The incidence and significance of central venous access device (CVAD) dysfunction and symptomatic thrombosis were determined by retrospective review of 253 consecutive children diagnosed and treated for brain tumors at St Jude Children’s Research Hospital, Memphis, TN, and Cleveland Clinic, OH. Symptoms of venous thromboses were pain and swelling of an extremity, chest pain, acute dyspnea, and CVAD dysfunction with need to instill a fibrinolytic agent to restore patency. Chemotherapy was used in 75% of patients and radiation in 66%. CVAD dysfunction was reported in 54 of 190 (28%) patients with central lines, and thrombotic occlusion was confirmed in 17. Major venous thromboembolic events (VTE) occurred in 6 patients with an episode rate of 2.8%. Major thrombosis was more likely with CVAD dysfunction than without, and CVAD dysfunction was associated with reduced survival rate. 
COMMENT. CVAD dysfunction and thrombotic occlusion are common complications of brain tumors in children and are risk factors for major VTE involving the upper extremities and superior vena cava. CVAD dysfunction is associated with a poor prognosis, and VTE prevention is recommended in high-risk patients.