1
|
Asymptomatic pulmonary thromboembolism due to hemodialisys catheter thrombosis: case series and literature review. CEN Case Rep 2022. [PMID: 36574198 PMCID: PMC10393924 DOI: 10.1007/s13730-022-00757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Right atrial thrombus is commonly associated to catheters. Catheter-related right atrial thrombus (CRAT) in hemodialysis patients frequently presents as pulmonary embolism. Although CRAT is sometimes asymptomatic, even in these cases it is associated with worse prognosis. The management strategy for CRAT is not well established, however, along with catheter removal, anticoagulation, thrombolysis, and surgical thrombectomy may be performed. Suspicion of asymptomatic pulmonary embolism associated to CRAT is important in order to perform proper treatment. The authors of this article report two cases of asymptomatic pulmonary thromboembolism due to CRAT in hemodialysis patients and perform a review of the literature.
Collapse
|
2
|
Singh A, Shrestha BK, Mehta Y, Trehan N. Permanent dialysis catheter-related right atrial mass: A case report. J Anaesthesiol Clin Pharmacol 2020; 36:280-282. [PMID: 33013056 PMCID: PMC7480300 DOI: 10.4103/joacp.joacp_130_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/28/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ajmer Singh
- Division of Cardiac Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Battu K Shrestha
- Division of Cardiac Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Division of Cardiac Anaesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Naresh Trehan
- Division of Cardiac Surgery, Medanta-The Medicity, Gurugram, Haryana, India
| |
Collapse
|
3
|
Surgical Management of Right Atrial Mass Associated with a Vascular Access Catheter. Case Rep Cardiol 2020; 2020:4590147. [PMID: 32577314 PMCID: PMC7305527 DOI: 10.1155/2020/4590147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/10/2020] [Accepted: 05/25/2020] [Indexed: 11/21/2022] Open
Abstract
Atrial masses are an uncommon but serious clinical problem. The authors report a case of an atrial mass associated with a tunnelled vascular access catheter in an immunosuppressed haemodialysis patient. In the setting of immunosuppression with fevers, a broad differential for the atrial mass was considered. Multidisciplinary team review was pursued to guide management decisions. Ultimately, surgical excision of the mass was pursued with an excellent result. The causes and management of this complex clinical scenario are discussed.
Collapse
|
4
|
Rossi L, Covella B, Libutti P, Teutonico A, Casucci F, Lomonte C. How to manage catheter-related right atrial thrombosis: Our conservative approach. J Vasc Access 2020; 22:480-484. [PMID: 32410490 DOI: 10.1177/1129729820922703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Catheter-related right atrial thrombosis is an underestimated, severe, and life-threatening complication of any type of central venous catheters. No clear-cut epidemiological data are available. Catheter-related right atrial thrombosis is often asymptomatic; however, it can lead to serious complications and death. CASE SERIES We report seven catheter-related right atrial thrombosis events occurred in five hemodialysis patients; two recurrences following primary treatment are included in the report, all of them managed with a conservative approach without catheter removal. Systemic anticoagulation (vitamin K antagonists), having a well-defined target of International Normalized Ratio of 2.5-3.0, combined with urokinase as a locking solution at the end of each hemodialysis session were the therapeutic strategy used in all patients. After the first month, the anticoagulation target was reduced to an International Normalized Ratio value of 1.5-2.0 and urokinase to a weekly administration. After sixth months, when no thrombus was identified at transthoracic echocardiographic examinations, the treatment was stopped. No bleeding complications were reported. CONCLUSION The combination therapy here described is safe, quick, and effective, achieving the goal of not removing catheters.
Collapse
Affiliation(s)
- Luigi Rossi
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| | - Bianca Covella
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| | - Pasquale Libutti
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| | - Annalisa Teutonico
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| | - Francesco Casucci
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| | - Carlo Lomonte
- Department of Nephrology, "F.Miulli" General Hospital, Acquaviva delle Fonti, Italy
| |
Collapse
|
5
|
Whalen H, Dako F, Patel P, Sahbaz J, Hong-Zohlman S, White CS, Jeudy J. Role of Imaging for Suspected Cardiac Thrombus. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:81. [PMID: 31820132 DOI: 10.1007/s11936-019-0792-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Cardiac thrombus formation is a frequent complication of a variety of prevalent diseases. Embolism of cardiac thrombus has the potential to result in significant morbidity and mortality from cerebrovascular and peripheral vascular events. RECENT FINDINGS Echocardiography is the most commonly used imaging modality for diagnosing intracardiac thrombus. However, technological advances in computed tomography and magnetic resonance imaging have allowed newer noninvasive modalities to evolve into robust tools for the clinical evaluation of patients suspected of disease. Complimentary use of these imaging techniques is crucial in the diagnosis of cardiac thrombus and initiation of anticoagulation therapy.
Collapse
Affiliation(s)
- Hallie Whalen
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Farouk Dako
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21210, USA
| | - Pratik Patel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21210, USA
| | - Jasmin Sahbaz
- Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Susie Hong-Zohlman
- Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Charles S White
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21210, USA
| | - Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21210, USA.
| |
Collapse
|
6
|
Kakareko K, Rydzewska-Rosolowska A, Czajkowska K, Lukasiewicz A, Hryszko T. How to get rid of the bug in the heart-An infected catheter-associated thrombus treated successfully with antibiotics only. Hemodial Int 2019; 23:E125-E126. [PMID: 31568633 DOI: 10.1111/hdi.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/15/2019] [Indexed: 11/29/2022]
Abstract
We present a case of a 53-year-old woman with end-stage renal disease, on hemodialysis for 4 years, who was diagnosed with an infected catheter-associated right atrial thrombus (CRAT). CRAT is an underreported and potentially life-threating complication of a central venous catheter and usually warrants a surgical approach. The patient was, however, disqualified by cardiac surgeons due to her overall poor condition. We used a combination of anticoagulation and antibiotics in the reported case as "rescue therapy" and showed that the successful resolution of CRAT complicated by infection might sometimes be feasible with pharmacological treatment only.
Collapse
Affiliation(s)
- Katarzyna Kakareko
- II Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Alicja Rydzewska-Rosolowska
- II Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Czajkowska
- II Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Adam Lukasiewicz
- Department of Radiology, Medical University of Bialystok, Bialystok, Poland
| | - Tomasz Hryszko
- II Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
7
|
Jeung S, Kang SM, Seo Y, Yu H, Baek CH, Kim H, Yang WS, Park SK. A Case Series of Asymptomatic Hemodialysis Catheter-Related Right Atrial Thrombi That Are Incidentally Detected Prior to Kidney Transplantation. Transplant Proc 2018; 50:3172-3180. [PMID: 30503665 DOI: 10.1016/j.transproceed.2018.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
Abstract
A hemodialysis (HD) catheter-related right atrial thrombus (RAT) is rarely encountered prior to kidney transplantation (KT) but necessitates a decision about whether to anticoagulate and/or delay the surgery. There is controversy surrounding the clinical implications of a RAT in this situation. It is sometimes considered fatal but other opinions consider it to be benign, especially when incidentally detected. We reviewed the clinical characteristics, management, and outcomes of a patient series with HD catheter-related RAT detected prior to KT and speculated on its clinical significance. Among 3677 cases of KT performed on 3607 patients between January 1997 and September 2015 in our single tertiary center, 11 cases of HD catheter-related RAT detected on transthoracic echocardiography (TTE) prior to KT were included for analysis. The average maximal diameter of the RAT was 23.2 ± 16.3 (SD in mm) and 9 (81.8%) of these 11 patients had no symptoms associated with the RAT. Four patients (36.3%) had their catheters replaced, 5 patients (45.5%) had their catheters removed, and the catheters were maintained in the remaining 2 patients (18.2%). Six patients (54.5%) were anticoagulated with either heparin or warfarin. However all 11 patients had a successful KT suggesting that a HD catheter-related RAT incidentally detected prior to this surgery may not be as serious as previously considered and should not be a reason for delaying the transplantation.
Collapse
Affiliation(s)
- S Jeung
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-M Kang
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y Seo
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H Yu
- Division of Nephrology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - C H Baek
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - W S Yang
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-K Park
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
8
|
Rossi L, Libutti P, Casucci F, Lisi P, Teutonico A, Basile C, Lomonte C. Is the removal of a central venous catheter always necessary in the context of catheter-related right atrial thrombosis? J Vasc Access 2018; 20:98-101. [DOI: 10.1177/1129729818774438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Catheter-related right atrial thrombosis is a severe and life-threatening complication of central venous catheters in both adult and young patients. Catheter-related right atrial thrombosis can occur with any type of central venous catheters, utilized either for hemodialysis or infusion. Up to 30% of patients with central venous catheter are estimated to be affected by catheter-related right atrial thrombosis; however, neither precise epidemiological data nor guidelines regarding medical or surgical treatment are available. This complication seems to be closely associated with positioning of the catheter tip in the atrium, whereas it is unlikely with a tip located within superior vena cava. Herein, we report the case of a patient affected by catheter-related right atrial thrombosis, who showed a quick resolution of thrombosis with a new therapeutic scheme combining loco-regional thrombolytic therapy (urokinase as a locking solution) and systemic anticoagulation therapy (vitamin K antagonists), thus avoiding catheter removal. Neither complications of the combination therapy were reported, nor recurrence of catheter-related right atrial thrombosis occurred. In conclusion, the combination therapy here described was safe, quick and effective, achieving the goal of not removing the catheter.
Collapse
Affiliation(s)
- Luigi Rossi
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Pasquale Libutti
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Francesco Casucci
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Piero Lisi
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Annalisa Teutonico
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Carlo Basile
- Clinical Research Branch, Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Carlo Lomonte
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| |
Collapse
|
9
|
Hemodialysis tunneled-cuffed catheter-related atrial thrombus complicated with asymptomatic pulmonary emboli. J Vasc Access 2017; 19:197-198. [PMID: 29147998 DOI: 10.5301/jva.5000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
10
|
Zayed MA, De Silva GS, Ramaswamy RS, Sanchez LA. Management of Cavoatrial Deep Venous Thrombosis: Incorporating New Strategies. Semin Intervent Radiol 2017; 34:25-34. [PMID: 28265127 DOI: 10.1055/s-0036-1597761] [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] [Indexed: 10/20/2022]
Abstract
Cavoatrial deep venous thrombosis (DVT) is diagnosed with increasing prevalence. It can be managed medically with anticoagulation or with directed interventions aimed to efficiently reduce the thrombus burden within the target venous segment. The type of management chosen depends greatly on the etiology and chronicity of the thrombosis, existing patient comorbidities, and the patient's tolerance to anticoagulants and thrombolytic agents. In addition to traditional percutaneous catheter-based pharmacomechanical thrombolysis, other catheter-based suction thrombectomy techniques have emerged in recent years. Each therapeutic modality requires operator expertise and a coordinated care paradigm to facilitate successful outcomes. Open surgical thrombectomy is alternatively reserved for specific patient conditions, including intolerance of anticoagulation, failed catheter-based interventions, or acute emergencies.
Collapse
Affiliation(s)
- Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri
| | - Gayan S De Silva
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Raja S Ramaswamy
- Interventional Radiology Section, Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - Luis A Sanchez
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
11
|
Investigation of the knowledge and attitudes of patients who are undergoing hemodialysis treatment regarding their arteriovenous fistula. J Vasc Access 2016; 18:64-68. [DOI: 10.5301/jva.5000618] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 01/01/2023] Open
Abstract
Purpose The major cause of morbidity in hemodialysis patients is arteriovenous fistula deficiency. The patient should have adequate knowledge to ensure arteriovenous fistula patency. Our aim is to investigate the knowledge and attitude of the patients undergoing hemodialysis treatment regarding arteriovenous fistula. Methods This study was conducted on 335 patients who met the study criteria. Data collection forms evaluating the “Socio-Demographic and Medical Characteristics” and “Knowledge and Attitudes about arteriovenous fistula” of the patients were developed following a literature review by the investigators. Results The rules most known and implemented were “to not measure blood pressure” and “to not draw blood from arms with fistula”, while the least known and implemented were “to use blood vessels on the hands in arms without fistula for intravenous intervention” and “to know which situations cause hypotension”. Conclusions Hemodialysis patients with arteriovenous fistulas need to know that developing self-care behavior is a means to reconcile lifestyles with current health status. Accordingly, planned training in self-care should be provided to hemodialysis patients and their families, and nurses should repeat information to patients who demonstrate a lack of knowledge.
Collapse
|