How to manage catheter-related right atrial thrombosis: Our conservative approach

Suction thrombectomy of catheter-associated right atrial thrombus in two patients

Catheter associated right atrial thrombus (CRAT) is an uncommon but potentially life-threatening condition. There are no established guidelines for management, and treatment ranges from systemic anticoagulation and thrombolysis to open surgery. While there have been reports on use of suction thrombectomy for right atrial thrombi, the feasibility and outcomes of suction thrombectomy in CRAT have not been described. These two cases describe a successful off-label use of two devices (Triever 20, Inari Medical, Irvine, CA, and AlphaVac, AngioDynamics, Latham, NY) for thrombectomy in CRAT. Both patients had near complete extraction of chronic appearing thrombus, with follow up imaging demonstrating complete resolution. Suction thrombectomy may have a unique role in management in CRAT, especially in cases of infected thrombi. A formal exemption from the institutional review board was obtained for publication.

Systemic thrombolysis and anticoagulation therapy for catheter-related right atrial thrombosis caused by TIVAP: A case report and review of the literature

INTRODUCTION

As an under-reported, severe, and life-threatening complication, catheter-related right atrial thrombosis (CRAT) can appear at any age with any type of central venous catheter (CVC). However, most reports are limited to hemodialysis patients with CVC. Totally implantable venous access port (TIVAP) is widely used for the infusion of high-concentration chemotherapeutic drugs in cancer patients. However, these catheters may cause CRAT.

CASE DESCRIPTION

A 27-year-old female patient with TIVAP was referred for neoadjuvant chemotherapy because of breast cancer. At 60 days after TIVAP implantation, routine transthoracic ultrasound examination confirmed a mass of 3.4 × 2.5 cm in the right atrium (RA). The mass was attached to the atrial wall and close to the catheter tip. Initially, we chose systemic anticoagulation therapy, but it failed. Subsequently, we decided to adopt a combination of systemic thrombolysis and anticoagulation therapy via a cubital vein. After 9 days of treatment, the thrombus disappeared, and the TIVAP was eventually removed.

CONCLUSIONS

Systemic thrombolysis and anticoagulation therapy seemed to be safe and effective for asymptomatic patients who had TIVAP-induced CRAT. We should position the catheter tip at the junction of the Superior Vena Cava with the Right Atrium during the implantation procedure in cancer patients undergoing chemotherapy.