Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France.
Department of Vascular Medicine, CHD La Roche-sur-Yon, La Roche-sur-Yon, France.
PLoS One. 2021 May 13;16(5):e0251269. doi: 10.1371/journal.pone.0251269. eCollection 2021.
Upper extremity venous thrombosis (UEVT) represents about 10% of venous thrombo-embolic disease. This is mainly explained by the increasing use of central venous line, for oncologic or nutritional care. The factors associated with venous recanalization are not known.
The aim of this study was to investigate prognosis factor associated with venous recanalization after UEVT.
This study included patients with UEVT diagnosed with duplex ultra-sonography (DUS) from January 2015 to December 2017 with DUS evaluations during follow-up. A multivariate Cox proportional-hazards-model analysis was performed to identify predictive factors of UEVT complete recanalization.
This study included 494 UEVT, 304 proximal UEVT and 190 distal UEVT. The median age was 58 years, 39.5% were women. Clinical context was: hematological malignancy (40.7%), solid cancer (14.2%), infectious or inflammatory context (49.9%) and presence of venous catheters or pacemaker leads in 86.4%. The rate of recanalization without sequelae of UEVT was 38%. For all UEVT, in multivariate analysis, factors associated with complete vein recanalization were: thrombosis associated with central venous catheter (CVC) (HR:2.40, [1.45;3.95], p<0.001), UEVT limited to a venous segment (HR:1.94, [1.26;3.00], p = 0.003), occlusive thrombosis (HR:0.48 [0.34;0.67], p<0.0001), the presence of a PICC Line (HR:2.29, [1.48;3.52], p<0.001), a thrombosis of deep and distal topography (HR:1.70, [1.10;2.63], p = 0.02) or superficial thrombosis of the forearm (HR:2.79, [1.52;5.12], p<0.001). For deep and proximal UEVT, non-occlusive UEVT (HR:2.23, [1.49;3.33], p<0.0001), thrombosis associated with CVC (HR:1.58, [1.01;2.47], p = 0.04) and infectious or inflammatory context (HR:1.63, [1.10;2.41], p = 0.01) were factors associated with complete vein recanalization.
In this study, factors associated with UEVT recanalization were UEVT limited to a venous segment, thrombosis associated with CVC, a thrombosis of deep and distal thrombosis topography and superficial thrombosis of the forearm. Occlusive thrombosis was associated with the absence of UEVT recanalization.
上肢静脉血栓形成（UEVT）占静脉血栓栓塞性疾病的 10%左右。这主要是由于中央静脉导管的使用越来越多，用于肿瘤或营养支持。与静脉再通相关的因素尚不清楚。
本研究旨在探讨 UEVT 后静脉再通的相关预后因素。
本研究纳入了 2015 年 1 月至 2017 年 12 月期间通过双功能超声（DUS）诊断为 UEVT 的患者，并在随访期间进行 DUS 评估。采用多变量 Cox 比例风险模型分析确定 UEVT 完全再通的预测因素。
本研究纳入了 494 例 UEVT，其中近端 UEVT 304 例，远端 UEVT 190 例。中位年龄为 58 岁，39.5%为女性。临床背景为：血液系统恶性肿瘤（40.7%）、实体瘤（14.2%）、感染或炎症（49.9%）和存在静脉导管或起搏器导线（86.4%）。UEVT 无后遗症再通率为 38%。对于所有 UEVT，多变量分析显示，与完全静脉再通相关的因素包括：与中央静脉导管（CVC）相关的血栓（HR：2.40，[1.45;3.95]，p<0.001）、UEVT 局限于静脉节段（HR：1.94，[1.26;3.00]，p=0.003）、闭塞性血栓（HR：0.48 [0.34;0.67]，p<0.0001）、PICC 置管（HR：2.29，[1.48;3.52]，p<0.001）、深及远段血栓（HR：1.70，[1.10;2.63]，p=0.02）或前臂浅表血栓（HR：2.79，[1.52;5.12]，p<0.001）。对于深部和近端 UEVT，非闭塞性 UEVT（HR：2.23，[1.49;3.33]，p<0.0001）、与 CVC 相关的血栓（HR：1.58，[1.01;2.47]，p=0.04）和感染或炎症（HR：1.63，[1.10;2.41]，p=0.01）是与完全静脉再通相关的因素。
本研究中，UEVT 再通的相关因素包括 UEVT 局限于静脉节段、与 CVC 相关的血栓、深及远段血栓形成和前臂浅表血栓形成。闭塞性血栓与 UEVT 再通的缺失相关。
