Massive catheter‐related thrombosis of vena cava superior protruding into the right atrium in a hemodialysis patient

Mach, Lukáš; Ondrůšková, Olga; Němec, Petr; Orban, Marek

doi:10.1111/hdi.12261

Cited by 4 publications

(4 citation statements)

References 7 publications

(8 reference statements)

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“…(17) There are several published recommendations supporting the use of surgery for large and/or mobile thrombi. (4,15,16) We have, however, demonstrated very poor surgical outcomes in all three operated cases in our series. This is unlikely to be due to poor patient selection, as all three had under 10% surgical risk estimated using EUROSCORE II and documented clearance of bacteraemia preoperatively.…”

Section: Discussionmentioning

confidence: 53%

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Contemporary management and outcomes of infective tunnelled haemodialysis catheter-related right atrial thrombi: a case series and literature review

Yew

Leong

2020

smedj

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We identified 14 cases of infective haemodialysis CRAT, and their characteristics are summarised in Table I. The median age of the patients was 59 (range 47-88) years and 11 (78.6%) INTRODUCTION Infective haemodialysis catheter-related right atrial thrombus (CRAT) is a complication of tunnelled catheter use. Management recommendations are based mainly on published case series prior to 2011. We report our institution's recent experience in managing infective haemodialysis CRAT and correlate treatment with outcomes. METHODSWe conducted a retrospective analysis of haemodialysis CRAT cases diagnosed on transthoracic echocardiography between 1 January 2011 and 31 December 2017. Clinical outcomes, including mortality at 180 days post diagnosis and thrombus resolution, were traced from electronic medical records. RESULTSThere were 14 cases identified. The median age was 59 (range 47-88) years and 11 (78.6%) were male. Sepsis was the most common reason for hospitalisation (71.4%). Blood cultures identified Staphylococcus aureus in seven cases, of which two were methicillin-resistant. Three had coagulase-negative Staphylococcus. All cases received antibiotics with infectious disease physician input. Seven were treated with catheter removal alone, of which three died within 180 days. Both cases treated with catheter removal plus anticoagulation survived at 180 days. Of the two cases who had anticoagulation without catheter removal, one died within 180 days and the other did not have thrombus resolution. Three underwent surgical thrombus removal, of which two died postoperatively and the last required repeated operations and prolonged hospitalisation. Mortality at 180 days post diagnosis was 42.9%.CONCLUSION Catheter removal and anticoagulation are modestly effective. Surgery is associated with poor outcomes. Despite contemporary management, infective haemodialysis CRAT still results in high mortality. Prospective studies are needed to identify the optimal management.

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Section: Discussionmentioning

confidence: 53%

“…(12) Data on infective CRAT published from 2011 and beyond is limited only to isolated case reports. (2,(13)(14)(15)(16) Catheter removal is strongly recommended as part of the initial treatment strategy and has been found to influence mortality. (11) In our series, catheter removal alone appears to be modestly effective.…”

Section: Discussionmentioning

confidence: 99%

Contemporary management and outcomes of infective tunnelled haemodialysis catheter-related right atrial thrombi: a case series and literature review

Yew

Leong

2020

smedj

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“…Our search produced a total of eight case series encompassing 32 cases and 32 additional individual case reports. 7–46 Same-patient CRAT recurrences were described in five reports 9,13,14,19,24 for a total of 68 cases of CRAT among 63 patients. Table 1 provides demographic details.…”

Section: Resultsmentioning

confidence: 98%

Catheter-related right atrial thrombosis

2019

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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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“…Not many data on VCS syndrome post-central venous catheter are available. Previous case reports describe either development of acute VCS syndrome during presence of a catheter [ 15 , 16 ] or short after its removal (2006 [ 17 ]: VCS syndrome 2 weeks after catheter extraction). To the best of our knowledge, this is the first case report describing occurrence of VCS syndrome several years after catheter removal.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Vena Cava Superior Syndrome Six Years after Central Venous Catheter Removal in a Patient on Hemodialysis

Janssen

Logtenberg

2022

Case Rep Nephrol Dial

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Vena cava superior (VCS) syndrome is rarely seen as a complication of central-venous-catheter placement. Usually, the syndrome appears when the presence of the catheter causes intraluminal obstruction or thrombosis. In this case report, however, we describe a patient on intermittent hemodialysis who had been free of any venous central line for over 6 years, presented with a VCS syndrome. The CT scan showed an absent VCS without extravascular compression. Previous catheter placement was diagnosed as the case of the VCS syndrome. It is important to realize that VCS syndrome can occur late after removal of central venous catheters, and thus, clinicians should be aware of its symptoms in any patient who has had an upper central line in the past medical history.

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Massive catheter‐related thrombosis of vena cava superior protruding into the right atrium in a hemodialysis patient

Cited by 4 publications

References 7 publications

Contemporary management and outcomes of infective tunnelled haemodialysis catheter-related right atrial thrombi: a case series and literature review

Contemporary management and outcomes of infective tunnelled haemodialysis catheter-related right atrial thrombi: a case series and literature review

Catheter-related right atrial thrombosis

Vena Cava Superior Syndrome Six Years after Central Venous Catheter Removal in a Patient on Hemodialysis

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