Luciani A, Clement O, Halimi P, Goudot D, Portier F, Bassot V, Luciani J A, Avan P, Frija G, Bonfils P
Department of Radiology, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris Cedex 15, France.
Radiology. 2001 Sep;220(3):655-60. doi: 10.1148/radiol.2203001181.
This prospective study extending for more than 3 years had two objectives: (a) to use Doppler ultrasonography (US) to estimate the incidence of asymptomatic catheter-related upper extremity deep venous thrombosis (DVT) in a large population and (b) to study the effect of the catheter position as an individual risk factor for catheter-related DVT.
Between October 1995 and June 1998, a total of 145 patients who had oropharyngeal tract cancer and who were fitted with the same totally implantable central venous catheters (CVCs) were included in the study. Follow-up included (a) estimation of the position of each catheter tip on a chest radiograph obtained immediately after surgery and (b) regular monthly Doppler US screening for catheter-related DVT.
Seventeen patients developed catheter-related DVT; 13 of them were asymptomatic. The mean interval between CVC implantation and detection of thrombosis was 42.2 days. Correct positioning of the distal catheter tip was associated with a significantly lower rate of catheter-related DVT. Only five of 87 patients with a correctly positioned distal catheter tip (ie, either in the superior vena cava or at the junction between the right atrium and the superior vena cava) developed thrombosis, compared with 12 of 26 patients with a misplaced catheter (P <.001). The side on which the CVC was implanted did not influence the catheter-related DVT rate.
The rate of asymptomatic catheter-related DVT is high and could be lowered with correct initial CVC positioning.
这项为期3年多的前瞻性研究有两个目标：（a）使用多普勒超声（US）评估大量人群中无症状导管相关性上肢深静脉血栓形成（DVT）的发生率；（b）研究导管位置作为导管相关性DVT的个体危险因素的作用。
1995年10月至1998年6月，共有145例患有口咽癌且植入相同完全植入式中心静脉导管（CVC）的患者纳入研究。随访包括：（a）在术后立即获得的胸部X线片上评估每个导管尖端的位置；（b）每月定期进行多普勒超声筛查导管相关性DVT。
17例患者发生了导管相关性DVT；其中13例无症状。CVC植入与血栓形成检测之间的平均间隔时间为42.2天。导管远端尖端的正确定位与导管相关性DVT的发生率显著降低相关。87例导管远端尖端定位正确（即位于上腔静脉或右心房与上腔静脉交界处）的患者中只有5例发生血栓形成，相比之下，26例导管位置不当的患者中有12例发生血栓形成（P<0.001）。CVC植入的侧别不影响导管相关性DVT的发生率。
无症状导管相关性DVT的发生率较高，正确的初始CVC定位可降低其发生率。
