Hemodialysis Catheter Thrombi: Visualization and Quantification of Microstructures and Cellular Composition

Lucas, Thabata Coaglio; Tessarolo, Francesco; Veniero, P.; Caola, Iole; Piccoli, Federico; Haase, Andrea; Nollo, Giandomenico; Huebner, Rudolf; Brunori, Giuliano

doi:10.5301/jva.5000142

Cited by 10 publications

(15 citation statements)

References 29 publications

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“…Blood velocity and pressure fluctuations close to the catheter surface could cause a transition from a laminar to a turbulent flow regime and promote the onset of the blood clotting process with thrombus formation in the catheter holes. Microscopic structure and composition of venous thrombi have been previously reported , and we recently showed that blood thrombi formed in a hemodialysis CVC present a complex structure and are mainly composed of fibrin and erythrocytes . A fibrin sheath commonly develops within 24 h after CVC insertion at the region where the catheter contacts the vessel wall, and may completely enclose the proximal portion of the CVC in 5 to 7 days .…”

mentioning

confidence: 70%

“…The study was approved by the Ethics Committee Concerning Research Involving Human Subjects and Clinical Trials (Process 04/2010) of Trento, Italy. Samples were treated as previously reported . Briefly, CVCs were rinsed in sterile saline and fixed in 4% buffered formaldehyde immediately after removal from the patient.…”

Section: Methodsmentioning

confidence: 99%

“…Two photon laser scanning microscopy (TPLSM), an optical technique based on fluorescence induced by two photon absorption, has recently been proposed as an additional tool for characterizing blood thrombi in a fully hydrated state without the need to section the sample . Recently, we reported the potential of TPLSM in imaging the fibrin structure of thrombi in CVCs removed from patients . All these methods allow a thorough investigation of the local blood flow and dynamic conditions in relation to fibrin deposition and blood thrombus formation resulting from the CVC presence in the vein.…”

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confidence: 99%

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Blood Flow in Hemodialysis Catheters: A Numerical Simulation and Microscopic Analysis of In Vivo‐Formed Fibrin

et al. 2013

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Although catheters with side holes allow high flow rate during hemodialysis, they also induce flow disturbances and create a critical hemodynamic environment that can favor fibrin deposition and thrombus formation. This study compared the blood flow and analyzed the influence of shear stress and shear rate in fibrin deposition and thrombus formation in nontunneled hemodialysis catheters with unobstructed side holes (unobstructed device) or with some side holes obstructed by blood thrombi (obstructed device). Computational fluid dynamics (CFD) was performed to simulate realistic blood flow under laminar and turbulent conditions. The results from the numerical simulations were compared with the fibrin distribution and thrombus architecture data obtained from scanning electron microscopy (SEM) and two photons laser scanning microscopy (TPLSM) on human thrombus formed in catheters removed from patients. CFD showed that regions of flow eddies and separation were mainly found in the venous holes region. TPLSM characterization of thrombi and fibrin structure in patient samples showed fibrin formations in accordance with simulated flux dynamics. Under laminar flow conditions, the wall shear stress close to border holes increased from 87.3±0.2 Pa in the unobstructed device to 176.2±0.5 Pa in the obstructed one. Under turbulent flow conditions, the shear stress increased by 47% when comparing the obstructed to the unobstructed catheter. The shear rates were generally higher than 5000/s and therefore sufficient to induce fibrin deposition. This findings were supported by SEM data documenting a preferential fibrin arrangement on side hole walls.

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confidence: 70%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Blood Flow in Hemodialysis Catheters: A Numerical Simulation and Microscopic Analysis of In Vivo‐Formed Fibrin

et al. 2013

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“…The enumeration of the two features of interest was performed according to a protocol adapted from Lucas et al . (). A squared grid of 15 μ m element size was superimposed to each acquired image and the observation of each single cross‐point allowed to quantify the occurrence of hyphae or blastospores.…”

Section: Methodsmentioning

confidence: 97%

Inhibition ofCandida albicansadhesion on medical-grade silicone by aLactobacillus-derived biosurfactant

et al. 2015

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“…A set of 20 electron-micrographs per each sample was than obtained in the same point of interest at a magnification of 2000x. The composition of the thrombus was determined by performing a semiquantitative analysis of the SEM images, modifying the procedure previously proposed by Lucas et al (Lucas, 2013). Briefly, a squared grid of 10μm element size was superimposed to each SEM image to obtain a total of 400 point of interest per sample.…”

Section: Scanning Electron Microscopy and Compositional Analysismentioning

confidence: 99%

Assessing Composition of Coronary Thrombus in STEMI Patients - A Multiscale Approach to Charaterize Samples Obtained by Catheter Aspiration

Tessarolo

Bonomi

Piccoli³

et al. 2014

Proceedings of the 2nd International Congress on Cardiovascular Technologies

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Percutaneous catheter thrombectomy allows collecting coronary thrombi from patients with ST-segment elevation myocardial infarction, preserving most of the sample characteristics available for both visual assessment and compositional analysis. This study aimed at identifying the association between thrombus macroscopic aspect and composition and, secondly, correlations between composition and ischemic time. Aspirated thrombi were grouped into "white", "red" or "mixed" according to their macroscopic appearance. Platelets, RBCs and fibrin were quantified on thrombus surface by SEM and on thrombus sections by a modified Carstairs histochemical staining. Fifty-three samples from 51 patients were included. The median [inter-quartile range] ischemic time was 210 [190-265] min. Seven (13%) "white", 19(36%) "mixed" and 27(51%) "red" thrombi were macroscopically identified. Median thrombus composition assessed by SEM was 23[11-41]%, 43[26-62]%, and 24[11-37]% for platelets, RBCs and fibrin respectively. Median histological analysis was 10[5-26]%, 45[31-64]% and 30[18-49]% for the same components. Significant difference in composition were found between "white" and "red" thrombi, showing respectively a higher amount of platelets (p=0.003) and fibrin (p=0.007). No significant correlations were found between composition and ischemic time suggesting that plaque instability and thrombus formation can occur before the symptom onset.

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Hemodialysis Catheter Thrombi: Visualization and Quantification of Microstructures and Cellular Composition

Cited by 10 publications

References 29 publications

Blood Flow in Hemodialysis Catheters: A Numerical Simulation and Microscopic Analysis of In Vivo‐Formed Fibrin

Blood Flow in Hemodialysis Catheters: A Numerical Simulation and Microscopic Analysis of In Vivo‐Formed Fibrin

Inhibition ofCandida albicansadhesion on medical-grade silicone by aLactobacillus-derived biosurfactant

Assessing Composition of Coronary Thrombus in STEMI Patients - A Multiscale Approach to Charaterize Samples Obtained by Catheter Aspiration

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