Venous Thrombosis Of Upper Extremity Research Articles

Upper extremity venous thrombosis in hospitalized patients: A prospective epidemiological study

BackgroundThe frequency of upper extremities vein thrombosis (UEVT) is rising with the increasing use of endovenous devices. These thromboses are particularly common among hospitalized patients. The epidemiology and risk factors for UEVT are poorly understood in a hospitalized population. ObjectiveTo assess the prevalence of UEVT in hospitalized patients and study thrombosis risk factors according to their location. MethodsProspective evaluation of patients hospitalized in a university hospital with clinical and Doppler ultrasound (DUS) assessment of the upper extremities. ResultsOf the 400 patients included, 91(22.8 %) had UEVT including 8 (8.8 %) proximal thrombosis, 32 (35.2 %) arm venous thrombosis and 51 (56.0 %) forearm venous thrombosis; 7 (7.7 %) patients with UEVT had a concomitant symptomatic pulmonary embolism. In this population of hospitalized patients, 40 (10 %) had proximal or arm thrombosis and 51 (12.8 %) forearm thrombosis. All patients with UEVT had a venous catheter and 63 (69.2 %) of UEVT patients had therapeutic or prophylactic anticoagulation at the time of DUS evaluation.In multivariate analysis, peripheral intravenous catheter (PIVC) OR 3.71 [1.90; 7.91] (p < 0.001); MID line OR 3.58 [1.46; 8.91] (p = 0.005) and infection disease OR 2.21 [1.26; 4386] (p = 0.005) were associated with UEVT. Central venous catheter OR 66.24 [12.64; 587.03] was associated with proximal UEVT and MID line OR 12.61 [4.64; 35.77] (p < 0.001) with arm UEVT. Forearm UEVT were associated with PIVCOR 10.71[3.14; 67.37] (p = 0.001); infectious disease OR 2.87 [1.48; 5.60] (p = 0.002), iron infusion OR 3.11 [1.23; 7.47] and hospitalization for postpartum OR 4.37 [0.97; 18.06] (p = 0.04). ConclusionOne in 5 hospitalized patients suffers from UEVT. Proximal venous thrombosis is uncommon. The presence of a catheter and hospitalization for infection are the factors most frequently associated with UEVT.

Evaluation of Upper Extremity Venous Thrombosis with Doppler Ultrasonography in Peripheral Venous Line Applied Patients

Objectives: Peripherally inserted venous lines (PVL) may increase the risk of venous thrombosis due to vessel wall disarrangement. Aim of this study is to identify the cases of upper extremity venous thrombosis (UEVT) related to PVL since most of the PVLs applied to upper extremities.&#x0D; Methods: Sixty-nine hospitalized patients with previous or present PVL insertions were included in this prospective study. Upper extremity Doppler compression ultrasonography (USG) examination were performed to on all patients. The cases with detected UEVTs were evaluated as group 1 and the remaining cases were evaluated as group 2. Demographic parameters, PVL applications, intravenous treatments were compared between the groups.&#x0D; Results: UEVT was diagnosed by Doppler USG in 26 (37.7%) patients out of 69 patients. Lower extremity thrombosis was found in 10 (14.49%) patients. UEVT was observed in cephalic vein in 14 (53.8%) and in basilic vein in four (15.4%) out of 26 (37.7%) patients. Axillary and brachial deep UEVT was located in two (2.9%) cases. Superficial UEVT was found in 24 (34.8%) cases. Ceftriaxone, cefoperazone/sulbactam and esomeprazole were the mostly associated treatments with UEVT. UEVT was detected in five patients with PVL that were inserted only for drawing blood.&#x0D; Conclusion: PVL is a risk factor for UEVT since almost 1/3 of the patients revealed UEVT. When PVL is no longer needed or the need for intravenous therapy decreases, oral therapy should be planned and PVL should be removed. Removal of PVL appears to be necessary to avoid UEVT.

Superficial Venous Thrombosis with Concomitant Deep Venous Thrombosis of Upper Extremity, A Case Report

Superficial Venous Thrombosis with Concomitant Deep Venous Thrombosis of Upper Extremity, A Case Report

A Randomized Trial of Lenient Versus Strict Arm Instruction Post Cardiac Device Surgery (LENIENT)

Arm restriction after cardiac implantable electronic device (CIED) placement is common practice despite minimal supporting evidence. Patients receive a range of restriction recommendations of variable durations with the goal of reducing complications such as wound dehiscence, infection, lead dislodgement, or hematoma formation. These movement limitations can lead to emotional stress and anxiety, complications such as frozen shoulder, and upper extremity venous thrombosis due to immobilization. There are no published clinical trials assessing the benefits and risks of arm restrictions post-CIED implant. The randomized trial of lenient vs strict arm and activity instruction post-CIED surgery (LENIENT trial; NCT04915261) is a single center nonblinded randomized prospective study designed to evaluate lenient compared to restrictive post-CIED care instructions. We hypothesize that there will be no significant difference in complications between the arms. All patients receiving a de novo CIED or those with upgrades and revisions requiring a new lead implant will be enrolled. Subjects are enrolled in a nonblinded randomized prospective trial with 6 randomly assigned 8-month periods, during which either a lenient or restrictive postoperative activity instructions will be given to all patients. Postoperative instructions are given at the time of discharge and further reinforced by recurrent interactive voice recognition (IVR) phone calls, text messages and emails. The requirement for individual consent has been waived. The primary end point is a composite of (1) lead dislodgement, (2) frozen shoulder, (3) upper extremity venous thrombosis, (4) clinically significant hematoma, and (5) infection occurring within 52 weeks of index surgery. The study is a noninferiority trial with a sample size of 1,250 per group. This is the first large randomized clinical trial designed to establish an evidence-based postoperative standard of care for patients undergoing CIED implantation. This will improve the quality of care provided to patients and help guide implanting physicians providing postoperative care instructions. ClinicalTrials.gov NCT04915261.

Paget-Schroetter Syndrome: A Case Report of effort induced upper extremity venous thrombosis

Effort induced thrombosis of the axillary-subclavian vein, also referred as Paget-Schroetter syndrome, is a relatively uncommon type of deep vein thrombosis of the upper extremity. Although rare, understanding its clinical presentation and etiology is essential for timely diagnosis and formatting correct treatment protocols. Most upper extremity deep vein thrombosis are secondary to either underlying pathology including cancer, chronic indwelling catheters, and hypercoaguable states making their clinical diagnosis relatively straight forward. On the contrary, effort induced deep vein thrombosis most commonly occur in young otherwise healthy people. Early detection and treatment of this type of thrombosis are essential in preventing late-term complications including post-thrombotic syndrome, and pulmonary embolus. There is no current consensus in treatment of effort induced upper extremity thrombosis with literature supporting conservative versus surgical treatment depending on patient presentation and physician preference.

Venous Thromboembolism in 2022

Venous thromboembolism encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE) [1]. Other venous thrombotic occlusion like superficial vein thrombosis, thrombophlebitis, cortical vein thrombosis, hepatic nonocclusive disease, portal vein thrombosis, mesenteric venous thrombosis, splenic vein thrombosis, upper extremity venous thrombosis, are not included in the same category by international societies including American college of chest physician, American college of physician, European society of cardiology, European respiratory society, European society of Haematology, due to the significant mortality and morbidity caused by pulmonary embolism and lower extremity deep vein thrombosis.

Prevalence of post-thrombotic syndrome in a cohort of upper extremity vein thrombosis

ObjectivePost-thrombotic syndrome (PTS) is one of the main complications that occurs after venous thrombosis. There are few data on the proportion of patients that will develop upper extremity PTS (UE-PTS) after upper extremity venous thrombosis (UEVT). The main objective of the study was to assess the prevalence of PTS in a UEVT cohort and to identify predictive factors of UE-PTS. MethodsThis study included patients with a history of proximal or arm UEVT, diagnosed on duplex ultrasound examination, between January 1, 2015, and December 31, 2017, in a university hospital. After UEVT, each patient was evaluated by a prospective standardized recording of clinical manifestations and duplex ultrasound examination in case of upper limb symptoms. UE-PTS was defined as a modified Villalta score of 4 or higher. ResultsNinety-two patients were included; 68 (73.9%) had deep vein thrombosis (DVT) and 24 (19.2%) arm superficial vein thrombosis. Thirteen patients had PTS (14.1%), 12 (17.6%) in the DVT group and 1 (4.2%) in the superficial vein thrombosis group. There was a history of DVT in 92.3% of the cases of PTS. PTS was more frequent in patients with strokes with limb movement reduction (P = .01). On multivariate Cox analysis, a history of stroke (hazard ratio, 5.4; 95% confidence interval, 1.46-20.22; P = .01) was predictive of UE-PTS. ConclusionsUE-PTS occurred in 14.1% of cases after UEVT. Stroke with a decrease in limb movement was a predictor of developing PTS. Diagnostic criteria should be established for UE-PTS and prospective studies are needed to improve the description and management of UE-PTS.

Validation of Michigan risk score and D-dimer to predict peripherally inserted central catheter-related thrombosis: A study of 206,132 catheter days

The Michigan Risk Score (MRS) was the only predicted score for peripherally inserted central venous catheters (PICC) associated upper extremity venous thrombosis (UEVT). Age-adjusted D-dimer increased the efficiency for UEVT. There were no external validations in an independent cohort. A retrospective study of adult patients with PICC insertion was performed. The primary objective was to evaluate the performance of the MRS and age-adjusted D-dimer in estimating risk of PICC-related symptomatic UEVT. The sensitivity, specificity and areas under the receiver operating characteristics (ROC) of MRS and age-adjusted D-dimer were calculated. Two thousand one hundred sixty-three patients were included for a total of 206,132 catheter days. Fifty-six (2.6%) developed PICC-UEVT. The incidences of PICC-UEVT were 4.9% for class I, 7.5% for class II, 2.2% for class III, 0% for class IV of MRS (p = 0.011). The incidences of PICC-UEVT were 4.5% for D-dimer above the age-adjusted threshold and 1.5% for below the threshold (p = 0.001). The areas under ROC of MRS and age-adjusted D-dimer were 0.405 (95% confidence interval (CI) 0.303-0.508) and 0.639 (95% CI 0.547-0.731). The sensitivity and specificity of MRS were 0.82 (95% CI, 0.69-0.91), 0.09 (95% CI, 0.08-0.11), respectively. The sensitivity and specificity of age-adjusted D-dimer were 0.64 (95% CI, 0.46-0.79) and 0.64 (95% CI, 0.61-0.66), respectively. MRS and age-adjusted D-dimer have low accuracy to predict PICC-UEVT. Further studies are needed.

The Caprini thrombosis risk model predicts the risk of peripherally inserted central catheter-related upper extremity venous thrombosis in patients with cancer

BackgroundA peripherally inserted central catheter (PICC) is often necessary for patients receiving chemotherapy, but there is a risk of PICC-related venous thrombosis (VT). We sought to use the Caprini thrombosis risk model and color Doppler flow imaging for the dynamic monitoring of an eventual thrombosis in patients receiving chemotherapy. MethodsThis prospective study was carried out from January 2018 to May 2019 in patients who underwent PICC implantation and maintenance at the First Affiliated Hospital of Fujian Medical University. The outcome event was the occurrence of PICC-related upper extremity venous thrombosis confirmed by color Doppler flow imaging. ResultsA total of 201 participants were enrolled, of whom 108 (53.7%) developed VT. Three participants (1.5%) developed symptomatic VT. Univariable logistic regression analysis suggested that the Caprini score (odds ratio [OR], 1.243; 95% confidence interval [CI], 1.074-1.438; P = .003), the PICC model (OR, 0.448; 95% CI, 0.223-0.901; P = .024), and a previous history of PICC-related deep vein thrombosis (OR, 9.388; 95% CI, 1.178-74.786; P = .034) were associated with PICC-related upper extremity VT. Multivariable logistic regression analysis showed that only the Caprini score (OR, 1.188; 95% CI, 1.018-1.386; P = .029) was an independent risk factor for PICC-related venous thrombus. A receiver operating characteristic curve analysis showed the Caprini risk assessment model had a predictive value for upper extremity VT, with an area under the curve of 0.615 (95% CI, 0.538-0.693), 74.1% sensitivity, and 44.1% specificity. ConclusionsThe Caprini score is an independent predictor of the development of PICC-related VT in patients with cancer. However, the moderate sensitivity and low specificity of the Caprini risk assessment model may limit its predictive value in the clinical setting.

Two Case Reports of Upper Extremity Venous Thrombosis From Midline Catheter Placement in Pregnancy

Midline catheters are often inserted in pregnant women for whom a prolonged hospital stay is anticipated to facilitate the administration of medications and for blood sampling. Midline catheters compared with peripheral intravenous catheters are associated with fewer venipunctures and scheduled line changes. We present 2 cases of pregnant women with no personal or family history of thrombosis who underwent midline catheter insertion and developed venous thromboembolism of the upper extremity requiring anticoagulation therapy. Studies are needed to evaluate the safety profile of midline catheters in pregnancy.

Patterns and risk factors of peripherally inserted central venous catheter-related symptomatic thrombosis events in patients with malignant tumors receiving chemotherapy

ObjectivePeripherally inserted central venous catheter (PICC)-related thrombosis (PRT) is a serious complication that can lead to interruptions in chemotherapy and other supportive care, as well as increased hospital stay and costs. We conducted a retrospective study to evaluate the patterns of symptomatic PRT in patients with cancer undergoing chemotherapy and their risk factors. MethodsA retrospective study of 938 PICC patients from our institution between November 2014 and July 2017 was performed. Symptomatic PRT events were confirmed by color Doppler ultrasonography or computed tomography pulmonary angiography in the presence of clinical symptoms. The variables of interest were extracted from the electronic medical record system. Logistic regression analysis was used to determine the risk factors for PRT. ResultsOf the 938 patients who were followed up for more than 120,000 patient-days, 63 patients (6.7%; 0.51 per 1000 catheter-days) had symptomatic PRT. Sixty-one patients were diagnosed with upper extremity venous thrombosis (UEVT), of which 18 were isolated superficial vein thrombosis (SVT), 19 were isolated deep vein thrombosis (DVT), and 24 were extensive venous thrombosis (EVT). Two patients were diagnosed with pulmonary embolism, and two patients were diagnosed with UEVT with pulmonary embolism. The symptomatic SVT occurred in 42 of 938 patients with cancer (4.5%), which accounted for 68.9% of all UEVT events. The median time to PRT was 21 days, and the median time to catheter removal in the PRT group was 66 days as compared with 117 days in the no PRT group. Predictors associated with increased risk of PRT were age >60 years (odds ratio [OR], 2.142; 95% confidence interval [CI], 1.118-4.103) and a chemotherapy regimen containing fluorouracil (OR, 2.429; 95% CI, 1.013-5.825). Hypertension with medication was a protective factor for PRT (OR, 0.306; 95% CI, 0.113-0.828). Among the 28 patients who did not remove their PICCs immediately after PRT was diagnosed, patients with SVT, DVT, and EVT had similar success rates of retaining catheters in situ after anticoagulant therapy (SVT, 83.3%; DVT, 62.5%; EVT, 75.0%; P = .667). ConclusionsAge >60 years and chemotherapy regimens containing fluorouracil were independent risk factors for PRT and hypertension with medication was associated with a lower risk of PRT in patients with cancer with PICCs receiving chemotherapy. PICCs-related SVT was a frequent type of PRT, which might need a better understanding and anticoagulant therapy in patients with cancer with PICCs.

Risk factors of PICC related upper extremity venous thrombosis in patients with head and neck neoplasm: a prospective study

Objective To explore the incidence and risk factors of peripherally inserted central catheter (PICC) related upper extremity venous thrombosis (UEVT) in patients with head and neck neoplasm so as to provide a basis for preventing thrombosis. Methods This study used the design of prospective cohort study. From January 2016 to March 2018, UEVT follow-up examination by B ultrasound was carried out for 1 137 head and neck neoplasm patients with PICC selected by convenience sampling. Single factor and multivariate Cox regression were used to determine the risk factors of PICC related UEVT. Results There were 3.6% (41/1 137) of patients with PICC related UEVT. Multivariate Cox regression showed that the independent risk factors of PICC related UEVT included the older patients (RR=1.04, 95%CI: 1.01-1.07, P=0.013) , being with a history of PICC catheterization (RR=3.22, 95%CI: 1.53-6.77, P=0.002) and high frequency of catheter delivery (RR=1.98, 95%CI: 1.30-3.00, P=0.001) . Conclusions Patients with head and neck neoplasm have the low incidence of PICC related UEVT. The independent risk factors of PICC related UEVT in patients with head and neck neoplasm include the older ages, history of PICC catheterization and high frequency of catheter delivery. Positive intervention should be carried out for those patients which may reduce the incidence of PICC related thrombosis. Key words: Head and neck neoplasm; Venous thrombosis; PICC; Risk factors; Prevention

WITHDRAWN: Anticoagulation management strategies in heart transplantation

Anticoagulation before, during, and after heart transplantation presents unique challenges to clinicians. Bleeding and thrombotic morbidity continues to affect this patient population throughout all phases of the transplant journey. Reversal is commonly required since patients are commonly bridged to transplantation with left ventricular assist devices, which require chronic anti platelet and anticoagulation. Caution must be exercised in patients requiring cardiopulmonary bypass during surgery who are at risk of complications from heparin induced thrombocytopenia. The reported incidence of venous thromboembolism following heart transplantation is high, particularly during the first post-transplant year, most likely due to surgery, biopsies, specific immunosuppression (mTOR inhibitors) and immobilization. It is crucial to maintain long-term oral anticoagulation after the first venous thromboembolism event, especially when risk factors exist. A major issue, and one for which there remains considerable debate, is the optimal treatment of such complications, particularly upper extremity venous thrombosis. For both warfarin and the thrombin inhibitors or Factor Xa inhibitors, the clinician must determine potential drug interactions based on the heart transplantation drug regimen, and then develop a patient-specific management strategy.

Eltrombopag, oral immunosuppressant and androgen combination therapy in twelve patients with refractory severe aplastic anemia

ABSTRACT Objective: Eltrombopag monotherapy or eltrombopag combined with immunosuppressant has achieved robust hematologic responses in severe aplastic anemia (SAA). In patients with refractory SAA, for whom hematopoietic stem cell transplantation is unavailable, we attempted to combine eltrombopag with oral immunosuppressant and androgen, to further improve hematologic response. Methods: We collected and analyzed data retrospectively from twelve refractory SAA cases who had received combination therapy of eltrombopag, oral immunosuppressant and androgen. All these patients had received intensive immunosuppressive treatment (IST) for more than 6 months and were evaluated as nonresponders. Results: A total of 12 SAA patients were treated with a combination of eltrombopag, an oral immunosuppressant (cyclosporine, N = 9; tacrolimus, N = 3) and androgen. The median maximum dose of eltrombopag was 75 mg/day (range, 75–150). After a median follow-up of 8.5 months (7–23), the overall response rate (ORR) was 42% (5/12, including trilineage, N = 4; hemoglobin + platelet, N = 1). Two of 5 responders reached normal blood counts. Optimal hematological response rates were reached at 6 months. The median increase in neutrophil, hemoglobin and platelet count were 1.64 × 109 /L (0.71–2.66), 53 g/L (25–66.5) and 25 × 109 /L (14–230), respectively. In general, the combination therapy was well tolerated; however, two patients suffered from non-lethal upper extremity venous thrombosis when they were platelet transfusion-dependent. Conclusion: Eltrombopag, oral immunosuppressant and androgen combination therapy in patients with IST-refractory SAA is feasible and could restore multi-lineage hematopoiesis. Thrombosis risk of eltrombopag still needs to be monitored.

Retrospective Study of Patients with Upper Extremity Clots Presenting to Emergency Departments in Tertiary Care Hospitals in a Major Canadian City in the Last Five Years

Objective: 5 year retrospective study of patients presenting to emergency departments at the four tertiary care hospitals in Calgary, Alberta with upper extremity (UE) deep vein thrombosis (DVT) to define the patient population, determine practice patterns and management of upper extremity clots. Methods: All adult patients with suspected upper extremity DVT presenting to any of the four tertiary care centers in the Calgary health region and who had undergone diagnostic imaging were included in the study. Ultrasounds and CT scans were obtained from the Diagnostic Imaging department from January 2014 to December 2018. Inclusion criteria included patients above 18 years of age and evidence of deep, superficial or catheter-associated upper extremity venous thrombosis on imaging. Exclusion criteria were any known cancer or life expectancy under 6 months. Basic demographic data were collected, in addition to disposition from emergency, choice of anticoagulant, duration of anticoagulation, history of thrombophilia and thoracic outlet obstruction (TOO) work-up. Results: 1236 patient records were reviewed, of which 151 (12.2%) were positive for UE deep venous thrombosis (DVT) and 114 (9.2%) for superficial vein thrombosis (SVT). Mean age was 47 years and 50.2% were males. Duration of treatment for both DVT and SVT ranged anywhere from no therapy to lifelong treatment, with an average of 5.01 months for DVT and 1.15 months for SVT. 22.5% of all DVTs were recommended lifelong therapy. 21 (18.4%) patients were treated for more than 45 days for SVT, of which only 9 had another indication for anticoagulation. Common risk factors identified for DVT included line associated thrombosis (17.2%), of which 38.5% were specifically PICC associated, trauma (2.6%) and intravenous drug use (2.0%). Anticoagulant agents for DVT included low molecular weight heparin (7.9%), direct oral anticoagulants (DOACs) (39.1%) and warfarin (42.4%). 8.6% of the DVTs received no treatment. Follow-up was variable from the emergency department ranging from following up with the patient's own family physician to sending an urgent referral to General Internal Medicine, Hematology or Vascular surgery. 30.5% of the patients with DVT were referred to General Internal Medicine (GIM) outpatient, compared to 24.5% to Hematology and 33.7% to their family doctor. 29.8% of the patients with SVT were referred to GIM, 7.9% to Hematology and 66.7% to their family doctor. 39.7% of the people with DVT were tested for thrombophilia, of which 10% tested positive for any type of thrombophilia. 29.8% were tested for TOO, of which 48.9% were found to have TOO and 11.1% received surgery for same. Conclusion: Our study demonstrates that there is significant variability in the management of upper extremity clots, highlighting the lack of literature in this field. Developing a structured, standardized approach along with ongoing provider education could help reduce this variability and optimize management of this patient population. Disclosures No relevant conflicts of interest to declare.

The anticoagulants rivaroxaban and low molecular weight heparin prevent PICC-related upper extremity venous thrombosis in cancer patients.

Peripherally inserted central catheter (PICC) is often applied in chemotherapy patients and commonly causes upper extremity venous thrombosis (UEVT), which should be prevented.To assess the preventive effects of the anticoagulants rivaroxaban and low molecular weight heparin (LMWH) on UEVT in patients receiving chemotherapy through PICCs.A total of 423 chemotherapy patients with continuous PICC use between January 2014 and June 2015 at the Oncology Department of Dongying People's Hospital were divided into 3 groups: rivaroxaban (10 mg/day, orally), LMWH (Enoxaparine, 4000 anti-Xa IU/day, subcutaneous injection), and control (no anticoagulant). UEVT incidence and other complications during PICC use were observed and recorded.The rivaroxaban, LMWH, and control groups included 138 (79 males; 54.9 ± 11.0 years), 144 (76 males; 56.0 ± 10.9 years), and 141 (71 males; 53.3 ± 10.9 years) patients, (P = .402 and P = .623 for age and sex respectively). There were no differences in cancer location (P = .628), PICC implantation site (P > .05), body mass index (BMI) (P = .434), blood pressure (all P > .05), blood lipids (5 laboratory parameters included, all P > .5), smoking (P = .138), history of lower limb venous thrombosis (P = .082), and 10 other associated comorbidities (all P > .5). Twenty-nine patients withdrew from the study (5 from the rivaroxaban, 12 from the LMWH, and 12 from the control groups, respectively), and 394 patients were analyzed. There were significant differences in the rivaroxaban group and the LMWH group compared to the control group (P = .010 and P = .009, respectively), but no significant difference was observed between the rivaroxaban group and the LMWH group (P = .743).Anticoagulants such as rivaroxaban and LMWH may reduce the incidence of PICC-related UEVT in patients receiving chemotherapy.

P3140Burden and the clinical significance of the retained cardiac implantable electronic device components after heart transplantation

Abstract Background Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. Frequency and clinical significance of retained CIED components after HT is not well studied. Methods Adult heart failure patients whom had heart transplantation in our institution from date June 2000 to December 2018 were retrospectively evaluated. Pre-post operative chest x-rays and recorded fluoroscopy images of the previous coronary angiograms or endomyocardial biopsies were reviewed by a single observer for retained CIED components. All patients clinical records were also reviewed for adverse outcomes of retained components such as deep venous thrombosis of upper extremity, infection and mortality. Results A total of 226 patients had bicaval orthotopic heart transplantation during study time. 73 (32%) of the patients had CIED before transplantation and 24 (32.8%) of the patients had retained lead components after HT. (Table 1) All of the components were part of a superior vena cava coil of the right ventricular ICD lead. Mean follow up time was 46.6±49.8 months and only 1 (1.3%) adverse event (right subclavian DVT) occurred in a patient with retained lead. There were not any statistical significance for mortality and infection between patients with and without lead fragments. Patients were also compared for history of any cardiac surgery before HT, especially ventricular assist device procedures and no differences were observed between groups. For history of any cardiac surgery p=0.748, for assist device surgery, p=0.269). Patient's medical records reviewed for a history of magnetic resonance imaging (MRI). Two patients with retained lead fragments had non-thorocic (abdominal and cranial) MRI and any clinical pathology did not observed after MRI. Table 1 All Patients With Retained CIED comp. Without Retained CIED comp. p (n=226) (n=24) (n=49) Age ± sd 42.91±12.2 44.88±12.6 41.59±13 0.290 Ischemic etiology 65 (28.8%) 8 (33.3%) 13 (26.5%) 0.546 CIED type CRT-D 5 (20.8%) 5 (%10.2) 0.215 DR-ICD 5 (20.8%) 8 (16.3%) 0.636 VR-ICD 14 (58.3%) 35 (71.4%) 0.263 Dual coil ICD lead 24 (100%) 48 (97%) 1 Mortality (%) 96 (42.5) 7 (37%) 20 (40.8%) 0.463 Conclusion Retained CIED components were seen 32.8% of the HT patients with CIED prior to transplantation. According to our data retained leads are not associated with severe adverse clinical outcomes. Also non cardiac MRI could be safe in patients with retained lead fragments.

Analysis of related factors of deep venous thrombosis in upper extremity after PICC catheterization

Objective To investigate the related risk factors of upper extremity deep venous thrombosis associated with peripherally inserted central catheter(PICC). Methods From January 2014 to February 2018, 300 patients with PICC in the No.117 Hospital of the Chinese People's Liberation Army were selected in the study, of whom 30 patients developed deep venous thrombosis(thrombosis group), the other 270 patients had no deep venous thrombosis(non-thrombotic group). General data of the patients (gender, age, body mass index), catheter technical parameters(number of punctures, length of catheter, position of catheter tip), retention vessel index(inner side of catheter, indwelling vein, internal diameter of catheter), past history(history of hypertension, history of diabetes, history of oncology, history of cancer chemotherapy, history of smoking, history of blood clots, history of PICC, or CVP insertion), and laboratory tests(platelet count, plasma D-dimer, plasma fibrin original, prothrombin time) were collected.Univariate analysis was used to find out the differences between the thrombosis group and the non-thrombosis group.Logistic regression analysis was used to identify the risk factors for deep vein thrombosis of the upper extremities after PICC catheterization. Results Univariate analysis showed that variables that differed between the thrombus group and the non-thrombosis group included catheter tip location, diameter of the cannulated vein, history of cancer, history of chemotherapy, plasma D-dimer (χ2=4.556, 10.973, 11.940, 5.357, 11.623, P=0.033, 0.001, 0.001, 0.021, 0.001). Multivariate Logistic regression analysis showed that the risk factors of upper extremity deep venous thrombosis after PICC catheterization were catheter tip placement on the upper vena cava 2/3, catheter vein diameter<4mm, tumor history and chemotherapy history(P=0.014, 0.023, 0.017, 0.028). Conclusion The risk factors of upper extremity deep venous thrombosis after PICC catheterization are catheter tip placed on the upper 2/3 of the superior vena cava, diameter of the catheter vein<4 mm, tumor history and chemotherapy history. Key words: Catheterization, central venous; Catheterization, peripheral; Vena cava, superior; Thrombosis; Risk factors

Does Hyperglycemia Affect Risk of Peripherally Inserted Central Catheter-Related Upper Extremity Venous Thrombosis?

It is not clear whether blood glucose (BG) affects the risk of peripherally inserted central catheter (PICC)-related upper extremity venous thrombosis (PRUEVT). A case-control study was conducted comparing patients with PRUEVT versus patients with PICCs who did not develop PRUEVT. BG on admission was significantly higher among cases with PRUEVT than controls. No significant differences were found between the groups in hemoglobin A1c or BG on the third day of hospitalization. PRUEVT cases were more likely to be diabetic, but this did not reach statistical significance. The time that a PICC was in place before PRUEVT was diagnosed was longer for diabetic patients, but the authors believe this result must be viewed with caution.

Increased risk of symptomatic upper-extremity venous thrombosis with multiple peripherally inserted central catheter insertions in pediatric patients.

Peripherally inserted central catheters (PICCs) are associated with superficial and deep venous thrombosis of the arm. The purpose of this study was to analyze the sequelae of repeated upper limb PICC insertions in children, in terms of the frequency of upper limb thrombosis in this patient group. The study population included all children who underwent their first successful arm PICC insertion between January 2010 and December 2015. We included subsequent ipsilateral arm PICCs in the analysis. Patients were followed until March 2016 or until any alternative central venous line insertion. For each PICC insertion, we collected demographic variables and line characteristics. We correlated all symptomatic deep and superficial thromboses of the arm with the PICC database. Applying inclusion and exclusion criteria, 2,180 PICCs remained for analysis. We identified first, second, third and fourth PICC insertions in the same arm in 1,955, 181, 38 and 6 patients, respectively. In total there were 57 upper body deep symptomatic thrombotic events. An increasing odds ratio was seen with higher numbers of PICC insertions, which was significant when comparing the first with the third and fourth PICC insertions in the same arm (odds ratio [OR] 6.00, 95% confidence interval [CI] 2.25-16.04, P=0.0004). Double-lumen PICCs were associated with a significantly higher risk of thrombosis than single lumen (OR 2.77, 95% CI 1.72-4.47, P=0.0003). Repetitive PICC insertions in the same arm are associated with an increased risk of symptomatic thrombosis. Double-lumen PICCs are associated with a higher risk of thrombosis compared to single-lumen lines.