Characterizing resolution of catheter-associated upper extremity deep venous thrombosis

Mark A Jones, Dae Y Lee, Jocelyn A Segall, Gregory J Landry, Timothy K Liem, Erica L Mitchell, Gregory L Moneta
Journal of Vascular Surgery 2010, 51 (1): 108-13

OBJECTIVE: Catheter-associated upper extremity deep venous thrombosis (CAUEDVT) is well known; however, resolution rates and factors affecting resolution of CAUEDVT are not well characterized. This study determined resolution rates and factors associated with resolution of CAUEDVT.

METHODS: From January 1, 2002, to June 30, 2006, 1761 upper extremity venous duplex ultrasound (DU) studies were performed, and a new UEDVT was found in 253 (14.4%). Of these, 150 patients had routine follow-up and 101 had CAUEDVT. Demographics, follow-up DU results, and risk factors for venous thrombosis were recorded in the patients with follow-up studies and CAUEDVT. Univariate analysis and multivariate logistic regression analysis was performed to determine independent risk factors for complete thrombus resolution.

RESULTS: There were 49 men (49%) and 52 women (51%) with CAUEDVT and follow-up studies. Mean age was 49 years (range, 5 months-80 years). Patients with CAUEDVT had risk factors for venous thrombosis that included malignancy in 34%, recent surgery/trauma in 34%, known hypercoagulable state in 11%, concomitant lower extremity DVT in 21%, and pulmonary embolism in 5%. Complete resolution of DVT on follow-up was documented in 46%. Thrombosis resolved in only 25% (6 of 24) when the catheter was not removed (P <or= .05). Anticoagulation did not improve the rate of thrombus resolution (P <or= 1.0) compared with catheter removal alone. Of the patients who had thrombus resolution, 75% resolved by 100 days (range, 1-914 days) after catheter removal <or=48 hours of diagnosis. In multivariate analysis, only catheter removal predicted the likelihood of thrombus resolution (odds ratio, 3.25; 95% confidence interval, 1.16-9.09; P = .025). New-site UEDVT developed in 86% of patients with CAUEDVT who underwent catheter removal and immediate catheter placement in a new site. Pulmonary embolism developed in five patients with CAUEDVT. Of these, three had documented lower extremity DVT as well. No pulmonary emboli were fatal.

CONCLUSIONS: More than half of CAUEDVT resolve <or=113 days when the catheter is removed <or=48 hours of diagnosis. New-site catheter placement has a high rate of new associated UEDVT. Anticoagulation does not appear to augment resolution of UEDVT.

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