Objective To evaluate the safety and feasibility of percutaneous superior vena cava (SVC) catheterization in patients with thoracic central vein obstruction (TCVO) and to assess the accuracy of preprocedural multi-detector computed tomography venography (MDCTV) in predicting SVC puncture angles.

Methods  A retrospective analysis was conducted on 106 patients who underwent percutaneous SVC catheterization for TCVO between January 2020 and December 2023. Patient baseline characteristics, surgical data, and follow-up information were collected. Preprocedural MDCTV images were analyzed using OsiriX, a medical imaging interpretation and processing software, to determine predicted puncture angles. A paired-sample t-test was used to examine the agreement between MDCTV-predicted puncture angle and the actual puncture angle measured by intraoperative digital subtraction angiography (DSA). Technical success rates and perioperative complication rates were recorded, and catheter patency rates were assessed using Kaplan-Meier survival analysis.

Results  Among the 106 patients, 78.3% (83/106) had type 2B TCVO and 19.8% (21/106) had type 3 TCVO. The technical success rate of the procedure was 100% (106/106), and the incidence of severe complications was 1.9% (2/106). There were no statistically significant differences between the preprocedural MDCTV-predicted and intraoperative DSA-measured puncture angles in the coronal plane (11.46° vs 11.37°, P = 0.977) or the sagittal plane (18.62° vs 17.12°, P = 0.848). Catheter patency rates were 98.1% at 14 days and 80% at 24 months.

Conclusion Percutaneous SVC catheterization is a safe and effective vascular access salvage option for patients with TCVO when conventional vascular access options have been exhausted. Preprocedural MDCTV can effectively predict SVC puncture angles, providing an objective basis for preprocedural route planning, thereby reducing operative risks and improving technical success rates.