Related Experiment Videos
Thrombosis caused by polyurethane double-lumen subclavian superior vena cava catheter and hemodialysis
M Wanscher1, J J Frifelt, C Smith-Sivertsen
1Department of Anesthesia, Odense University Hospital, Denmark.
Insights
Subclavian catheters for hemodialysis are linked to thrombosis, especially with longer use. Phlebography is recommended before creating arteriovenous fistulas on the same side to prevent complications.
Area of Science:
- Nephrology
- Vascular Surgery
Background:
- Subclavian catheters are commonly used for hemodialysis access.
- Complications associated with these catheters, such as thrombosis, require careful evaluation.
Purpose of the Study:
- To investigate the incidence of thrombosis in patients undergoing hemodialysis with subclavian catheters.
- To identify risk factors for catheter-related thrombosis.
- To assess the utility of phlebography prior to arteriovenous fistula creation.
Main Methods:
- Retrospective analysis of 82 patients undergoing hemodialysis with 91 polyurethane double-lumen subclavian catheters over 18 months.
- Venography and autopsy were used to detect thrombosis.
- Statistical analysis to correlate catheter duration and thrombosis.
Main Results:
- Overall thrombosis incidence was 23%.
- Catheter duration was significantly longer in patients with thrombosis (p < .01).
- No significant difference in thrombosis frequency between genders.
- Two cases of subclavian vein occlusion occurred after arteriovenous fistula creation.
Conclusions:
- Longer hemodialysis catheter duration increases the risk of thrombosis.
- Phlebography is recommended before creating an arteriovenous fistula on the same side as a previous catheter to rule out thrombosis.
- No clinical pulmonary embolism was observed.
Abstract:
During an 18-month period, 82 consecutive patients (37 women and 45 men), with a mean age of 50 yr (range 15 to 74), underwent hemodialysis with 91 polyurethane double-lumen subclavian superior vena cava catheters inserted via the right subclavian vein. Upon catheter removal, venograms were performed in 53 which revealed thrombosis in 13. Autopsy performed in 13 other patients revealed thrombosis in three. Mean catheter duration was 27 days (range 1 to 138). Catheter duration was significantly (p less than .01) longer in the 16 cases complicated by thrombosis. There was no significant difference in the frequency of thrombosis between men and women. Two patients developed symptoms of subclavian vein occlusion after the creation of an arteriovenous fistula on the same side as a previous hemodialysis catheter. Overall, thrombosis was found in 23% and increased with longer catheter duration. We recommend phlebography to exclude thrombosis before creating an arteriovenous fistula on the same side as the previous hemodialysis catheter. There was no case of clinical discernible pulmonary embolism.