RSS-Feed abonnieren
DOI: 10.1055/s-0038-1648912
Pulmonary Embolism in Patients with Upper Extremity DVT Associated to Venous Central Lines - A Prospective Study
Publikationsverlauf
Received 18. April 1994
Accepted after revision 23. Juni 1994
Publikationsdatum:
26. Juli 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/199404/lookinside/thumbnails/10-1055-s-0038-1648912-1.jpg)
Summary
We performed a prospective study in 86 consecutive patients with central vein catheter-related deep venous thrombosis (DVT) of the upper extremity, to evaluate the prevalence of pulmonary embolism (PE), and to identify clinical variables that would increase the likelihood of developing PE in an individual patient.
Since upper-extremity DVT was established, all patients received intravenous heparin therapy. Then, a ventilation-perfusion lung scan was obtained within 24 h of DVT diagnosis, whether respiratory symptoms were present or not. Six points of clinical information were recorded on entering in the study, and then compared with the scintigraphic findings: age, sex, the underlying disease, the catheter material, the character of the infusate, and the duration of cannulation.
Thirteen patients were considered to have PE. Sixty-six patients were finally classified as having a normal lung scan, and 7 patients were excluded from the study (because of indeterminate lung scan 6; because of femoropopliteal thrombosis simultaneously present 1). Two out of the 13 patients with PE subsequently died because of recurrent, massive embolism, despite adequate heparin therapy. PE was more commonly present in patients with polyvinyle chloride or polyethylene catheters (10/38,26%) as compared to patients with either polyurethane or siliconized catheters (3/41, 7%; p <0.05, Chi-Square test; Odds Ratio = 4.52,95% Cl 1.01-23.07).
We conclude that PE is not a rare event in these patients, and it may be life-threatening even despite adequate heparin therapy. Since the more recently available soft catheters seem to carry a lower risk of developing PE, there seems to be no reason to continue to use polyvinyl chloride or polyethylene catheters.
-
References
- 1 Coon WW, Willis PW. Thrombosis of axillary and subclavian veins. Arch Surg 1966; 94: 657-663
- 2 Swinton NW, Edgett JW, Hall RJH. Primary subclavian-axillary vein thrombosis. Circulation 1968; XXXVIII: 737-745
- 3 Tilney NL, Griffiths HJG, Edward EA. Natural history of major venous thrombosis of the upper extremity. Arch Surg 1970; 101: 792-796
- 4 Prescott SM, Tikoff G. Deep venous thrombosis of the upper extremity: a reappraisal. Circulation 1979; 59: 350-355
- 5 Demeter SL, Pritchard JS, Piedad OH, Cordasco EM, Taherj S. Upper extremity thrombosis: etiology and prognosis. Angiology 1982; November 743-755
- 6 Davis G, Kaplan K, Kwaan HC. Pulmonary emboli from a platelet-rich thrombus attached to a pacemaker electrode. Pace 1983; 6: 883-886
- 7 Anderson AJ, Krasnow SH, Boyer MW, Cutler DJ, Jones BD, Citron ML, Ortega LG, Cohen MH. Thrombosis: the major Hickman catheter complication in patients with solid tumor. Chest 1989; 95: 71-75
- 8 Becker DM, Philbrick JT, Walker FB. Axillary and subclavian venous thrombosis. Prognosis and treatment. Arch Intern Med 1991; 151: 1934-1943
- 9 Monreal M, Lafoz E, Ruiz J, Vails R, Alastrue A. Upper extremity deep venous thrombosis and pulmonary embolism. A prospective study. Chest 1991; 99: 280-283
- 10 Monreal M, Ruiz J, Olazabal A, Arias A, Roca J. Deep venous thrombosis and the risk of pulmonary embolism. A systematic study. Chest 1992; 102: 677-681
- 11 Monreal M, Montserrat E, Salvador R, Bechini J, Donoso L, Callejas JM, Foz M. Real-time ultrasound for diagnosis of symptomatic venous thrombosis and for screening of patients at risk: correlation with ascending conventional venography. Angiology 1989; June 527-533
- 12 Biello DR, Mattar AG, McKnight RC, Siegel BA. Ventilation-perfusion studies in suspected pulmonary embolism. Am J Roentgenol 1979; 133: 1033-1037
- 13 Moser KM, LeMoine JR. Is embolic risk conditioned by location of deep venous thrombosis?. Ann Intern Med 1981; 94: 439-444
- 14 Horattas MC, Wright DJ, Fenton AH, Evans DM, Oddi MA, Kamienski RW, Shields EF. Changing concepts of deep venous thrombosis of the upper extremity - Report of a series and review of the literature. Surgery 1988; 104: 561-567
- 15 Lindblad B, Stemby NH, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years. Brit Med J 1991; 302: 709-711
- 16 Chastre J, Comud F, Bouchama A, Viau F, Benacerraf R, Gibert CI. Pulmonary thromboembolic complications from Swan-Ganz catheters. Presse Méd 1983; 2: 395-398
- 17 Kerr TM, Lutter KS, Moeller M, Hasselfeld KA, Roedersheimer LR, McKenna PJ, Winkler JL, Spirtoff K, Sampson MG, Cranley JJ. Upper extremity venous thrombosis diagnosed by dupplex scanning. Amer J Surg 1990; 160: 202-206
- 18 Burihan E, Poli de Figueiredo LF, Francisco J, Miranda F. Upper-extremi-ty deep venous thrombosis: analysis of 52 cases. Cardiovasc Surg 1993; 1: 19-22
- 19 Welch GW, McKeel DW, Silverstein P, Walker H. The role of catheter composition in the development of thrombophlebitis. Surg Gynecol Obstet 1974; 138: 421-424
- 20 Borow M, Crowley JG. Evaluation of central venous catheter thrombo-genicity. Acta Anaesth Scand 1985; 81: 59-64
- 21 Bozzetti F, Scarpa D, Terno G, Scotti A, Ammatuna M, Bonalumi MG, Ceglia E. Subclavian venous thrombosis due to indwelling catheters: A prospective study on 52 patients. JPEN 1983; 7: 560-562