Impact of body mass index on PICC-related thrombosis in cancer patients
Abstract:
Background: Peripherally inserted central catheters (PICCs) are widely used in cancer patients but carry a significant thrombosis risk. While body mass index (BMI) is recognized as a thrombogenic factor, the role of vascular morphology remains unclear.
Materials and methods: A total of 338 adults with cancer requiring PICC insertion at our hospital were prospectively enrolled between January 11 and 30 December 2023. All study participants underwent ultrasound-guided PICC placement using a 4-Fr single-lumen catheter. Patients were monitored for thrombosis by serial ultrasonography. Demographic, clinical, and vascular characteristics were compared between patients who developed thrombosis and those who did not.
Results: PICC-related thrombosis developed in 35.5% of patients and was asymptomatic in 75.8% of cases. Bivariate analysis showed that BMI, vessel depth, arm circumference, vessel diameter, and blood flow velocity on the first post-insertion day were associated with the risk of thrombosis (P<0.05). Multivariate regression analysis identified shallower vessel depth (<1.0 cm, odds ratio [OR] 0.324, 95% confidence interval [CI] 0.120-0.874, P = 0.026) and smaller post-insertion vessel diameter (reduction <0.6 cm, OR 0.025, 95% CI 0.001-0.550, P = 0.019) as independent risk factors for thrombosis. Blood flow on the first post-insertion day was significantly slower in the thrombosis group (13.4 cm/s vs. 14.9 cm/s, P = 0.007). Blood flow velocity increased with increasing BMI, peaking at a BMI of 28.3 kg/m2 before declining beyond this threshold.
Conclusion: Low BMI and poor vascular morphology increase the risk of PICC-related thrombosis. The influence of BMI is likely mediated by vascular remodeling, with blood flow velocity peaking at 28.3 kg/m2 before declining, reflecting a compensatory hemodynamic balance.
Reference:
Wang G, Shen Y, Wang X, Dong J, Wang X, Zheng Y, Chen J, Meng X, Liu F, Song J, Dong J. Impact of vascular morphology and body mass index on PICC-related thrombosis in cancer patients: a prospective cohort study. Int J Surg. 2025 Dec 2. doi: 10.1097/JS9.0000000000004130. Epub ahead of print. PMID: 41347856.