[Thrombosis of the superior vena cava after prolonged catheterization. Treatment by progressive removal of the catheter combined with urokinase-heparin administration].
A retrospective study of 13 cases of complete superior vena cava thrombosis due to prolonged catheterization is reported. All the polyurethane catheters had been inserted by anaesthetists in theatre between January 1985 and December 1989, using Seldinger's technique. On the 10th day after the first catheter had been placed, the catheter was replaced by using a guide wire. Superior vena cava obstruction was diagnosed clinically (eyelid, neck, facial and upper limb oedema, cyanosis, collateral venous circulation, lack of blood reflux in the catheter). The clinical diagnosis was confirmed by phlebography. Treatment consisted in administration of urokinase (1,500 IU.kg-1.h-1), together with 10,000 to 25,000 IU.day-1 of heparin, both being injected via the catheter. The catheter was removed progressively (1 cm every 2 to 4 h). As soon as a venous pressure curve was obtained, the catheter was completely removed. Overall 8,784 catheters were inserted during that period. The incidence of superior vena caval obstruction may therefore be estimated to be 1.48 per 1,000 catheters. The catheters remained in place up to a mean of 14.75 +/- 9.6 days before the obstruction occurred. Treatment with urokinase and heparin lasted a mean of 2.53 +/- 1 days. The clinical picture returned to normal in all 13 patients. Phlebography carried out in three of them, after treatment, showed an excellent degree of venous repermeability. Thrombolysis was confirmed by the increase in the concentration of D-dimers, without any decrease in fibrinogen concentration. There were five haemorrhagic complications, including two haematomas of the psoas muscle, one of which required surgical drainage.(ABSTRACT TRUNCATED AT 250 WORDS)
Prudhomme
S
S
Service d'Anesthésiologie, Clinique Universitaire Saint-Luc, Bruxelles.
Colin
L
L
Laloux
A
A
D000368:Aged; D000369:Aged, 80 and over; D001780:Blood Coagulation Tests; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D014683:Vena Cava, Superior
D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator
Thrombose de la veine cave supérieure après cathétérisation prolongée. Traitement par retrait progressif du cathéter et association urokinase-héparine.