Deep venous thrombosis after central catheter insertion in cancer patients

Objectives: The aim of this review article is to assess the epidemiology, d iagnosis and treatment of deep venous thrombosis of the upper limbs which a re becoming more common with the use of central catheterizations in oncolog y. Risk factors: The incidence is differently estimated. The catheterization i s the main risk factor which is added to the proper patient's risk factors in a highly thrombogenic context (cancer, chemotherapy, infection,...), The outcome can be limited to the catheter (thrombotic) dysfunction: or can pr ogress towards vein thrombosis, pulmonary embolism, most often asymtomatic or to a superior vena cava syndrom. Ultrasounds and CT scan have an importa nt role although their efficacy have not been demonstrated yet. Treatment: Prophylactic anticoagulation with unfractionnated heparin, low m olecular weight heparin or oral anticoagulant seems to be effective, low do se thrombolysis by bolus of urokinase or tissue plasminogen activator allow s restoring the patency of the catheter in 70 to 90 % cases of thrombotic d ysfunction. The modalities of treatment of the vein thrombosis are much dis cussed. (C) 2001, Masson, Paris.