Evidence-based review on catheter-related thrombosis of the implantable venous access device

An implantable venous access device (IVAD) is routinely implanted for long-term intravenous access. Despite its reliability and safety, catheter-related thrombosis remains the most common complication leading to irreversible dysfunction. Thrombosis incidence is underestimated because clinical manifestation is usually asymptomatic. In this evidence-based review, we compared the distinct natural courses of four thrombosis locations with respect to the vessel (right atrium/central vein) or the catheter (intralumen/fibrin sheath). Practical management recommendations are also proposed. Specifically, right atrial thrombus is a rare but life-threatening complication possibly leading to pulmonary embolism and cardiac arrest. Prompt surgical thrombectomy is strongly recommended, while medical treatments may be tried for pediatric patients with small to moderate-sized thrombi. Central vein thrombosis is usually unnoticeable but, when left untreated, may progress to extensive obstruction of the superior vena cava. An antithrombotic agent, such as unfractionated or low-molecular-weight heparin, is the first choice, while surgical intervention is not recommended due to lack of benefits. Intraluminal thrombotic occlusion (2-3%) and fibrin sheath formation (42-100%) are common etiologies associated with device malfunction. Both conditions are minor and can be readily resolved by fibrinolytic agents. Surgical removal of the device should only be considered after fibrinolytic agents have failed or therapy has been terminated because of its minor severity and high success rate of medical treatment. In conclusion, while IVAD is a durable and sustainable device that can provide a long-term intravenous route, identification of the exact thrombosis location will lead to rational treatment strategies and thereby avoid unnecessary surgical intervention.