Retrospective comparative examination of the long term effects of venous access devices on upper extremity limb measurement in children with haemophilia: pilot observations from a single haemophilia treatment centre.

BACKGROUND: Venous access devices (VADs) have been used in some individuals with haemophilia to facilitate infusions of factor concentrates. Studies have reported complications of infection and thrombosis with VADs but there have been no studies looking at the potential effect that VADs may have on growth of the upper extremities in children with haemophilia. We hypothesize that there could be potential growth discrepancies in upper extremities in children with VADs related to changes in blood flow to the extremity caused by the VADs. METHODS: This study was a cohort descriptive comparative study to determine if VAD use correlated to discrepancies in upper extremity limb measurement data. A multivariate analysis compared limb measurements with VAD use, bleeding, clotting, infections, surgeries, chest wall collateral patterns and magnetic resonance venogram results. RESULTS: A total of 59 children with haemophilia participated (36 subjects with VADs, 23 subjects without). Overall, in subjects with VADs the non-VAD side was found to be shorter and measured less in girth than the VAD side. These differences did not reach statistical significance except bicep/tricep girth in the 11-15 age group. There was no correlation found between duration of VAD placement and subject age vs. length and girth measurements. When comparing subjects with VADs to those without VADs, no differences in measurements were seen. Differences in girth were measured between dominant hand and non-dominant hand in all subjects indicating that the dominant hand arm was larger. Reproducibility of this data may be hampered by limitations of sample size, subject homogeneity and variability in bleeding history between subject groups.