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Clinical Impact of Chronic Venous Changes Induced by Central Lines in Children: A Cohort with Abnormal Venograms

Ralph Gnannt1, Racha Chamlati2, Nicolas Waespe3

  • 1Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada; Pediatric Interventional Radiology, Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich, Switzerland.

Journal of Vascular and Interventional Radiology : JVIR
|April 1, 2019
PubMed

Insights

Central venous stenosis/obstructions in children are linked to prior central venous access device use. These conditions increase the risk of future thromboses, impacting venous health.

Area of Science:

  • Pediatric vascular access
  • Venous thromboembolism in children
  • Central venous catheter complications

Background:

  • Central venous access devices (CVADs) are crucial for pediatric care.
  • Central venous stenosis/obstructions (CVS/O) are potential complications.
  • The relationship between CVAD characteristics and CVS/O risk is not fully understood.

Purpose of the Study:

  • To investigate if prior central venous access devices influence central venous stenosis/obstructions in children.
  • To determine if CVS/O are associated with an increased risk of future thromboses.

Main Methods:

  • Retrospective analysis of 100 pediatric patients with abnormal venography during PICC placement.
  • Categorization into groups based on venographic evidence of superior vena cava connection.
  • Analysis of CVAD history, venographic findings, and subsequent thrombotic events.

Main Results:

  • Patients with absent superior vena cava connection (Group B) had more prior CVADs, larger diameter devices, and malpositions.
  • Successful ipsilateral PICC placement was significantly higher in Group A (98%) vs. Group B (32%).
  • Group B experienced more subsequent Doppler ultrasounds and diagnosed thromboses (36%) compared to Group A (8%).

Conclusions:

  • Prior central venous access device characteristics significantly influence the severity of central venous stenosis/obstructions.
  • Children with venographic CVS/O are at higher risk for subsequent symptomatic thromboses.
  • Findings aid in anticipating adverse outcomes and managing pediatric venous health.
Abstract

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