Kraybill W G, Allen B T
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
J Surg Oncol. 1993 Apr;52(4):244-8. doi: 10.1002/jso.2930520410.
Occult or clinically apparent central venous thrombosis frequently complicates central venous catheter placement in patients requiring long-term vascular access. Thirty-three patients, aged 12-83 years, underwent duplex scanning of the internal jugular, axillary, and brachial veins prior to placement of long-term venous access catheters. Twenty-seven patients underwent duplex scanning because of a prior history of either long-term or short-term central venous access. Of 12 patients with a history of long-term central venous access, without complications, 42% (5/12) had an abnormal duplex scan demonstrating thrombosis. Duplex scans on 15 patients having complications associated with central venous access demonstrated thrombosis of one or more of the central veins, 46% (7/15). Five patients who underwent duplex scanning without a history of a previous central venous catheter or other indication were found to have normal central veins. In 13 patients found to have thrombosis or obstruction by duplex scan, the surgeon was directed to successful venous access in all cases. Normal findings were very helpful in confirming that the venous system was normal in selected patients. In approximately 40% of patients with a history of venous access, catheters were found to have evidence of thrombosis of one or more of the central veins. In 13 patients found to have thrombosis or obstruction by duplex scan, the surgeon was directed to a successful site for venous access in all cases.
隐匿性或临床显性中心静脉血栓形成常常使需要长期血管通路的患者在进行中心静脉导管置入时出现并发症。33例年龄在12至83岁之间的患者，在置入长期静脉通路导管之前，接受了颈内静脉、腋静脉和肱静脉的双功超声扫描。27例患者因有长期或短期中心静脉通路的既往史而接受双功超声扫描。在12例有长期中心静脉通路且无并发症病史的患者中，42%（5/12）的双功超声扫描异常显示有血栓形成。对15例有中心静脉通路相关并发症的患者进行的双功超声扫描显示一条或多条中心静脉有血栓形成，占46%（7/15）。5例没有中心静脉导管置入既往史或其他指征而接受双功超声扫描的患者，其中心静脉正常。在13例经双功超声扫描发现有血栓形成或梗阻的患者中，所有病例的外科医生都成功地找到了静脉通路。正常结果对于确认选定患者的静脉系统正常非常有帮助。在约40%有静脉通路病史的患者中，发现导管有一条或多条中心静脉血栓形成的证据。在13例经双功超声扫描发现有血栓形成或梗阻的患者中，所有病例的外科医生都成功地找到了静脉通路的部位。
