Lalor Peter F, Sutter Francis
Department of Surgery, Lankenau Hospital, Wynnewood, Pennsylvania 19096, USA.
Curr Surg. 2006 May-Jun;63(3):186-9. doi: 10.1016/j.cursur.2005.08.011.
The placement of hemodialysis catheters are widely performed by vascular surgeons and surgical residents for use in both the hospital and the outpatient setting. Although long-term complications of this type of vascular access are relatively uncommon, an appreciation is warranted for the life-threatening complication of right atrial thrombus (RAT). Once recognized, medical or surgical management is mandatory to prevent further consequences from RAT. The optimal treatment for catheter-induced RAT is still controversial. Our case and review illustrates how the routine placement of a malpositioned hemodialysis catheter in a young man can lead to the serious complication of RAT that necessitated cardiac surgery after thrombolysis failed. We describe the successful surgical management of a hemodialysis catheter-induced RAT and suggest that in cases of large, mobile RATs with adherence to both atrial wall and catheter, suspicion or evidence of pulmonary embolus (PE), and low-risk surgical candidates, open thrombectomy may be an optimal and definitive treatment.
血管外科医生和外科住院医师广泛进行血液透析导管的置入操作，用于医院和门诊环境。尽管这种类型的血管通路的长期并发症相对不常见，但对于危及生命的右心房血栓（RAT）并发症仍需予以重视。一旦确诊，必须进行药物或手术治疗以防止RAT引发进一步后果。导管诱发的RAT的最佳治疗方法仍存在争议。我们的病例及综述表明，一名年轻男性常规置入位置不当的血液透析导管如何导致RAT这一严重并发症，在溶栓失败后需要进行心脏手术。我们描述了一例成功通过手术治疗血液透析导管诱发的RAT的病例，并建议对于大型、可移动且附着于心房壁和导管的RAT、存在肺栓塞（PE）的怀疑或证据以及手术风险较低的患者，开放性血栓切除术可能是一种最佳的确定性治疗方法。
