title: Identification of risk factors for catheter-related thrombosis in patients with totally implantable venous access ports in the forearm.
abstract: OBJECTIVE
  To identify risk factors for the development of catheter-related thrombosis (CRT) in patients with totally implantable venous access ports (TIVAP) in the forearm, and to analyze the effect of prophylaxis and treatment.
  
  
  METHODS
  We retrospectively identified 200 patients (94 men, 106 women, mean age 57.7 +/-14 y) with TIVAP implantation in the forearm between 3/2010 and 11/2010. Type, number of punctures and sonographically defined diameter of the accessed vein were analyzed. Chemotherapy administered prior to the implantation procedure and history of thrombo-embolic events were assessed. Thrombo-embolic prophylaxis (TEP) following port implantation and treatment as well as course of CRT were analyzed.
  
  
  RESULTS
  Twenty-one patients (10.5%) were diagnosed with CRT. Accessed vessels and mean diameter were basilic (n=150, 3.7 mm), brachial (n=39, 3.5 mm) and cephalic (n=11, 3.5 mm) vein. Neither type nor vessel diameter had effect on CRT development (P>.05). Implantation in the left forearm resulted in a significantly higher rate of CRT (P=.04). Ninety-five patients (47.5%) received chemotherapy and 30 patients (15.0%) had a history of thrombosis prior to implantation; both had no effect on development of CRT. Low molecular weight heparin (LMWH) was prescribed in 94/200 patients (47.0%) and had no effect on development of CRT (P>.05). Therapeutic anticoagulation with LMWH resulted in clinical improvement in 12/21 patients (57.4%).
  
  
  CONCLUSIONS
  TIVAPs of the forearm may be associated with a certain rate of early and late CRT. The simplest vein to puncture should be selected for vascular access. Thrombo-embolic prophylaxis appears to be rather ineffective for prevention of CRT.
authors.affiliation: Institute of Radiology, Julius-Maximilians-University of Würzburg, Germany. Goltz@roentgen.uni-wuerzburg.de
authors.forename: Jan P
authors.initials: JP
authors.lastname: Goltz
authors.forename: Jan S
authors.initials: JS
authors.lastname: Schmid
authors.forename: Christian O
authors.initials: CO
authors.lastname: Ritter
authors.forename: Pascal
authors.initials: P
authors.lastname: Knödler
authors.forename: Bernhard
authors.initials: B
authors.lastname: Petritsch
authors.forename: Johannes
authors.initials: J
authors.lastname: Kirchner
authors.forename: Dietbert
authors.initials: D
authors.lastname: Hahn
authors.forename: Ralph
authors.initials: R
authors.lastname: Kickuth
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D005542:Forearm / Q000098:blood supply*; D005858:Germany; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D010690:Phlebography / Q000379:methods; D011655:Pulmonary Embolism / Q000209:etiology; D011677:Punctures; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013923:Thromboembolism / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D056824:Upper Extremity Deep Vein Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D020246:Venous Thrombosis / Q000209:etiology
chemical_list: D000925:Anticoagulants; D000970:Antineoplastic Agents; D006495:Heparin, Low-Molecular-Weight