[Thromboembolic complications and permanent endocavitary stimulation catheters]

Based on four cases of phlebitis associated with permanent intravenous cardiac stimulation catheters, the authors review the pathophysiology, clinical signs, diagnosis and treatment of this disease. The insertion of the catheter causes varying degrees of radiologically detectable thrombosis in 30 to 50 per cent of cases. The most frequent clinical presentation is the typical picture of phlebitis of the upper limb due to axillo-subclavian thrombosis. However, clinical signs are only present in 0.5 to 5 per cent of cases (1.7 per cent of cases in the present series). The risk of this complication can not be predicted on the basis of delay after the implantation. The incidence is increased in patients with more than one stimulating electrode, but this disease is not confined to this group of patients. The thrombosis may affect the superior vena cava or the right cardiac cavities, when it may also be associated with pulmonary embolism, as in one of the cases in this series. One case with arteriolar involvement (phlegmatia cerulea) is also described. The diagnosis may require impedance rheoplethysmography, two dimensional echocardiography, isotope phlebography or contrast phlebography, which remains the most frequently used technique. The treatment is medical, consisting of intravenous or subcutaneous heparin. Fibrinolysis may be indicated in cases with recent superior vena cava thrombosis and or other complications. To our knowledge, no controlled studies have been performed to define the optimal treatment. Long term prophylactic anticoagulant therapy is useless. There is never any indication for removal and replacement of the catheter responsible or for the removal of useless catheters left in place in patients with multiple implants.