Puel V, Caudry M, Le Métayer P, Baste J C, Midy D, Marsault C, Demeaux H, Maire J P
Department of Cardiology, Université de Bordeaux II, Hôpital Saint-André, France.
Cancer. 1993 Oct 1;72(7):2248-52. doi: 10.1002/1097-0142(19931001)72:7<2248::aid-cncr2820720731>3.0.co;2-u.
Thrombosis of the central veins is one of the most frequent complications of implanted venous access devices. Among the first cases occurring in our patients, most were associated with left-sided placement of the ports, with catheter tips lying against the external wall in the upper half of the superior vena cava. Some chest radiographs showed lateromediastinal opacities centered on the catheter tip, suggesting a vessel injury. This position allows a narrow contact between the catheter tip and the vessel wall, thus endothelial injuries might result from mechanical and chemical attack.
To assess the role of catheter position, we reviewed the routine chest radiographs of 379 patients who received chemotherapy through venous access devices and were followed up at our department between December 1985 and December 1990. Four groups (upper left, upper right, lower left, and lower right) were defined according to the level of the catheter tip (innominate veins or upper half of the vena cava versus lower half of the vena cava or auricula) and to the side of port implantation.
Ten patients developed symptomatic venous thrombosis (superior vena cava in 9 patient, left subclavian vein in 1 patient). A strong correlation existed between catheter position and incidence of thrombosis: upper left, 8/28 (28.6%); upper right, 1/33 (3%); lower right, 1/68 (1.5%); and lower left, 0/250. Since 1988, we have insisted on replacement of malpositioned catheters, and we have observed fewer thromboses (2/191 versus 8/188).
The current study suggests that patients with left-sided ports and catheter tips lying in the upper part of the vena cava are at high risk for severe thrombotic complications.
中心静脉血栓形成是植入式静脉通路装置最常见的并发症之一。在我们患者发生的首批病例中，大多数与端口左侧置入有关，导管尖端位于上腔静脉上半部分的外壁。一些胸部X线片显示以导管尖端为中心的纵隔外侧模糊影，提示血管损伤。这种位置使导管尖端与血管壁之间的接触狭窄，因此机械和化学攻击可能导致内皮损伤。
为评估导管位置的作用，我们回顾了1985年12月至1990年12月在我们科室接受静脉通路装置化疗并随访的379例患者的常规胸部X线片。根据导管尖端水平（无名静脉或上腔静脉上半部分与上腔静脉下半部分或心耳）和端口植入侧将患者分为四组（左上、右上、左下和右下）。
10例患者发生有症状的静脉血栓形成（9例为上腔静脉，1例为左锁骨下静脉）。导管位置与血栓形成发生率之间存在强烈相关性：左上，8/28（28.6%）；右上，1/33（3%）；右下，1/68（1.5%）；左下，0/250。自1988年以来，我们坚持更换位置不当的导管，并且观察到血栓形成减少（2/191对8/188）。
当前研究表明，端口位于左侧且导管尖端位于上腔静脉上部的患者发生严重血栓性并发症的风险很高。
