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Large atrial thrombus formation associated with tunneled cuffed hemodialysis catheters

O Negulescu1, M Coco, J Croll

  • 1Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.

Clinical Nephrology
|February 8, 2003
PubMed

Insights

Large atrial thrombus (AT) is a serious complication of tunneled cuffed hemodialysis catheters (TCCs). Management strategies vary, with TCC removal and thrombectomy showing 0% mortality in this study.

Area of Science:

  • Nephrology
  • Cardiology
  • Vascular Surgery

Background:

  • Paucity of data exists on large atrial thrombus (AT) as a complication of tunneled cuffed hemodialysis catheters (TCCs).
  • Understanding risk factors, mortality, and management of TCC-associated AT is crucial for hemodialysis patients.

Purpose of the Study:

  • To determine the risk factors, mortality, and appropriate management strategies for TCC-associated atrial thrombus (TCC-AT).

Main Methods:

  • A literature search identified 16 previous cases of TCC-AT, combined with 6 new cases for a total of 22.
  • Demographic data were collected prospectively from 85 hemodialysis patients using TCCs for comparison.

Main Results:

  • TCC-AT diagnosis occurred at a mean of 4.5 months post-TCC insertion, with infection present in 68% of cases.
  • Mean thrombus size was 3.7 cm; management included TCC removal with thrombectomy (n=9), anticoagulation (n=6), or removal alone (n=5).
  • Overall mortality was 27%, with 83% of deaths occurring in patients with bacteremia. TCC removal and thrombectomy had 0% mortality.

Conclusions:

  • Atrial thrombus is a serious complication of TCC use in hemodialysis patients, associated with significant mortality.
  • TCC-AT may be more common than previously recognized, necessitating a high index of suspicion for early diagnosis and intervention.
Abstract

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