PO72 | CATHETER-RELATED THROMBOSIS VS. FIBROBLASTIC SLEEVE. INCIDENCE AND IMPACT IN ONCOLOGICAL AND HEMATOLOGICAL PATIENTS WITH PERIPHERALLY INSERTED CENTRAL CATHETER

M. Nunziata¹, S. Mangiacapra¹, F.P. Damiano¹, N. Iuliano¹, V. Iorio¹, R. Natale², L. Santarpia², M. Amitrano¹ | ¹Internal Medicine, A.O.R.N. San Giuseppe Moscati, Avellino, Italy; ²Internal Medicine, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy

Introduction. Oncohematological patients often have peripherally inserted central venous catheters (PICC). Associated complications are venous thrombosis or fibroblastic sleeve. The correct discrimination between the two is important, as they are similar by ultrasound, but their management is different, with anticoagulant therapy needed only for thrombosis.

Materials and Methods. In a cohort of 45 consecutive oncological patients with PICC, we evaluated the incidence of catheter-related thrombosis (CRT) versus fibroblastic sleeve (FS) at 7-10 and 28-30 days. The type of oncological disease was also assessed.

Results. FS was identified in 11 patients (24.4%): 6 at 7-10 days (13.3%) and 5 at 28-30 days (11.1%); 5 patients (45.6%) had gastrointestinal cancer, 2 (18.1%) had respiratory tract cancer, and 4 had breast cancer (36.3%). CRT was identified in 5 patients (11.1%): 3 at 7-10 days (60.0%) and 2 at 28-30 days (40.0%); 3 patients had gastrointestinal cancer (60.0%), 1 (20%) had gynecological cancer, and 1 (20%) had an onco-hematological disease. Three thromboses were asymptomatic (60.0%). The relationship between vein diameter and the development of fibroblastic sleeve/thrombosis was not significant (p=0.069), whereas the relationship between the timing of the complication and the platelet count (OR 1.03, 95% CI: 1.01–1.08) was statistically significant (p=0.039).

Discussion. FS is frequent (24.4%), however, mainly asymptomatic, in cancer patients. CRT is less frequent (11.1%), but it carries significant morbidity. Discrimination between FS and CRT is clinically relevant to avoid unnecessary anticoagulation and its potentially serious side effects.

References

1. Passaro G, Pittiruti M, La Greca A. The fibroblastic sleeve, the neglected complication of venous access devices: a narrative review. J Vasc Access 2021;22:801-13.

2. Trezza C, Califano C, Iovino V, D’Ambrosio C, Grimaldi G, Pittiruti M. Incidence of fibroblastic sleeve and of catheter-related venous thrombosis in peripherally inserted central catheters: a prospective study on oncological and hematological patients. J Vasc Access 2021;22:444-9.