Catheter-related atrial thrombosis: prevalence and risk factors in the pediatric age group—a retrospective study

Annals of Pediatric Surgery - Tập 18 Số 1
Hasan Nassereldine1, Adel Hajj-Ali1, Joelle Hassanieh1, Dima Hamideh2, Rola Jaafar1, Samir Akel1, Ahmad Zaghal1
1Department of Surgery, American University of Beirut-Medical Centre, PO box: 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
2Children’s Cancer Institute, American University of Beirut-Medical Center, Beirut, 1107 2020, Lebanon

Tóm tắt

Abstract Background Catheter-related right atrial thrombosis (CRAT) is an under-studied complication of a long-term implantable venous access devices (IVAD), particularly in children with incidence rates extrapolated from the adult literature ranging between 2 and 29%. This is a single-center retrospective review of electronic medical records of children who underwent insertion of IVADs and had at least one echocardiogram performed prior to catheter removal between 2008 and 2018. Data collection included demographic information, development of CRAT, systemic infection, and administration of thrombogenic chemotherapeutic agents. We identified six patients who developed CRAT and compared them to 120 control patients. We also performed a detailed chart review for the patients who developed CRAT. Data was entered and analyzed using SPSS. Results A total of 764 patients underwent IVAD placement between 2008 and 2018. Six (0.79%) patients developed CRAT, and 120 patients were identified as controls that match the CRAT patients based on definitive criteria that include age, gender, chemotherapy type, steroid therapy, reason of line insertion, site of catheter insertion, tip-location at insertion, and history of systemic infections. In the CRAT group, 3 (50%) patients had their catheter tips placed in the superior vena cava-right atrial junction and 3 (50%) in the right atrium, whereas in the control group, all patients had their catheter tips placed in the superior vena cava-right atrial junction (p=0.000). Five (83.3%) patients in the CRAT group received L-asparaginase as compared to 75 (62.5%) patients in the control group (p=0.301). In the CRAT group, all patients had a history of systemic infection compared to 47 (39.2%) in the control group (p=0.180). Conclusion We identified 6 (0.79%) children with CRAT. Catheter-tip location within the right atrium is a potential risk factor for CRAT development in children.

Từ khóa


Tài liệu tham khảo

Ensminger W, Gyves JW, Liepman M, Doan K, Cozzi E. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery. 1982;92(4):706–12.

Zaghal A, Khalife M, Mukherji D, El Majzoub N, Shamseddine A, Hoballah J, et al. Update on totally implantable venous access devices. Surg Oncol. 2012;21(3):207–15.

Hartkamp A, van Boxtel A, Zonnenberg B, Witteveen P. Totally implantable venous access devices: evaluation of complications and a prospective comparative study of two different port systems. Neth J Med. 2000;57(6):215–23.

Yildizeli B, Lacin T, Batirel HF, Yuksel M. Complications and management of long-term central venous access catheters and ports. J Vasc Access. 2004;5:174–8.

Baskin JL, Pui C-H, Reiss U, Wilimas JA, Metzger ML, Ribeiro RC, et al. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. Lancet. 2009;374(9684):159–69.

Stavroulopoulos A, Aresti V, Zounis C. Right atrial thrombi complicating haemodialysis catheters. A meta-analysis of reported cases and a proposal of a management algorithm. Nephrol Dial Transplant. 2012;27(7):2936–44.

Ducatman BS, McMichan JC, Edwards WD. Catheter-induced lesions of the right side of the heart: a one-year prospective study of 141 autopsies. JAMA. 1985;253(6):791–5.

Chen K, Agarwal A, Tassone M, Shahjahan N, Walton M, Chan A, et al. Risk factors for central venous catheter-related thrombosis in children: a retrospective analysis. Blood Coagul Fibrinolysis. 2016;27(4):384–8.

Yang H, Chen F, Jiao H, Luo H, Yu Y, Hong HG, et al. Management of tunneled-cuffed catheter-related right atrial thrombosis in hemodialysis patients. J Vasc Surg. 2018;68(5):1491–8.

Pui CH, Campana D, Pei D, Bowman WP, Sandlund JT, Kaste SC, et al. Treating childhood acute lymphoblastic leukemia without cranial irradiation. N Engl J Med. 2009;360(26):2730–41.

Burns K, McLaren A. Catheter-related right atrial thrombus and pulmonary embolism: a case report and systematic review of the literature. Can Respir J. 2009;16:163–5.

Suratkal V, Ahmed A. Right atrial thrombus and challenges in its management. J Assoc Physicians India. 2018;66(12):65–8.

Korones DN, Buzzard CJ, Asselin BL, Harris JP. Right atrial thrombi in children with cancer and indwelling catheters. J Pediatr. 1996;128(6) (0022-3476 (Print)):841–6.

Chen C-Y, Liu C-C, Sun W-Z. Evidence-based review on catheter-related thrombosis of the implantable venous access device. Tzu Chi Med J. 2007;19(4):207–19.

Mitchell L, Sutor A, Andrew M. Hemostasis in childhood acute lymphoblastic leukemia: coagulopathy induced by disease and treatment. Semin THromb Hemost. 1995;21(4):390–401.

Athale UH, Chan AK. Thrombosis in children with acute lymphoblastic leukemia: part I. Epidemiology of thrombosis in children with acute lymphoblastic leukemia. Thromb Res. 2003;111(3):125–31.

Male CCPF-A, Maureen Andrew M, Hanna F, Kim Hanna K, Julian F, Jim Julian J, et al. Central venous line-related thrombosis in children: association with central venous line location and insertion technique. Blood. 2003;101(11) (0006-4971 (Print)):4273–8.

Chick JF, Reddy SN, Bhatt RD, Shin BJ, Kirkpatrick JN, Trerotola SO. Significance of echocardiographically detected central venous catheter tip-associated thrombi. J Vasc Interv Radiol. 2016;27(12):1872–7.

Gilon D, Schechter D, Rein AJ, Gimmon Z, Or R, Rozenman Y, et al. Right atrial thrombi are related to indwelling central venous catheter position: insights into time course and possible mechanism of formation. Am Heart J. 1998;135(3) (0002-8703 (Print)):457–62.

Bayón J, Martín M, García-Ruíz JM, Rodríguez C. “We have a tenant” a right atrial thrombus related to a central catheter. Int J Cardiovasc Imaging. 2011;27(1):5–6.

Sharara-Chami R, Arabi M, Hassanieh J, Hamideh D, Zaghal A. Catheter related atrial thrombosis in an infant: a case report and review of the literature. Thrombosis. Update. 2020:100003.

Haddad TC, Greeno EW. Chemotherapy-induced thrombosis. Thromb Res. 2006;118(5):555–68.

Hijiya N, Millot F, Suttorp M. Chronic myeloid leukemia in children: clinical findings, management, and unanswered questions. Pediatr Clin. 2015;62(1):107–19.

Ozsoylu S, Strauss HS, Diamond LK. Effects of corticosteroids on coagulation of the blood. Nature. 1962;195(4847):1214–5.

Peeters P, Colle I, Van der Niepen P, Verbeelen D. Infected intracardiac thrombi: complication of vascular access in haemodialysis patients. Nephrol Dial Transplant. 1995;10(6) (0931-0509 (Print)):909–10.

Negulescu O, Coco M, Croll J, Mokrzycki MH. Large atrial thrombus formation associated with tunneled cuffed hemodialysis catheters. Clin Nephrol. 2003;59(1):40–6.

van Laecke S, Dhondt A, de Sutter J, Vanholder R. Right atrial thrombus in an asymptomatic hemodialysis patient with malfunctioning catheter and patent foramen ovale. Hemodial Int. 2005;9(3):236–40.

Corapçioğlu F, Uysal KM, Silistreli E, Unal N, Oren H, Açikel U. Catheter-associated recurrent intracardiac thrombosis and factor V Leiden mutation in a child with non-Hodgkin's lymphoma. Turk J Pediatr. 2005;47(3):279–82.

Vidal E, Sharathkumar A, Glover J, Faustino EV. Central venous catheter-related thrombosis and thromboprophylaxis in children: a systematic review and meta-analysis. J Thromb Haemost. 2014;12(7):1096–109.

Sol JJ, van de Loo M, Boerma M, Bergman KA, Donker AE, van der Hoeven M, et al. NEOnatal Central-venous Line Observational study on Thrombosis (NEOCLOT): evaluation of a national guideline on management of neonatal catheter-related thrombosis. BMC Pediatr. 2018;18(1):84.

Romantsik O, Bruschettini M, Zappettini S, Ramenghi LA, Calevo MG. Heparin for the treatment of thrombosis in neonates. Cochrane Database Syst Rev. 2016;11(11):Cd012185.

Rossi L, Libutti P, Casucci F, Lisi P, Teutonico A, Basile C, et al. Is the removal of a central venous catheter always necessary in the context of catheter-related right atrial thrombosis? J Vasc Access. 2019;20(1):98–101.

Thông tin
Thông tin xuất bản

Annals of Pediatric Surgery

Tập 18 Số 1

Thông tin tác giả