Thrombotic risk factors in patients with superior vena cava syndrome undergoing chemotherapy via femoral inserted central catheter

Highlights

• Femoral inserted central catheter has been proved effective during clinical verifications.

• Femoral inserted central catheter has become the preferred choice in patients with superior vena cava syndrome.

• The incidence of femoral inserted central catheter -related thrombosis was 16.48%.

• Bevacizumab is a risk factor of femoral inserted central catheter-related thrombosis.

• Puncture site at the groin is a risk factor of femoral inserted central catheter-related thrombosis.

Abstract

Objective

Our study aimed to scrutinize the incidence and risk factors of femoral inserted central catheter (FICC)-related thrombosis in patients with superior vena cava syndrome (SVCS) undergoing chemotherapy.

Methods

A retrospective analysis of patients with SVCS undergoing chemotherapy who received FICC catheterization at the Xiangya Hospital, Central South University, Changsha City, Hunan Province between May 2012 and February 2019 was performed. Both asymptomatic thrombosis and symptomatic thrombosis were diagnosed by color doppler ultrasound (CDUS). Univariate and multivariate logistic regression analyses were performed to identify patient-, insertion-, and catheter-related factors.

Results

Eight hundred and seventy-four patients with SVCS undergoing chemotherapy, with a total of 157,180 catheter days were enrolled in our study. FICC-related thrombosis was detected in 144 patients, and yielding an overall incidence of 16.47% or 0.92 events per 1000 catheter days. Of these, 19(2.17%) patients had symptomatic thrombosis. The mean time interval between FICC insertion and thrombosis onset was (10.40 ± 6.32) days and the mean catheter indwelling time was (179.84 ± 46.15) days. The history of deep venous thrombosis, treatment with vascular endothelial growth factor (VEGF) inhibitor (bevacizumab), puncture site (mid-thigh, groin), tip position and catheter size showed association with FICC-related thrombosis. Treatment with VEGF inhibitor [odds ratio (OR) = 2.779; 95%confidence interval (CI): 1.860–4.153; P < 0.001] and puncture site at the groin (OR = 10.843; 95%CI: 6.575–17.881; P < 0.001) were identified as independent risk factors of FICC-related thrombosis.

Conclusion

Treatment with VEGF inhibitor and puncture site at the groin during FICC catheterization were considered as high-risk factors in FICC-related thrombosis.

Introduction

Nowadays, peripherally inserted central catheter (PICC) has been widely used to obtain central venous access for both hospitalized and discharged patients [[1], [2], [3]]. The advantages of PICC are as follows: firstly, it is considered to be a safe and well acceptable method by patients with a preferable cost-efficiency ratio [[4], [5], [6], [7]]; secondly, the PICC catheterization is minimally invasive and could be performed at patient's bedside, making it convenient for patients as well as providers [[8], [9]]; thirdly, PICC could eliminate the pain [10] of patients by repeated puncturing, causing no hemothorax or pneumothorax [11]; and finally, it is easy to maintain. So, PICC is considered as in situ for longer time, with shorter length of hospital stay.

Superior vena cava syndrome (SVCS) is caused by the obstruction or compression of superior vena cava, leading to the edema of head, neck, and upper extremities, shortness of breath, and headaches [12]. The severity of these symptoms is associated with decreased venous return from the head, neck, and upper extremities, which in turn depends on the degree of superior vena cava stenosis [13]. This might be due to benign causes, but advanced lung cancer and malignant lymphoma are the most often causes in most of the patients. In general, such patients should avoid infusion from the veins of upper extremities, external jugular veins and subclavian veins as much as possible, but for patients with complete superior vena cava obstruction, infusion from the veins of lower extremities is the only choice [14]. However, patients with malignant tumors complicated with SVCS require multi-stage chemotherapy due to their critical condition [15]. So, femoral inserted central catheter (FICC) has become the preferred choice for venous access in patients with SVCS undergoing chemotherapy [16].

However, studies have shown that catheterization is a risk factor of thrombosis [[17], [18]]. Current studies have largely focused on PICC-related upper extremity venous thrombosis, as well as on the incidence and independent risk factors of thrombosis, suggesting that they greatly differ. However, very little work has been focused on FICC-related thrombosis in patients with SVCS undergoing chemotherapy. Therefore, our study aimed to explore the incidence and risk factors of FICC-related thrombosis in patients with SVCS undergoing chemotherapy to provide a theoretical basis for clinical intervention and effective reduction of FICC-related thrombosis.