MRI after removal of central venous access device reveals a high number of asymptomatic thromboses in children with haemophilia

Abstract

Central venous access devices (CVADs) are often required in children with haemophilia to secure venous access for prophylactic treatment or immune tolerance therapy. Complications of CVADs include infections, thrombosis and mechanical problems. This study sought to determine the outcome of the vessels by magnetic resonance imaging (MRI) in children with haemophilia and to assess risk factors for development of catheter-related deep venous thrombosis (DVT). After the removal of CVAD an MRI of the chest and neck was performed to 20 boys with haemophilia who each had 1-3 (total number 27) CVADs placed. MRI revealed DVT in five children (25%). As their CVADs were functional at the time of the removal, the DVTs were clinically silent. However, there had been suspicion of DVT leading to replacement of the CVAD in one case. All the children with DVT had their CVADs inserted initially below the age of 1 year. The clinical signs of mild post-thrombotic syndrome (PTS) were common: dilated chest wall veins were observed in 11 (55%) children and were associated with DVT in three cases. Arm circumference discrepancy was observed in one child with DVT. No correlation between the duration or number of CVADs and DVT was detected. None of the patients had subjective symptoms of PTS. Silent DVT is a common complication of CVAD. Catheter insertion at a young age seems to predispose to thrombosis. The long-term consequences of the DVTs remain unknown.

Complications associated with central venous access device in children with haemophilia: a nationwide multicentre study in Finland

“…We were unable to assess the prevalence of silent thrombosis because venograms, ultrasound or MRI‐angiography were not routinely performed. A recent study investigating 20 children screened by MRI after the removal of CVAD, found a high number of silent DVT (25% of patients had abnormal MRI, consistent with DVT corresponding to CR 0.10/1000 CVAD days) .…”

Implantable central venous access device in infants: Long‐term results

“…One of the most common complications of CVAD was CLABSI . Previous studies have also reported occlusion, skin damage on the septum, catheter leakage, and port–catheter disconnection, and deep venous thrombosis . Al‐Bassam et al .…”

“…The indications for CVAD implantation have recently broadened in children in order to improve their quality of life. Some clinical studies that have involved a small number of babies have been published . The effectiveness of the implantation of CVAD in newborns with congenital coagulation disorders has been reported .…”

“…Some clinical studies that have involved a small number of babies have been published. 7 The effectiveness of the implantation of CVAD in newborns with congenital coagulation disorders has been reported. 8,9 Fallon et al found that babies with CVAD or tunneled central line had a higher early complication rate (mostly attributable to infection), than toddlers.…”

“…9 Previous studies have also reported occlusion, skin damage on the septum, catheter leakage, and port-catheter disconnection, and deep venous thrombosis. 2,5,7 Al-Bassam et al and McMahon et al noted that 30% of CVAD were unavoidably removed because of CLABSI. 6,9 Moreover, De Backer et al noted that the most frequent late complication was occlusion, which they encountered in 11% of children, because pediatric CVAD were smaller and narrower than adult CVAD.…”