Local Low-Dose Thrombolysis for Safe and Effective Treatment of Venous Port-Catheter Thrombosis

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• 作者：Alexander Massmann MD ; Philippe Jagoda MD…
• 刊名：Annals of Surgical Oncology
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：22
• 期：5
• 页码：1593-1597
• 全文大小：448 KB
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• 刊物主题：Surgical Oncology; Oncology; Surgery;
• 出版者：Springer US
• ISSN：1534-4681

文摘

Purpose Retrospective evaluation of local low-dose thrombolysis for treatment of venous port-catheter thrombosis. Methods A total of 1,031 patients with dysfunctional port systems underwent port angiography depicting 181 patients with thrombosis around the port-catheter. A total of 165 patients (male 35, female 130; age 57.3?±?12.9 [20-3]?years) underwent thrombolysis by single injection of 3?mg alteplase into the port system. Patients were followed up by clinical and angiographic/radiological port controls the next day and 12.9?±?17.9 [1-1]?months on the basis of regular oncologic staging examinations. Results Thrombosis occurred 10.1?±?19.3 [median 2.9] months after port implantation and was clinically suspected by difficult blood aspiration in 146 of 181 (80.7?%) and high resistance to injection fluids in 75 (41.4?%) patients. A predictor for angiographically confirmed port-catheter thrombosis was a combination of both (73, 40.3?% patients) (Fisher’s exact test p?p?=?0.0047; positive predictive value 0.8276). The cumulative success rate of thrombolysis was 92.7?% (153 of 165 patients). Initial thrombolysis was effective in 127 (77.0?%) patients. Repeated (up to 6 times) thrombolysis was effective in 26 of 31 patients after second or third thrombolysis. Extensive central venous thrombosis (9 patients) predicted ineffective thrombolysis (p? Conclusions Difficult aspiration combined with high resistance to injection fluids or suboptimal port-catheter position are strong independent predictors for port-catheter thrombosis. Local low-dose thrombolysis or repeat thrombolysis is safe and effective in the absence of large central venous thrombosis.