Thrombectomy reduces the systemic complications in device-related right atrial septic thrombosis

Sontineni, Siva P.; White, Michael; Singh, Somendra Pal; Arouni, Amy; Cloutier, David; Nair, Chandra K.; Mohiuddin, Syed M.

doi:10.1016/s0828-282x(09)70482-9

Cited by 9 publications

(13 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…The 13 cases 11,12,14,15,24,26 (three cases), 30,31,38,40,46 in which thrombolysis was applied are summarized in Table 4. Thrombolysis was carried out with recombinant tissue plasminogen activator (rTPA) in 7/14 (50.0%) cases, and the overall success rate was 8/14 (57.1%).…”

Section: Resultsmentioning

confidence: 99%

“…Per-case and per-patient mortality rates in our series were 19.1% and 20.6%, respectively, similar to previously reported rates of 18.3%–25%. 7,40…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Catheter-related right atrial thrombosis

2019

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Catheter-related right atrial thrombosis

2019

View full text Add to dashboard Cite

show abstract

“…According to case reports, it particularly occurs in patients with an indwelling central venous catheter (3)(4)(5), during puerperal fever (6) and in association with long-term IV drug abuse (4,7). In the presence of catheter sepsis, the catheter should be immediately removed or switched to another access point (3)(4)(5).…”

Section: Discussionmentioning

confidence: 99%

A rare case of septic thrombosis in the inferior vena cava with embolism

Regeniter¹,

Burkert²,

Majewski³

et al. 2016

Phlebologie

View full text Add to dashboard Cite

SummaryThis paper presents the case of a 61-year-old female patient who complained about exhaustion and fever during curative therapy, a few weeks after hysterectomie and adnexectomy. Antibiotic therapy could only improve these symptoms though only in the short term. Additionally, a venous port, which had been implanted for the purpose of cytoreduction chemotherapy, was suspected of a catheter infection and was removed. However, this did not lead to a substantial improvement of the patient’s general state of health, but ultimately triggered a sepsis, making necessary treatment in intensive care unit. At this stage, the detailed search for the focus of the infection led to the discovery of an infected thrombosis of the inferior vena cava with bilateral septic pulmonal embolisms and with an abscess. Thus, the source of sepsis had to be removed by surgery, a transfemoral thrombectomy was performed and an inguinal arteriovenous fistula was created. The further course of the disease was without complications; the patient could be released into ambulant treatment 24 days after the surgery. The elective sealing of the arteriovenous fistula was carried out 11 months later. In the follow- up, there were no hints for infection; the deep venous system in particular did not indicate any new thrombosis or of residual thrombi, with the tumor follow-up-care showing a complete remission.

show abstract

“…1 However, the substantial complication rate associated with this strategy has led several authors to recommend a surgical approach if the sepsis is refractory to this conservative treatment. 1,10 The surgical management of septic thrombophlebitis consists of various treatment modalities. 1 Surgical thrombectomy can safely remove the source of embolization and the patency of the vein is re-established in many cases.…”

Section: Discussionmentioning

confidence: 99%