FIBRINOLYSIS OF DEEP VENOUS THROMBOSIS ON IMPLANTABLE ACCESS DEVICES - A CONSECUTIVE SERIES OF 57 THROMBOSES AND 32 FIBRINOLYSES

The main complication of totally implantable venous access devices is deep venous thrombosis on catheter It may dramatically reduce the alre ady limited venous capacity of patients undergoing chemotherapy and ob turate catheters, causing pulmonary embolism or functional disorders. These thromboses usually involve veins of the superior vena cava syste m where the catheters are implanted. Generally, they occur early, are extensive and often asymptomatic. Doppler ultrasonography is the diagn ostic investigation of choice, phlebography being reserved for particu lar cases or to specify the limits of the the thrombus. In a series of 412 vein access devices implanted and systematically monitored by Dop pler ultrasonography, we found 57 thromboses (13,8%), 15 partial and 4 2 complete. The lowest thrombosis rate was observed in the right inter nal jugular vein (10% vs 20 to 23%, p = 0,006). Thirty-two patients re ceived a systemic fibrinolytic treatment, 16 with streptokinase (SK), five with urokinase (UK), four with tissue plasminogen activator (rt-P A) and seven with SK/UK association. No serious side effects were obse rved. Sixteen repermeabilizations (50% of fibrinolysis) were obtained. There were no significant differences with respect to the fibrinolyti c, the initial characteristics of thrombosis or the patients. Patients without fibrinolysis received 3 weeks of low molecular weight heparin (curative doses) then warfarin. Only one patient was repermeabilized with this treatment (significative difference with fibrinolysis: p = 0 .009). Fibrinolysis is indicated in symptomatic thrombosis and/or in c ases of extension to the innominate vein or the superior vena cava. Sy stematic monitoring by Doppler ultrasonography and prophylactic anti-t hrombotic treatment are recommended in patients with implantable venou s access devices in order to decrease the occurrence of thromboses, to detect asymptomatic patients at an early stage and to increase the ef fectiveness of fibrinolysis.