| Popis: |
Background: The use of portacath became a commonplace in anticancer treatment. However infections and deep venous thrombosis are two serious complications that might be encountered. The mere evidence of infection spells immediate catheter removal, whereas the situation is totally different with deep venous thrombosis and represents a matter of debate. Aim of the study: This study was designed to address the issue of portacath related subclavian vein thrombosis to clarify the pros & cons of either catheter removal or leaving to justify when to adopt each plan. Patients and methods: Twenty-eight patients having portacath with subclavian vein thrombosis were randomly divided between 2 groups (14 patients each) according to the management plan. Group A were subjected to medical treatment without catheter removal and group B were subjected to medical treatment, catheter removal and insertion of a new one as necessary in another vascular bed. Both groups were compared regarding the baseline relevant data and the treatment outcome. Results: There was no statistically significant difference between both groups regarding the duration till start of clinical improvement (P value 0.682), maximum clinical improvement (P value 0.445), and start of recanalization (P value 0.218). However, the duration until complete recanalization was significantly shorter in the catheter removal group B (P value 0.05). Although in the catheter leaving group A the hospital stay was significantly longer (P value 0.001), yet, the overall cost was significantly less (P value 0.05). Re-thrombosis, postphlebitic limb, pulmonary embolism were not encountered in either groups. Conclusion: In addition to the cost and the extra-procedure, removal of a still needed well placed functioning catheter with subsequent insertion of another one in the contra-lateral side has no clinical privilege. It also carries the same risk of subclavian vein re-thrombosis in the old side and the chance of thrombosis in the new side. |
