Right atrial thrombus in an asymptomatic hemodialysis patient with malfunctioning catheter and patent foramen ovale.
ABSTRACT The creation of an accurate functioning arteriovenous fistula has been a long-lasting problem in the hemodialysis setting. In spite of recent guidelines and largely because of the old age of the current dialysis population and a high incidence of diabetes mellitus, atherosclerosis, and related vascular problems, it is not always possible to create an adequate fistula. In that case, long-term tunneled indwelling central vein catheters are a frequently used alternative. Of the many possible complications related to venous access in hemodialysis patients, catheter dysfunction is the most prevalent. We report a 23-year-old female hemodialysis patient in whom such malfunctioning was followed by echocardiography that revealed a large right atrial thrombus (RAT) in close contact to the tip of a long-term indwelling catheter in the presence of a patent foramen ovale. Although RAT is a rare complication in hemodialysis patients, it has very specific therapeutic implications. The present patient underwent a successful surgical atrial thrombectomy. Our experience underscores that in cases of malfunctioning catheter, echocardiographic screening is mandatory.
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ABSTRACT: To track the natural history of tunneled hemodialysis catheters requiring removal or exchange at a single institution. Over a 2-year period, tunneled hemodialysis catheters that presented to interventional radiology for removal or exchange were entered into this retrospective study. Patient demographics, catheter location, dwell time, and indication for removal were recorded. Pull-back contrast venography was performed with imaging over the chest. Catheters were then removed or exchanged. Three hundred thirty-four tunneled dialysis catheters were removed or exchanged in 207 patients; 108 male, median age 53 years. Dwell time, available from 296 catheters, ranged from 1 to 114 days (median, 66 days) for a total of 32,847 catheter days. One hundred three catheters were removed for infection, yielding a rate of infection requiring catheter removal of 3.0 per 1,000 catheter days. One hundred catheters were removed for other working access, and 96 catheters were exchanged for poor function. Two hundred sixty-five were removed or exchanged from the internal jugular vein, 22 from the subclavian vein, and 24 from the femoral vein. One hundred seventy-two (76%) of the 226 catheters studied with contrast had fibrin sheaths; of which 42 had thrombus identified along the catheter tract. One hundred ninety-three catheters were removed, and 141 catheters were exchanged for new catheters with 82 catheters receiving balloon disruption of the fibrin sheath. Approximately one third of tunneled dialysis catheters are removed for infection, one third for other working access, and one third for poor function. Catheters usually remain in the patient for a median of 2 months. Fibrin sheaths associated with hemodialysis catheters are very common. Thrombus formation around the sheath is frequent.Journal of Vascular and Interventional Radiology 03/2007; 18(2):227-35. · 2.00 Impact Factor
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ABSTRACT: Little is known about the potentially fatal complication of catheter-related right atrial thrombus (CRAT) in dialysis patients, and the optimal management is controversial. The aims of our study were to identify the prognostic factors of mortality in cases of CRAT in dialysis patients and to compare treatment options. Retrospective analysis of all reported cases of CRAT in adult dialysis patients, in English-language literature (PubMed search), in which therapy and outcome data were available. Up to December 2010, we identified 71 cases of CRAT in dialysis patients (including our patient). Overall mortality was 18.3% (13/71) and significant predictors were advanced age, presence of complications and non-removal of the catheter. Nine patients received no treatment, except for catheter removal and antibiotics, four of them died. Systemic thrombolysis was administered in eight patients but was successful only in two with pulmonary embolism, the remaining required further treatment. Finally, 37 patients received anticoagulation and 23 underwent surgical thrombectomy (one percutaneous intravascular removal of the thrombus). Mortality was 16.2% (6/37) and 13% (3/23), respectively, P=1. Regarding presence of various complications, no treatment choice was superior over the other. Five of the six patients who had a thrombus≥60 mm underwent successful surgical thrombectomy. We propose a management algorithm emphasizing the removal of the catheter and recommending anticoagulation as first-line treatment. Surgical thrombectomy is valuable when other treatments fail or in special circumstances. Thrombolysis has a poor success rate but may be useful in pulmonary embolism.Nephrology Dialysis Transplantation 12/2011; 27(7):2936-44. · 3.37 Impact Factor
- Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 12/2013; 17(6):638-640. · 1.53 Impact Factor