Thrombotic complications and tip position of transjugular chronic dialysis catheter scheduled into superior vena cava

Abstract

Background:Catheter-related thrombotic complications(TCs) can occur during the long term use of a chronic dialysis catheter (CDC), including fibrin sheath (FS), mural thrombosis (MT), venous thrombosis (VT), and intraluminal clots (IC), which has not been reported with MRI. The aim of our study was to evaluate the determination of catheter tip position (TP) and resolution of TCs in patients with transjugular CDC scheduled into the superior vena cava using high resolution magnetic resonance cholangiopancreatography (HR-MRCP) and T2-weighted imaging (HR-T2WI).Methods:The study protocol was approved by the local Research Ethics Committee. Informed consent was obtained from all patients. In total, 41 consecutively enrolled transjugular CDC patients with suspected catheter dysfunction were scanned with HRMRCP and HR-T2WI. The distance from the top to the tip of the catheter and the presence and nature of catheter TCs were assessed by 2 experienced radiologists. Chest x-ray was taken within 1 to 2 days and CDC was withdrawn within 3 to 10 days from those patients with TCs identified by HR-MRI.Results:A total of 38 subjects successfully underwent HR-MRI, including 13 normal and 25 with TCs (fibrin sheath [FS]: n = 21, mural thrombosis [MT]: n = 7, venous thrombosis [VT]: n = 3, intraluminal clots [IC]: n = 4). There was no significant difference between HR-MRCP and chest x-ray in catheter TP determination (P = .124). Normal catheter appeared as “double eyes” on HR-T2WI and “double tracks” on HR-MRCP. TCs appeared as follows: FS displayed as a “thin ring” (<1mm) around the catheter, MT as patchy hyperintensity and VT as a “thick ring” (>5mm) on HR-T2WI. Unilateral IC appeared as a “single eye” on HR-T2WI and a “single track” on HR-MRCP (n = 3). Bilateral IC appeared as neither “eye” nor “track” (n = 1). Catheter withdrawal confirmed FS (n = 16), MT (n = 6), VT (n = 1), and IC (n = 4).Conclusion:HR-MRCP and HR-T2WI are promising methods for visualizing TP and TCs in CDC patients, and are helpful in adjusting the treatment plan and avoiding the risk of pulmonary embolism.

Prevalência E Fatores Associados Para a Ocorrência De Eventos Adversos No Serviço De Hemodiálise

“…2,22 A study that evaluated transjugular catheter tips used in chronic dialysis by means of imaging tests, identified at least one thrombotic complication in 25 of the 38 study participants. 23 Another study conducted in China with 865 patients undergoing dialysis using catheters found that 56.65% of the sample had catheter dysfunction and 38.61% of the patients developed a catheter infection. 24 Problems with central venous catheters can be reduced by correct handling of the device.…”