Catheter-related thrombosis and fibroblastic sleeve in a cohort of cancer patients with PICC
Mariagrazia Nunziata, Francesco Paolo Damiano, Maria Amitrano, Raffaele Natale, Lidia Santarpia, Sara MangiacapraBackground:
An increasing number of patients with solid and hematologic malignancies require the insertion of peripherally inserted central catheters (PICCs) for the administration of therapy. Among device-related complications, catheter-related thrombosis (CRT) and fibroblastic sleeve (FS) are the most common. Although their ultrasound appearance may be similar, their management differs substantially, as only thrombosis requires anticoagulant therapy. Only a few studies have investigated the incidence of these complications.
Methods:
We conducted a prospective study in a cohort of cancer patients with PICCs to assess the incidence of CRT and FS at 7 to 10 and 28 to 30 days after catheter insertion. Associations with the type of underlying malignancy were also evaluated.
Results:
Forty-five consecutive patients who underwent insertion of a polyurethane PICC (4 Fr) were enrolled. FS was detected in 11 patients (24.4%): six at 7 to 10 days (13.3%) and five at 28 to 30 days (11.1%). CRT occurred in five patients (11.1%): three cases were detected at 7 to 10 days and two at 28 to 30 days. Three of the five CRT events were symptomatic (6.6%), whereas two (4.4%) were asymptomatic. FS was most frequently observed in patients with gastrointestinal (45.6%) or breast (36.3%) cancer, whereas CRT predominated in gastrointestinal malignancies (60.0%). A non-significant trend toward an association was observed between vein diameter and the type of complication. Finally, a significant association was found between complication timing and platelet count (
Conclusions:
FS is a common but asymptomatic ultrasound finding in cancer patients with PICCs. CRT is less frequent but clinically significant. Accurate differentiation between these two conditions is essential to avoid unnecessary anticoagulation, prevent adverse events, and optimize healthcare resource utilization.