Central Line-Associated Venous Late Effects in Children without Any Prior History of Thrombosis - A Cross-Sectional Study of Children Previously Treated for Malignant or Hematological Diseases.

Background: The frequency of asymptomatic central line-associated thromboses is high and well recognised among children with cancer, while the long-term consequences are mainly unknown. In a cross-sectional study, we have evaluated clinical and radiological venous outcome in children with previous long-standing intravascular catheters.

Methods: The study enrolled 71 children previously treated for malignant or haematological diseases, 4–180 (median 37) months after removal of their central lines. The central lines had been placed in a jugular vein for a minimum of six months, and none had a previously identified event of thrombosis. The children were clinically examined for post-thrombotic syndrome (PTS) and had Doppler ultrasonography of their central neck veins. In a subgroup of twelve children, venous magnetic resonance imaging (MRI) of the same area of interest was performed.

Results: We observed mild PTS with increased superficial collaterals in four children (6 %), but no cases of more severe PTS. None complained of symptoms related to venous late effects. By ultrasonography, post-thrombotic venous alterations were detected in 17 children (24 %), and five of these had complete occlusion of veins. The sensitivity for pathologically increased collaterals to identify occlusive thrombosis was 0.6, while the specificity was 0.98. Occlusive thrombosis was associated with previous central line-associated infections (p = 0.001) and duration of central lines in place (p = 0.042). MRI did not give any extra information, and only occlusive thromboses were confirmed at MRI.

Conclusions: In spite of no prior history of thrombosis, children with previous long-term jugular lines had often local thrombotic sequelae, while clinical symptoms of PTS were rare.