Preoperative duplex venous imaging in the assessment of patients with venous access

Occult or clinically apparent central venous thrombosis frequently complicates central venous catheter placement in patients requiring long-term vascular access. Thirty-three patients, aged 12-83 years, underwent duplex scanning of the internal jugular, axillary, and brachial veins prior to placement of long-term venous access catheters. Twenty-seven patients underwent duplex scanning because of a prior history of either long-term or short-term central venous access. Of 12 patients with a history of long-term central venous access, without complications, 42% (5/12) had an abnormal duplex scan demonstrating thrombosis. Duplex scans on 15 patients having complications associated with central venous access demonstrated thrombosis of one or more of the central veins, 46% (7/15). Five patients who underwent duplex scanning without a history of a previous central venous catheter or other indication were found to have normal central veins. In 13 patients found to have thrombosis or obstruction by duplex scan, the surgeon was directed to successful venous access in all cases. Normal findings were very helpful in confirming that the venous system was normal in selected patients. In approximately 40% of patients with a history of venous access, catheters were found to have evidence of thrombosis of one or more of the central veins. In 13 patients found to have thrombosis or obstruction by duplex scan, the surgeon was directed to a successful site for venous access in all cases.