Intimal Hyperplasia after Long-Term Venous Catheterization

Abstract

Objective: Intimal hyperplasia is a well-known consequence of arterial injury and arterialization in vein grafts. However, the subacute and chronic vein wall changes which occur after catheterization have not been well studied. In this animal study, intimal hyperplasia in the vein wall after catheterization was examined. Methods: A silicon catheter was placed in the anterior caval vein of 54 rats. After in situ fixation at scheduled intervals (1 day to 6 months), the pathologic changes in the vein wall were studied on semi-serial histology sections by means of light microscopy. Results: Three forms of intimal hyperplasia could be observed: plaque-like, papillary-like and incorporation of the mural part of the sleeve into the underlying vein wall. Although the appearance of each was different, their composition was identical. All were mainly composed of α-actin-positive cells and collagen localized above the internal elastin layer, and covered by endothelium if facing the lumen. The plaque-like and papillary-like forms were mainly localized in the anterior vena cava, while sleeve incorporation mainly occurred in the jugular vein. Plaque-like and papillary-like intimal hyperplasia could be seen together on the same slide, but these two forms were never seen together with sleeve incorporation. Conclusion: Intimal hyperplasia occurs after venous catheterization and is probably caused by chronic injury to the vein wall due to knocking and rubbing movements of the catheter against the wall.

A multiinstitutional review of central venous line complications: retained intravascular fragments

“…2). Other authors have made similar observations when studying the formation of these sheaths [10,11]. The extent of scar formation is reflected by the occurrence of calcification within the sheath as noted in several of our patients and has been noted by others [12].…”

Anticoagulant effect of low molecular weight heparin on central venous catheters in haemodialysis patients

“…In recent years, the number of patients undergoing haemodialysis has increased as the incidences of chronic diseases, such as diabetes and nephropathy, have risen among elderly patients [11,12]. In fact, one study showed that 54.80 % of people over 65 years of age undergo haemodialysis and that diabetic nephropathy is the leading cause for this procedure [13,14].…”

Catheter-Related Sheaths (CRS): Pathophysiology and Treatment Strategies

“…The development of the catheter-related sheath is postulated to begin with thrombus that develops after trauma associated with the catheter insertion procedure [3,21]. Local trauma occurs at the venotomy site.…”

“…Factors contributing to thrombus formation include disturbance of normal flow through the venous segment and stasis that occurs between the catheter and the vein wall. Other locations of trauma occur at foci of friction of the catheter against the vein wall or catheter tip impact against the vein wall and in segments where catheters lie in acute angles within the course of the vein [20,21]. In addition, acute or chronic (organized) thrombus has been confirmed in catheter stripping specimens [13].…”