Haire W D, Lynch T G, Lieberman R P, Edney J A
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-3330.
Arch Surg. 1992 Feb;127(2):229-30. doi: 10.1001/archsurg.1992.01420020123017.
Subclavian catheterization in patients with cancer is associated with up to a 38% incidence of subclavian vein thrombosis. These thrombi seldom recanalize. The persistent occlusion of the subclavian vein may hinder subsequent catheter placement. To determine the frequency of this occurrence and to determine if preoperative duplex scanning could identify these individuals, we performed preoperative duplex scanning in 22 patients who had previously had an indwelling subclavian catheter for chemotherapy. Subsequent subclavian vein catheterization was attempted without knowledge of the results of the duplex scan. Nineteen scans were normal. Of these, 18 patients underwent successful catheter placement. In one patient, catheterization was unsuccessful and an intraoperative venogram showed a focal obstruction of the proximal portion of the subclavian vein. Three scans showed noncompressibility of the vein, and catheter placement was unsuccessful in these three veins. In patients who have had previous subclavian catheters, persistent obstruction of the vein prevents subsequent catheter placement in 14%. Duplex scanning before subsequent catheter placement generally identifies these individuals.
癌症患者进行锁骨下静脉置管时，锁骨下静脉血栓形成的发生率高达38%。这些血栓很少再通。锁骨下静脉的持续闭塞可能会妨碍后续的导管置入。为了确定这种情况的发生频率，并确定术前双功扫描能否识别出这些患者，我们对22例曾留置锁骨下导管进行化疗的患者进行了术前双功扫描。在不知道双功扫描结果的情况下尝试进行后续的锁骨下静脉置管。19次扫描结果正常。其中，18例患者成功置入导管。1例患者置管失败，术中静脉造影显示锁骨下静脉近端有局灶性梗阻。3次扫描显示静脉不可压缩，这3条静脉的导管置入均未成功。在曾有过锁骨下导管置入史的患者中，14%的患者因静脉持续梗阻而无法进行后续导管置入。后续导管置入前的双功扫描通常能识别出这些患者。
