title: Prospective study of catheter-related central vein thrombosis in home parenteral nutrition patients with benign disease using serial venous Doppler ultrasound.
abstract: OBJECTIVE
  Catheter-related central vein thrombosis (CRVT) is a severe complication of home parenteral nutrition (HPN) that may be clinically manifest or subclinical. The aims of the study were to prospectively investigate the incidence of CRVT in patients on HPN with benign disease and determine the influence of different variables on this complication.
  
  
  METHODS
  A prospective, multicentre, observational study in the Home Artificial Nutrition-Chronic Intestinal Failure ESPEN group was performed. Patients with benign disease starting HPN or already on HPN after the insertion of a new catheter, were recruited and followed up with Color Doppler Duplex Sonography (CDDS) evaluations at baseline, 1 week, 3, 6 and 12 months after catheter insertion. Fisher's exact test was used to calculate the association of different variables (related to the patient, type of catheter, vascular access, insertion method, catheter care and anticoagulant treatment) with CRVT events.
  
  
  RESULTS
  Sixty-two patients (31 males, 31 females) aged 50 ± 19 (19-83) years were included and followed for a median 363 days, with an Inter Quartile Range of 180-365 days, and a total of 16,186 catheter-days. Six patients had previous CRVT and 16 had history of thromboembolic disease (pulmonary and mesenteric). Forty one patients were receiving anticoagulant treatment. Fifty two patients had tunneled catheters and 10 implanted ports. Two patients had symptomatic thrombosis at 3 and 12 months of follow-up (2 and 3 weeks after normal routine CDDS evaluation). The incidence of CRVT was 0.045/catheter/year. CRVT was not significantly associated with any of the variables analyzed.
  
  
  CONCLUSIONS
  The incidence of CRVT in patients on HPN for benign disease followed by CDDS is low in the first year of catheterization. We did not observe any case of asymptomatic CRVT. Based on our data, CDDS seems to have low effectiveness as a screening tool for CRVT in asymptomatic patients on HPN with benign disease.
authors: Nutrition Unit, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: cuerda.cristina@gmail.com.
authors: Cristina
authors: C
authors: Cuerda
authors: Department of Gastroenterology and Nutrition Support, L'hopital Beaujon, Clichy, France.
authors: Francisca
authors: F
authors: Joly
authors: Department of Gastroenterology and Nutrition Support, L'hopital Beaujon, Clichy, France.
authors: Olivier
authors: O
authors: Corcos
authors: Vascular Surgery Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Javier
authors: J
authors: Concejo
authors: Nutrition Support Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors: Carolina
authors: C
authors: Puiggrós
authors: Service of Endocrinology and Nutrition, Hospital Gómez Ulla, Madrid, Spain.
authors: Carmen
authors: C
authors: Gil
authors: Center for Chronic Intestinal Failure, Department of Gastroenterology, University of Bologna, Italy.
authors: Loris
authors: L
authors: Pironi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D055499:Catheter-Related Infections / Q000000981:diagnostic imaging*; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Catheter; Home parenteral nutrition; Venous thrombosis