Venous thrombosis associated with central venous catheter in cancer patients with surgical chest port (S) or venography- guided arm port insertion (R): A randomized controlled study.

Abstract

9158 Background: The aims of this prospective randomized study were two-fold: To estimate the incidence of overall venous thrombosis (VT) including catheter-related upper extremity venous thrombosis in a low-risk oncology population; To study risk factors for catheter-related VT Methods: Adult patients with solid tumor malignancy eligible for central venous catheter (CVC) were randomized between surgical chest port (S) and venography-guided arm port insertion (R). Follow-up included clinical assessment, chest radiograph control of the catheter tip, 3-month Doppler Ultrasound screening of catheter-related VT and CT angiography. Exclusion criteria included previous VT or pulmonary embolism, previous ipsilateral venous catheter or pacemaker, ipsilateral central venous compression/irradiation, poor WHO performance status and anticoagulation Results: 215 patients (median age 59 years; range: 25-82) were eligible in 3 years. 106 CVC patients were assigned to S arm and 109 to arm R to yield a total of 32,075 and 29,007 catheter-days, respectively. Thirty-eight patients (17.7%) developed VT: 25 (66%) were related to CVC (ipsilateral), 14/25 (56%) were asymptomatic. Median interval between CVC implantation and thrombosis was 48 days (rge; 5-350). All had their catheter tip correctly positioned. The following items were significant risk factors for overall VT: tumor location (breast vs others- HR=3), UICC stage (O-2 vs 3-4 – HR=2.3). There was a trend for male gender and body mass index (BMI>23). Catheter-related VT rate was 0.044% per patient-day in 14/106 (S) patients vs 0.038% in 11/109 (R) (p= .48). Pulmonary embolism occurred in three patients. One (R) patient with VT died of anticoagulant therapy-related complication and one (S) patient developed persistent upper extremity edema. Conclusions: VT occurred in 17.7% of these cancer patients at low-risk of DVT including 66% related to ipsilateral CVC and 56% asymptomatic cases. Tumor location, UICC stage were significant risk factors for VT. Both surgical chest port (S) or venography-guided arm port were safe. There was no influence of either procedure on the rate of VT. No significant financial relationships to disclose.