selection operator (LASSO) regression. Eight machine-learning models were compared for discrimination, calibration, and clinical utility. The final model was interpreted using SHapley Additive Explanations (SHAP), and computational fluid dynamics (CFD) was performed in representative cases.ResultsXGBoost-linear showed stable discrimination, with areas under the curve of 0.891 in the internal testing cohort and 0.904 in the temporal validation cohort. SHAP analysis identified catheter spatial parameters as the leading predictors, while coagulation and inflammatory indices provided complementary information. In the two representative cases, hemodynamic disturbances were observed near venous curvature, confluence, and catheter–wall contact regions, with heterogeneous wall-based indices in the lower superior vena cava (SVC) above the right atrium (RA). A simplified six-variable model retained comparable performance in temporal validation (area under the curve, 0.893) and was implemented as an interactive web-based tool.ConclusionThe model may support interpretable early risk stratification and closer catheter-function monitoring, subject to prospective multicenter validation. Exploratory CFD analysis in two representative cases provided preliminary hemodynamic context for the model-identified spatial predictors.
SN - 2234-943X
ER -