Venous Access Problems in Sickle Cell Disease Patients: Results of Upper Extremity Thrombolysis in the setting of Catheter Related Thrombosis

Abstract

AbstractPurposeSickle cell disease is the most common monogenic disorder. All the elements of Virchow’s triad – hypercoagulability, endothelial dysfunction and impaired blood flow – are present in sickle cell disease patients, and can lead to thrombosis and vaso-occlusive crises. Central venous catheters are commonly used in sickle cell disease patients for rapid transfusion to avoid a vaso-occlusive crisis or for treatment after crises onset. However, central venous catheters themselves are an additional source for thrombus formation. We investigate a single day thrombolysis protocol for the treatment of catheter related thrombosis.Materials and MethodsWe present an Institutional Review Board approved retrospective analysis spanning from June 2016 to April 2018 evaluating upper extremity thrombolysis in the setting of catheter related thrombosis. All patients underwent a similar protocol involving peripheral upper extremity access, pharmomechanical thrombolysis, and angioplasty, which is described in detail. In 33% of the procedures, a recalcitrant stenosis was then stented. Maximal balloon size and stent sizes are included for reference.ResultsIn follow up, one patient had a severe complication possibly related to the large thrombus burden, and expired. One patient who did not initially have recalcitrant stenosis and therefor did not have a stent placed during the initial procedure, had recurrent stenosis and thrombosis 6 months after the initial procedure, and had repeat pharmomechanical thrombolysis performed, with stent placement at that time. The other procedures were without complication, and the upper extremity and central venous systems remained patent at most recent follow-up, up to 30 months post procedure.ConclusionsIn the circumstance of severe catheter related thrombosis, we present a protocol which can be considered for therapeutic use without further intervention required in 78% of cases at 2 years.