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Catheter related atrial thrombosis in an infant: A case report and review of the literature. THROMBOSIS UPDATE 2020. [DOI: 10.1016/j.tru.2020.100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
INTRODUCTION Catheter-related right atrial thrombosis is an under-recognized complication of central venous catheter placement. We performed a retrospective review, characterizing clinical aspects of catheter-related right atrial thrombosis (CRAT). METHODS To identify cases, a literature search was conducted in PubMed and additional items selected by review of related items and bibliography review. Key clinical data were extracted and analyzed both in total and as stratified by hemodialysis versus non-hemodialysis groups. RESULTS A total of 68 catheter-related right atrial thrombosis events were reported in 63 patients (five recurrences, of which 4 involved catheter left in place following primary treatment). Median (interquartile range) time to CRAT diagnosis was longer among hemodialysis patients - 12 (4.0-24.0) weeks compared to 5.5 (1.8-16.1) weeks among non-hemodialysis patients. The most common presentations were asymptomatic in 16/68 (23.5%), fever/sepsis in 21/68 (30.9%), pulmonary embolism in 11/68 (16.2%), catheter dysfunction in 8/68 (11.8%), dyspnea in 8/68 (11.8%), and new murmur or valvular dysfunction in 8/68 (11.8%) patients. Primary treatment selection was anticoagulation in 33/68 (48.5%), surgical thrombectomy in 17/68 (25.0%), thrombolysis in 12/68 (17.6%), or no active therapy in 6/68 (8.8%) patients. Primary treatment failure for anticoagulation and thrombolysis was 27.3% and 33.3%, respectively. The most common rescue therapy was surgical thrombectomy, ultimately resulting in an overall rate of 26/62 (41.9%). Overall, per-patient mortality was 13/63 (20.6%). Intracardiac tip position - 27/34 (79.4%) - overshadowed thrombophilia - 16/63 (25.4%) - as a risk factor for CRAT. CONCLUSION Catheter-related right atrial thrombosis is an underdiagnosed complication of central venous catheter placement. For the hemodialysis population, a fistula-first approach is advocated. While many instances were asymptomatic, the development of unexplained fever, dyspnea, catheter dysfunction, or new murmur should trigger a search for this complication.
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Affiliation(s)
- Minh-Ha Tran
- Department of Pathology and Laboratory Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA.,Department of Internal Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Tanya Wilcox
- Department of Internal Medicine, School of Medicine, New York University, New York, NY, USA
| | - Phu N Tran
- Department of Hematology and Oncology, Genesis Cancer Center, Zanesville, OH, USA
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Management of tunneled-cuffed catheter-related right atrial thrombosis in hemodialysis patients. J Vasc Surg 2018; 68:1491-1498. [DOI: 10.1016/j.jvs.2018.02.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 02/20/2018] [Indexed: 11/20/2022]
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Premuzic V, Perkov D, Smiljanic R, Brunetta Gavranic B, Jelakovic B. The Different Impacts on the Long-Term Survival of Tunneled Internal Jugular Hemodialysis Catheters Based on Tip Position and Laterality. Blood Purif 2017; 43:315-320. [DOI: 10.1159/000454670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/21/2016] [Indexed: 11/19/2022]
Abstract
Background/Aims: The aim of this study was to examine the impact of different catheter tip positions on the life of the catheter, dysfunction, infection, and quality of hemodialysis and possible differences between the access site laterality in jugular-tunneled hemodialysis catheters. Methods: Catheters were evaluated for the following parameters: place of insertion, time of insertion, duration of use, and reason for removal. In all patients, the catheter tip position was checked using an X-ray. Results: The mean duration of implanted catheters with the tip placed in the cavo-atrial junction and right atrium was significantly longer. There were no differences in catheter functionality at follow-up or complications based on catheter laterality for each catheter tip position. Conclusion: According to our results, the localization of the catheter tip in superior vena cava still remains the least preferable method. Our results showed that the main factor responsible for better catheter functionality was not laterality but the depth to which the catheter tip is inserted into the body.
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Premuzic V, Smiljanic R, Perkov D, Gavranic BB, Tomasevic B, Jelakovic B. Complications of Permanent Hemodialysis Catheter Placement; Need for Better Pre-Implantation Algorithm? Ther Apher Dial 2016; 20:394-9. [PMID: 27020172 DOI: 10.1111/1744-9987.12397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/01/2015] [Accepted: 12/04/2015] [Indexed: 12/01/2022]
Abstract
There is a correlation between central venous cannulation and the development of central venous stenosis. Minor retrosternal vein lesions can be easily missed. Computerized tomographic (CT) venography is the diagnostic procedure of choice. The aim of this study was to examine the complications after catheter implantation in patients with prior permanent catheter placement and to evaluate present diagnostic procedures performed prior to choosing permanent access site in order to reduce possible complications after catheter placement. Complications of permanent CVC insertion in our department were analyzed between October 2011 and February 2015. We have implanted the Tesio twin catheter system and the Hickman Bard dual lumen catheter. All patients with prior permanent dialysis catheter were evaluated with color doppler, while patients with suspected central venous stenosis (CVS) or thrombosis were evaluated with phlebography or CT venography prior to catheter placement. One hundred and ninety-eight permanent dialysis catheters were placed (173 Tesio [87.4%] and 25 Hickman [12.6%]) in 163 patients. There were 125 patients (76.7%) with prior temporary catheter and 61 (48.8%) of them had more than one prior permanent catheter (1.92 catheter per person).There were 4/61 (6.5%) patients with catheter-related complications without prior phlebography and CT venography. Phlebography and CT venography were performed in 30 (24.0%) patients with suspected CVS/thrombosis and with dialysis vintage of 76.23 months (52.78-98.28). Phlebography and CT venography were more sensitive than color doppler in the detection of CVS/thrombosis in patients with prior permanent catheter placements (P < 0.001). Since this diagnostic algorithm was introduced prior to catheter placement there were no catheter insertion-related complications or dysfunctions (P < 0.001). All our procedures on patients with prior permanent catheters followed preliminary color doppler diagnostics. Nevertheless, in four cases, the vessel obstruction and abnormality led to catheter insertion-related complications. When phlebography and CT venography was performed before the procedure in patients with prior permanent catheters and one or more CVS or thrombosis, early and late catheter-related complications were avoided by careful selection of the least injured vein and planning of procedure. When planning a permanent dialysis catheter placement in patients with prior multiple CVC, phlebography and CT venography may be diagnostic procedures of choice for avoidance of early catheter dysfunction and CVC placement complications.
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Affiliation(s)
- Vedran Premuzic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, Zagreb, Croatia
| | - Ranko Smiljanic
- Department of Diagnostic and Interventional Radiology, Zagreb, Croatia
| | - Drazen Perkov
- Department of Diagnostic and Interventional Radiology, Zagreb, Croatia
| | | | - Boris Tomasevic
- Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Bojan Jelakovic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, Zagreb, Croatia
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Ohara K, Akimoto T, Miki T, Otani N, Sugase T, Masuda T, Murakami T, Imai T, Takeda SI, Ando Y, Muto S, Nagata D. Therapeutic Challenges to End-Stage Kidney Disease in a Patient with Tetralogy of Fallot. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2015; 8:97-100. [PMID: 26609249 PMCID: PMC4648563 DOI: 10.4137/ccrep.s32121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/21/2015] [Accepted: 09/27/2015] [Indexed: 11/18/2022]
Abstract
In this report, we describe the case of an end-stage kidney disease patient with tetralogy of Fallot (TOF). A 33-year-old female with TOF was admitted to our hospital with complaints of general fatigue and appetite loss probably due to uremic milieu. She was ultimately treated with peritoneal dialysis (PD) with a favorable clinical course. TOF patients with chronic kidney disease are not exceptional, although the currently available information regarding the association between TOF and renal failure severe enough to require dialysis treatment is limited. We also discuss the complex processes of how and why PD was selected as a mode of chronic renal replacement therapy in this case.
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Affiliation(s)
- Ken Ohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Takuya Miki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Naoko Otani
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Taro Sugase
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Takuya Murakami
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Toshimi Imai
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Shin-Ichi Takeda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Yasuhiro Ando
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Tochigi, Japan
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Adriano M, Mondim V, Cavaco R, Germano N, Nunes J, Bento L. Cardiac arrest every other day. Med Intensiva 2015; 39:320-2. [DOI: 10.1016/j.medin.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
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CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review. Int J Cardiovasc Imaging 2015; 31 Suppl 2:159-67. [PMID: 25651878 DOI: 10.1007/s10554-015-0610-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/29/2015] [Indexed: 12/12/2022]
Abstract
Cardiac complications with hematologic diseases are not uncommon but it is difficult to diagnose, due to non-specific clinical symptoms. Prompt recognition of these potentially fatal complications by cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI) may help to direct clinicians to specific treatments according to causes. Thrombosis is often related to central venous catheter use and is usually located at the catheter tip near the atrial wall. Differentiation of thrombosis from normal structure is possible with CT and, distinction of a thrombus from a tumor is possible on a delayed enhancement MRI with a long inversion time (500-600 ms). Granulocytic sarcoma of the heart is indicated by an infiltrative nature with involvement of whole layers of myocardium on CT and MRI. MRI with T2* mapping is useful in evaluating myocardial iron content in patients with hemochromatosis. Diffuse subendocardial enhancement is typically observed on delayed MRIs in patients with cardiac amyloidosis. T1 mapping is an emerging tool to diagnose amyloidosis. Myocardial abscess can occur due to an immunocompromised status. CT and MRI show loculated lesions with fluid density and concomitant rim-like contrast enhancement. Awareness of CT and MRI findings of cardiac complications of hematologic diseases can be helpful to physicians for clinical decision making and treatment.
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Aatif T, El Farouki MR, Mouaine N, Raissouni M. Catheter-related atrial thrombus in a patient on hemodialysis. Ther Apher Dial 2013; 17:638-40. [PMID: 24330560 DOI: 10.1111/1744-9987.12039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Taoufiq Aatif
- Department of Nephrology, Dialysis and Renal Transplantation, Military Hospital Mohammed V, Rabat, Morocco.
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Song YJ, Lee YK, Choi SR, Kim JH, Kim SW, Noh JW. Giant Right Atrial Thrombus associated with Tunneled Cuffed Hemodialysis Catheter: A Case of Successful Treatment with Thrombolytic Agent and Anticoagulant. KOSIN MEDICAL JOURNAL 2013. [DOI: 10.7180/kmj.2013.28.1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
There are a variety of tunneled cuffed hemodialysis catheter-related complications including infection, thrombus formation, and catheter dysfunction. Catheter-related thrombus in right atrium is a rare complication and treatment guideline for atrial thrombus does not exist. A 3.0×2.8 cm sized giant atrial thrombus was found in a 35-year-old female hemodialysis patient. She was treated with catheter removal, thrombolysis and anticoagulation therapy. Size of atrial thrombus was gradually decreased and left ventricular systolic function was clearly improved after treatment. We experienced and reported a case of giant right atrial thrombus associated with tunneled cuffed hemodialysis catheter that was successful treated with thrombolytic agent and anticoagulant.
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Stavroulopoulos A, Aresti V, Zounis C. Right atrial thrombi complicating haemodialysis catheters. A meta-analysis of reported cases and a proposal of a management algorithm. Nephrol Dial Transplant 2012; 27:2936-2944. [DOI: 10.1093/ndt/gfr739] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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[Atypical obstruction during a hemodialysis catheter replacement]. Nephrol Ther 2011; 7:188-90. [PMID: 21296633 DOI: 10.1016/j.nephro.2010.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 12/08/2010] [Accepted: 12/11/2010] [Indexed: 11/20/2022]
Abstract
We followed a 60-year-old woman in our department for a vascular chronic kidney disease. The peritoneal dialysis was stopped because of a Candida albicans catheter infection. As the patient refused the arterio-venous fistula creation, we have placed a central venous catheter (Medcomp 32cm). Because the instability of the cuff, we decided to remove and change it by another one (Quinton 40cm). The discovery of an important cylindrical calcification has complicated the manipulation requiring tranquility and agility. The finding of a massive calcification is uncommon and confirms the major risk of calcification in chronic kidney disease patients.
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Erkut B, Ates A, Dag O, Kaygin MA, Arslan S. Surgical removal of dialysis catheter related atrial thrombus. J Vasc Access 2010; 11:175-6. [PMID: 20574944 DOI: 10.1177/112972981001100220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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