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Contrast venography in young haemophiliacs with implantable central venous access devices
D Medeiros1, K L Miller, N K Rollins
1North Texas Comprehensive Hemophilia Center, Children's Medical Center of Dallas, TX 75235, USA.
Insights
Hemophiliacs with long-term central venous catheters have a low risk of deep vein thrombosis. Central venous catheters can be safely used in hemophiliacs, despite theoretical risks.
Area of Science:
- Hematology
- Vascular Surgery
- Medical Devices
Background:
- Hemophiliacs often require long-term central venous access.
- Central venous catheters (CVCs) are associated with thrombosis risk in general populations.
- The specific risk of deep vein thrombosis (DVT) in hemophiliacs with CVCs is not well-established.
Purpose of the Study:
- To evaluate the risk of deep vein thrombosis (DVT) in hemophiliacs using long-term central venous catheters (CVCs).
Main Methods:
- Retrospective review of medical records for catheter-related complications.
- Physical examination for signs of thrombosis.
- Contrast venography to assess venous patency.
- Study included 19 hemophiliacs with implantable venous access devices (ports) in place for over 6 months.
Main Results:
- No clinically relevant upper venous system thrombosis was identified by venography (95% CI, 0-23%).
- One patient had a non-occlusive thrombus, and another had minimal subclavian vein narrowing at a prior catheter site.
- Two ports were replaced due to mechanical dysfunction or infection; three experienced infusion/withdrawal difficulties, two resolved with urokinase.
Conclusions:
- Hemophiliacs with long-term CVCs have a lower thrombosis risk compared to other patient populations.
- The use of CVCs should not be contraindicated in hemophiliacs due to thrombosis concerns.
Abstract:
To assess the risk of deep vein thrombosis in haemophiliacs with long-term central venous catheters, we studied haemophiliacs followed at our centre with implantable venous access devices (ports) in place for > 6 months. Medical records were reviewed for a history of catheter-related complications. Each patient was examined for physical stigmata of thrombosis. Patency of the vessels was evaluated by contrast venography. Of 21 males with ports, 19 had factor VIII deficiency and two factor IX deficiency. Nineteen ports were evaluable (i.e. were in place for > 6 months). Seventeen patients have their original ports in place; two ports were replaced for mechanical dysfunction (1) and recurrent infection (1). Difficulty withdrawing or infusing occurred with three ports, two of which were cleared with urokinase. Physical examination was normal on all 19 patients. Venograms were performed in 13 of 19 patients. Parents of the remaining six patients refused venography because of the need for peripheral venipuncture. One patient had a small nonocclusive thrombus on the same side as his functioning catheter, and another had minimal narrowing of the subclavian vein at the site of a prior catheter. The overall prevalence of clinically relevant upper venous system thrombosis identifiable by contrast venography was zero (95% CI, 0-23%). We conclude that haemophiliacs do not have as high a risk of thrombosis as other populations of patients with central venous catheters. The theoretical risk of thrombosis should not preclude use of central venous catheters in patients with haemophilia.