Coan Kathryn E, O'Donnell Mark E, Fankhauser Grant T, Bodnar Zachary, Chandrasekaran Krishnaswamy, Stone William M
Division of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ 85054, USA.
Vasc Endovascular Surg. 2013 May;47(4):317-9. doi: 10.1177/1538574413484973. Epub 2013 Apr 8.
We present a 33-year-old dialysis-dependent female who presented with new onset split second heart sound. Following a failed left upper extremity dialysis fistula, a right upper extremity hemodialysis reliable outflow (HeRO) graft was performed in 2011. Her subsequent cadaveric renal transplant had delayed function necessitating concurrent use of hemodialysis. However, as renal function improved, hemodialysis was discontinued. Two weeks following transplantation, the HeRO graft occluded. Subsequent clinical and radiological assessment confirmed widespread pulmonary emboli. Following cessation of hemodialysis and subsequent HeRO graft occlusion, removal was deemed appropriate to reduce further thromboembolic phenomenon. Right atrial thrombi are complications associated with central venous catheters. However, their actual incidence varies significantly. Right heart thromboemboli are associated with a 4% to 6% pulmonary embolism rate. Katzman et al assessed 38 patients who underwent HeRO graft and reported 1 (2.6%) patient with right atrial emboli and likely pulmonary embolism. Although thrombotic complications remain rare, consideration of graft removal should always be evaluated particularly in the absence of an alternative thrombotic source.
我们报告一名33岁依赖透析的女性，她出现了新的第二心音分裂。2011年，其左上肢透析动静脉内瘘失败后，进行了右上肢血液透析可靠流出道（HeRO）移植物手术。她随后接受的尸体肾移植功能延迟，需要同时进行血液透析。然而，随着肾功能改善，血液透析停止。移植后两周，HeRO移植物闭塞。随后的临床和影像学评估证实存在广泛的肺栓塞。在停止血液透析及随后HeRO移植物闭塞后，认为移除移植物以减少进一步的血栓栓塞现象是合适的。右心房血栓是与中心静脉导管相关的并发症。然而，其实际发生率差异很大。右心血栓栓塞与4%至6%的肺栓塞发生率相关。Katzman等人评估了38例接受HeRO移植物手术的患者，报告1例（2.6%）患者出现右心房栓子并可能发生肺栓塞。尽管血栓形成并发症仍然少见，但尤其在没有其他血栓形成来源的情况下，应始终评估是否考虑移除移植物。
