Post-thrombotic syndrome after central venous catheter removal in childhood cancer survivors is associated with a history of obstruction

Abstract

Background: A potential long-term complication of central venous catheter (CVC)-related deep vein thrombosis (DVT), both symptomatic and asymptomatic, is development of post-thrombotic syndrome (PTS) characterized by persistent pain, swelling, and skin changes. Signs and symptoms of PTS were reported after CVC removal. The aim of this study was to assess the risk factors for development of PTS in childhood cancer survivors.

Procedure: Children followed at the after cancer follow-up clinic were enrolled. The patients were screened for PTS using Kuhle's PTS pediatric score. Patient's records were retrospectively reviewed for clinical and CVC-related data.

Results: Fifty-one children were enrolled at a median of 2.3 (range 0.33-7.5) years after removal of their CVC. The median age of the children the time of treatment was 6.5 (range 0.25-18) years. Mild PTS was present in 20 children (39%, 95% CI 26-54%). Pain symptoms were reported in five children (9.5%, 95% CI 3.3-21.4%). Higher rate of PTS was found in children with history of CVC occlusion. The odd ratio (95% CI) for PTS in children with history of occlusion was 3.7 (95% CI 1.1-12.5%) (P = 0.029). The occurrence of PTS was not associated with age at the time of treatment, time from CVC removal, duration of CVC, and history of infection.

Conclusions: Screening cancer survivors for PTS after CVC removal should be integrated to the after cancer follow-up clinic. Obstruction of CVC may indicate for asymptomatic DVT. Whether thromboprophylaxis and/or prevention of CVC occlusion can decrease the rate of PTS needs to be studied.