Hemodialysis catheter thrombi: visualization and quantification of microstructures and cellular composition

Area of Science:

• Nephrology
• Biomaterials Science
• Medical Imaging

Background:

• Central venous catheters (CVCs) are essential for hemodialysis but their role in thrombus formation is not fully understood.
• Thrombus development within CVCs can impede treatment efficacy and lead to complications.

Purpose of the Study:

• To develop and validate novel methods for analyzing the micromorphology and composition of thrombi found in hemodialysis CVCs.
• To investigate thrombi from both tunneled and non-tunneled CVCs removed from patients.

Main Methods:

• Collected 29 CVCs from hemodialysis patients.
• Quantified intra-luminal thrombus micromorphology using scanning electron microscopy (SEM).
• Visualized thrombus structures using two-photon laser scanning microscopy (TPLSM).

Main Results:

• SEM analysis indicated fibrin plaque (42.6%) and fibrin network (16.3%) were the most abundant components in the thrombus surface layer.
• Platelets (9.3%), erythrocytes (10.3%), and white blood cells (1.7%) were also present in the surface layer.
• TPLSM revealed that sub-surface thrombus layers contained less fibrin and platelets but more blood cells.

Conclusions:

• The combined use of SEM and TPLSM provides an effective approach for characterizing hemodialysis CVC thrombi.
• The presented protocols and techniques can aid in developing strategies to mitigate CVC-associated thrombus formation.
• Understanding thrombus composition is crucial for improving vascular access management in hemodialysis.