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© 2006 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 25:1297-1303 • 0278-4297

Prevalence of Upper Extremity Deep Venous Thrombosis Diagnosed by Color Doppler Duplex Sonography in Cancer Patients With Central Venous Catheters

Diana Gaitini, MD, Nira Beck-Razi, MD, Nissim Haim, MD and Benjamin Brenner, MD

Ultrasound Unit, Department of Diagnostic Imaging (D.G., N.B.-R.), Chemotherapy Unit, Division of Oncology (N.H.), and Blood Coagulation Unit, Department of Hematology (B.B.), Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Address correspondence to Diana Gaitini, MD, Ultrasound Unit, Department of Diagnostic Imaging, Rambam Health Care Campus, 8 Ha’aliyah St, 35254 Haifa, Israel. E-mail: d_gaitini{at}rambam.health.gov.il

Objective. The purpose of this study was to review the literature concerning upper extremity deep venous thrombosis (UEDVT) diagnosed by color Doppler duplex sonography (CDDS) in cancer patients with indwelling central venous catheters (CVCs). Methods. From computerized databases (MEDLINE and Ovid), relevant publications regarding CDDS of the upper limb veins in cancer patients with CVCs were reviewed. Results. Patients with malignancy have a higher rate of thrombosis, which is increased by the presence of CVCs. Screening CDDS in asymptomatic patients showed CVC-related UEDVT in 11.7% to 44% of patients. In symptomatic cancer patients, the range was similar to the asymptomatic ones, 6.7% to 48%. The presence of a CVC almost doubled the incidence of UEDVT in symptomatic patients. Color Doppler duplex sonography is an accurate examination for the diagnosis of UEDVT, with sensitivity ranging from 78% to 100% and specificity ranging from 82% to 100%. The main obstacle for the diagnosis of UEDVT is the presence of overlying bones, making it difficult to visualize and impossible to directly assess by compression techniques. Color and spectral Doppler sonography and the use of small transducers aid in the diagnosis. When several parameters are evaluated in combination, CDDS is a reliable method for diagnosing CVC-related thrombosis. Conclusions. Great variability in the prevalence of catheter-related thrombosis in cancer patients has been reported, although it is uniformly higher compared with patients without cancer. Color Doppler duplex sonography is the modality of choice for the diagnosis of CVC-related UEDVT in symptomatic cancer patients and for screening for asymptomatic thrombosis in this specific population.

Key Words: central venous catheter • color Doppler sonography • embolism • extremities • venous thrombosis

Abbreviations: CDDS, color Doppler duplex sonography • CVC, central venous catheter • DVT, deep venous thrombosis • PE, pulmonary embolism • SVC, superior vena cava • UEDVT, upper extremity deep venous thrombosis • VTE, venous thromboembolism

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Copyright © 2006 by the American Institute of Ultrasound in Medicine.