Thromboembolism following removal of femoral venous apheresis catheters in patients with breast cancer

M. Wasif Saif, S. F. Leitman, G. Cusack, M. Horne, A. Freifeld, D. Venzon, A. PremKumar, K. H. Cowan, R. E. Gress, J. Zujewski, Claude Sportes

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Apheresis catheters have simplified collection of peripheral blood stem cells (PBSC), but may be associated with thrombosis of the instrumented vessels. We performed a retrospective analysis to study the prevalence of thromboembolism associated with the use of femoral apheresis catheters in patients with breast cancer. Patients and methods: Patients were participants in clinical trials of high-dose chemotherapy with autologous PBSC rescue. They underwent mobilization with either high-dose cyclophosphamide (n = 21) or cyclophosphamide/paclitaxel (n = 64), followed by filgrastim. Double lumen catheters (12 or 13 Fr) were placed in the femoral vein and removed within 12 h of the last apheresis procedure. Apheresis was performed using a continuous flow cell separator and ACD-A anticoagulant. Thromboembolism was diagnosed by either venous ultrasonography or ventilation-perfusion scan. Results: Nine of 85 patients (10.6%) undergoing large volume apheresis with use of a femoral catheter developed thromboembolic complications. Pulmonary embolus (PE) was diagnosed in five and femoral vein thrombosis in four patients. Four of the five patients who developed PE were symptomatic; one asymptomatic patient had a pleural-based, wedge-shaped lesion detected on a staging computed tomography scan. The mean number of apheresis procedures was 2.4 (range one to four) and the mean interval between removal of the apheresis catheter and diagnosis of thrombosis was 17.6 days. In contrast, none of 18 patients undergoing apheresis using jugular venous access and none of 54 healthy allogeneic donors undergoing concurrent filgrastim-mobilized PBSC donation (mean 1.7 procedures/donor) using femoral access experienced thromboembolic complications. Conclusions: Thromboembolism following femoral venous catheter placement for PBSC collection in patients with breast cancer may be more common than previously recognized. Healthy PBSC donors are not at the same risk. Onset of symptoms related to thrombosis tended to occur several weeks after catheter removal. This suggests that the physicians not only need to be vigilant during the period of apheresis, but also need to observe patients for thromboembolic complications after the catheter is removed. The long interval between the removal of apheresis catheter and the development of thromboembolism may have a potential impact on prophylactic strategies developed in future, such as the duration of prophylactic anticoagulation. Avoidance of the femoral site in breast cancer patients, and close prospective monitoring after catheter removal, are indicated.

Original languageEnglish (US)
Pages (from-to)1366-1372
Number of pages7
JournalAnnals of Oncology
Volume15
Issue number9
DOIs
StatePublished - Sep 1 2004
Externally publishedYes

Fingerprint

Blood Component Removal
Thromboembolism
Thigh
Catheters
Breast Neoplasms
Thrombosis
Femoral Vein
Tissue Donors
Embolism
Cyclophosphamide
Lung
Paclitaxel
Anticoagulants
Ventilation
Ultrasonography
Neck
Perfusion
Cross-Sectional Studies
Tomography
Peripheral Blood Stem Cells

Keywords

  • Apheresis
  • Breast cancer
  • Femoral apheresis catheters
  • Malignancy
  • Peripheral blood stem cell transplantation
  • Thromboembolism

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Saif, M. W., Leitman, S. F., Cusack, G., Horne, M., Freifeld, A., Venzon, D., ... Sportes, C. (2004). Thromboembolism following removal of femoral venous apheresis catheters in patients with breast cancer. Annals of Oncology, 15(9), 1366-1372. https://doi.org/10.1093/annonc/mdh347

Thromboembolism following removal of femoral venous apheresis catheters in patients with breast cancer. / Saif, M. Wasif; Leitman, S. F.; Cusack, G.; Horne, M.; Freifeld, A.; Venzon, D.; PremKumar, A.; Cowan, K. H.; Gress, R. E.; Zujewski, J.; Sportes, Claude.

In: Annals of Oncology, Vol. 15, No. 9, 01.09.2004, p. 1366-1372.

Research output: Contribution to journalArticle

Saif, MW, Leitman, SF, Cusack, G, Horne, M, Freifeld, A, Venzon, D, PremKumar, A, Cowan, KH, Gress, RE, Zujewski, J & Sportes, C 2004, 'Thromboembolism following removal of femoral venous apheresis catheters in patients with breast cancer', Annals of Oncology, vol. 15, no. 9, pp. 1366-1372. https://doi.org/10.1093/annonc/mdh347
Saif, M. Wasif ; Leitman, S. F. ; Cusack, G. ; Horne, M. ; Freifeld, A. ; Venzon, D. ; PremKumar, A. ; Cowan, K. H. ; Gress, R. E. ; Zujewski, J. ; Sportes, Claude. / Thromboembolism following removal of femoral venous apheresis catheters in patients with breast cancer. In: Annals of Oncology. 2004 ; Vol. 15, No. 9. pp. 1366-1372.
@article{428f1a5f62654a8496047a8982578798,
title = "Thromboembolism following removal of femoral venous apheresis catheters in patients with breast cancer",
abstract = "Background: Apheresis catheters have simplified collection of peripheral blood stem cells (PBSC), but may be associated with thrombosis of the instrumented vessels. We performed a retrospective analysis to study the prevalence of thromboembolism associated with the use of femoral apheresis catheters in patients with breast cancer. Patients and methods: Patients were participants in clinical trials of high-dose chemotherapy with autologous PBSC rescue. They underwent mobilization with either high-dose cyclophosphamide (n = 21) or cyclophosphamide/paclitaxel (n = 64), followed by filgrastim. Double lumen catheters (12 or 13 Fr) were placed in the femoral vein and removed within 12 h of the last apheresis procedure. Apheresis was performed using a continuous flow cell separator and ACD-A anticoagulant. Thromboembolism was diagnosed by either venous ultrasonography or ventilation-perfusion scan. Results: Nine of 85 patients (10.6{\%}) undergoing large volume apheresis with use of a femoral catheter developed thromboembolic complications. Pulmonary embolus (PE) was diagnosed in five and femoral vein thrombosis in four patients. Four of the five patients who developed PE were symptomatic; one asymptomatic patient had a pleural-based, wedge-shaped lesion detected on a staging computed tomography scan. The mean number of apheresis procedures was 2.4 (range one to four) and the mean interval between removal of the apheresis catheter and diagnosis of thrombosis was 17.6 days. In contrast, none of 18 patients undergoing apheresis using jugular venous access and none of 54 healthy allogeneic donors undergoing concurrent filgrastim-mobilized PBSC donation (mean 1.7 procedures/donor) using femoral access experienced thromboembolic complications. Conclusions: Thromboembolism following femoral venous catheter placement for PBSC collection in patients with breast cancer may be more common than previously recognized. Healthy PBSC donors are not at the same risk. Onset of symptoms related to thrombosis tended to occur several weeks after catheter removal. This suggests that the physicians not only need to be vigilant during the period of apheresis, but also need to observe patients for thromboembolic complications after the catheter is removed. The long interval between the removal of apheresis catheter and the development of thromboembolism may have a potential impact on prophylactic strategies developed in future, such as the duration of prophylactic anticoagulation. Avoidance of the femoral site in breast cancer patients, and close prospective monitoring after catheter removal, are indicated.",
keywords = "Apheresis, Breast cancer, Femoral apheresis catheters, Malignancy, Peripheral blood stem cell transplantation, Thromboembolism",
author = "Saif, {M. Wasif} and Leitman, {S. F.} and G. Cusack and M. Horne and A. Freifeld and D. Venzon and A. PremKumar and Cowan, {K. H.} and Gress, {R. E.} and J. Zujewski and Claude Sportes",
year = "2004",
month = "9",
day = "1",
doi = "10.1093/annonc/mdh347",
language = "English (US)",
volume = "15",
pages = "1366--1372",
journal = "Annals of Oncology",
issn = "0923-7534",
publisher = "Oxford University Press",
number = "9",

}

TY - JOUR

T1 - Thromboembolism following removal of femoral venous apheresis catheters in patients with breast cancer

AU - Saif, M. Wasif

AU - Leitman, S. F.

AU - Cusack, G.

AU - Horne, M.

AU - Freifeld, A.

AU - Venzon, D.

AU - PremKumar, A.

AU - Cowan, K. H.

AU - Gress, R. E.

AU - Zujewski, J.

AU - Sportes, Claude

PY - 2004/9/1

Y1 - 2004/9/1

N2 - Background: Apheresis catheters have simplified collection of peripheral blood stem cells (PBSC), but may be associated with thrombosis of the instrumented vessels. We performed a retrospective analysis to study the prevalence of thromboembolism associated with the use of femoral apheresis catheters in patients with breast cancer. Patients and methods: Patients were participants in clinical trials of high-dose chemotherapy with autologous PBSC rescue. They underwent mobilization with either high-dose cyclophosphamide (n = 21) or cyclophosphamide/paclitaxel (n = 64), followed by filgrastim. Double lumen catheters (12 or 13 Fr) were placed in the femoral vein and removed within 12 h of the last apheresis procedure. Apheresis was performed using a continuous flow cell separator and ACD-A anticoagulant. Thromboembolism was diagnosed by either venous ultrasonography or ventilation-perfusion scan. Results: Nine of 85 patients (10.6%) undergoing large volume apheresis with use of a femoral catheter developed thromboembolic complications. Pulmonary embolus (PE) was diagnosed in five and femoral vein thrombosis in four patients. Four of the five patients who developed PE were symptomatic; one asymptomatic patient had a pleural-based, wedge-shaped lesion detected on a staging computed tomography scan. The mean number of apheresis procedures was 2.4 (range one to four) and the mean interval between removal of the apheresis catheter and diagnosis of thrombosis was 17.6 days. In contrast, none of 18 patients undergoing apheresis using jugular venous access and none of 54 healthy allogeneic donors undergoing concurrent filgrastim-mobilized PBSC donation (mean 1.7 procedures/donor) using femoral access experienced thromboembolic complications. Conclusions: Thromboembolism following femoral venous catheter placement for PBSC collection in patients with breast cancer may be more common than previously recognized. Healthy PBSC donors are not at the same risk. Onset of symptoms related to thrombosis tended to occur several weeks after catheter removal. This suggests that the physicians not only need to be vigilant during the period of apheresis, but also need to observe patients for thromboembolic complications after the catheter is removed. The long interval between the removal of apheresis catheter and the development of thromboembolism may have a potential impact on prophylactic strategies developed in future, such as the duration of prophylactic anticoagulation. Avoidance of the femoral site in breast cancer patients, and close prospective monitoring after catheter removal, are indicated.

AB - Background: Apheresis catheters have simplified collection of peripheral blood stem cells (PBSC), but may be associated with thrombosis of the instrumented vessels. We performed a retrospective analysis to study the prevalence of thromboembolism associated with the use of femoral apheresis catheters in patients with breast cancer. Patients and methods: Patients were participants in clinical trials of high-dose chemotherapy with autologous PBSC rescue. They underwent mobilization with either high-dose cyclophosphamide (n = 21) or cyclophosphamide/paclitaxel (n = 64), followed by filgrastim. Double lumen catheters (12 or 13 Fr) were placed in the femoral vein and removed within 12 h of the last apheresis procedure. Apheresis was performed using a continuous flow cell separator and ACD-A anticoagulant. Thromboembolism was diagnosed by either venous ultrasonography or ventilation-perfusion scan. Results: Nine of 85 patients (10.6%) undergoing large volume apheresis with use of a femoral catheter developed thromboembolic complications. Pulmonary embolus (PE) was diagnosed in five and femoral vein thrombosis in four patients. Four of the five patients who developed PE were symptomatic; one asymptomatic patient had a pleural-based, wedge-shaped lesion detected on a staging computed tomography scan. The mean number of apheresis procedures was 2.4 (range one to four) and the mean interval between removal of the apheresis catheter and diagnosis of thrombosis was 17.6 days. In contrast, none of 18 patients undergoing apheresis using jugular venous access and none of 54 healthy allogeneic donors undergoing concurrent filgrastim-mobilized PBSC donation (mean 1.7 procedures/donor) using femoral access experienced thromboembolic complications. Conclusions: Thromboembolism following femoral venous catheter placement for PBSC collection in patients with breast cancer may be more common than previously recognized. Healthy PBSC donors are not at the same risk. Onset of symptoms related to thrombosis tended to occur several weeks after catheter removal. This suggests that the physicians not only need to be vigilant during the period of apheresis, but also need to observe patients for thromboembolic complications after the catheter is removed. The long interval between the removal of apheresis catheter and the development of thromboembolism may have a potential impact on prophylactic strategies developed in future, such as the duration of prophylactic anticoagulation. Avoidance of the femoral site in breast cancer patients, and close prospective monitoring after catheter removal, are indicated.

KW - Apheresis

KW - Breast cancer

KW - Femoral apheresis catheters

KW - Malignancy

KW - Peripheral blood stem cell transplantation

KW - Thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=4644320194&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4644320194&partnerID=8YFLogxK

U2 - 10.1093/annonc/mdh347

DO - 10.1093/annonc/mdh347

M3 - Article

VL - 15

SP - 1366

EP - 1372

JO - Annals of Oncology

JF - Annals of Oncology

SN - 0923-7534

IS - 9

ER -