Chest port-related deep venous thrombosis: retrospective analysis of its management and clinical outcomes

Sunday, March 5, 2023

3:09 PM – 3:18 PM

Location: Phoenix Convention Center, 221C

Presenting Author(s)

Griffin Johnson, BA

Medical Student
SUNY Upstate Medical University

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Robert She, BS

Medical Student
SUNY Upstate Medical University
EG

Eytan Galanter, BS

Medical Student
SUNY Upstate Medical University
KK

Katsuhiro Kobayashi, M.D.

Associate Professor
SUNY Upstate Medical University

Disclosure(s):

Griffin Johnson, BA: No financial relationships to disclose

Robert She, BS: No financial relationships to disclose

Purpose: Management of chest port (port)-associated deep venous thrombosis (DVT) has not been well studied and established guidelines do not currently exist. We retrospectively investigate the treatment and clinical outcome of patients with port-related DVT.

Materials and Methods: A total of 3,419 ports placed between 2013 and 2021 were included in this single-institution retrospective study. Patients with port-related DVT were identified through chart review. The characteristics of DVT, treatment, and clinical outcomes were recorded. Port salvage rate, which was defined as percentage of ports functionally remaining in situ following treatment for DVT, was calculated.

Results:

The cumulative follow-up period for the study population was 1,731,050 catheter-days (median per patient: 506.30 catheter-days, range:1-3,405 catheter-days). A total of 58 p</span>orts corresponding to 57 patients (23 male/34 female, mean age: 54) developed port-related DVTs (1.696%, 0.0335 DVTs/1000 catheter days). The median time to DVT was 237 days (range: 1-1084 days). Of these, most were oncologic cases (n= 54, 93%) with hematologic cancer being the most common (n= 15, 25.9%). Locations of DVT include internal jugular vein (n= 38, 65.5%), subclavian vein (n= 12, 20.7%), superior vena cava (n= 6, 10.3%), brachiocephalic vein (n= 2, 3.4%), and others (n= 13, 22.4%). More than one vein was affected in 12 cases (20.7%).

Fifty-three cases received anticoagulation therapy including Enoxaparin sodium (n= 17), Rivaroxaban (n= 16), intravenous Heparin (n= 7 alone, n=2 within combination), Apixaban (n= 5), and Warfarin (n= 2). Combination therapies used were Enoxaparin-Rivaroxaban (n= 2) and Enoxaparin-Apixaban (n= 2). Of these, 24 had the port removed due to non-resolving DVT (n= 23) and associated infection (n= 1), accounting for port salvage rate of 54.7%. One patient underwent SVC angioplasty following Heparin therapy and port removal. Two patients had their ports removed without prior anticoagulation due to intracranial extension (n= 1, subsequent anticoagulant therapy) and contraindication due to history of GI bleed (n= 1). One of the remaining 3 patients did not receive any treatment and the other 2 lacked documented information regarding treatment.

Conclusion: Port-related thrombosis (DVT) is a relatively rare complication. More than half of cases with port-related DVT were successfully salvaged with anticoagulation alone. Initiation of anticoagulant therapy is recommended in port-related DVT before considering port removal.