Dilek Melda, Kaya Coskun, Karatas Ahmet, Ozer Ismail, Arık Nurol, Gulel Okan
Department of Nephrology, Ondokuz Mayıs University School of Medicine , Samsun , Turkey .
Ren Fail. 2015 May;37(4):567-71. doi: 10.3109/0886022X.2015.1007461. Epub 2015 Feb 19.
Although guidelines recommend catheters as a last resort for establishing a vascular access in patients undergoing dialysis, they continue to be used widely for this purpose. Catheter-related atrial thrombus (CRAT) is rarely reported in this group of patients, and it can lead to serious complications. The aim of this study was to determine the incidence of CRAT in patients undergoing hemodialysis with permanent-tunneled catheters. A total of 50 patients undergoing hemodialysis with permanent catheters were included in this study. The diagnosis of CRAT was based on transthoracic echocardiography findings. Thrombus was present in nine patients (18%) and related to the tip of the catheter in all cases. Except for one patient with two foci of thrombus, all patients had a single focus. There were no significant associations between the development of thrombus and the duration of catheter use or the location of the catheter. Furthermore, catheter-related atrial thrombus did not appear to have a significant effect on mortality. The asymptomatic character of CRAT can be responsible for the low reporting rates, and its exact role in increased mortality and morbidity related with catheter use remains unknown. While planning management strategies, information on different options for vascular access routes and possible catheter-related complications should be provided to all patients who will undergo dialysis, together with a discussion involving other replacement alternatives for end-stage renal disease.
尽管指南建议将导管作为透析患者建立血管通路的最后手段，但它们仍被广泛用于此目的。导管相关性心房血栓（CRAT）在这类患者中很少被报道，并且它可能导致严重并发症。本研究的目的是确定使用永久性隧道导管进行血液透析的患者中CRAT的发生率。本研究共纳入了50例使用永久性导管进行血液透析的患者。CRAT的诊断基于经胸超声心动图检查结果。9例患者（18%）存在血栓，且所有病例的血栓均与导管尖端相关。除1例有两个血栓病灶的患者外，所有患者均有单个病灶。血栓形成与导管使用时间或导管位置之间无显著关联。此外，导管相关性心房血栓似乎对死亡率没有显著影响。CRAT的无症状特征可能是报告率低的原因，其在与导管使用相关的死亡率和发病率增加中的确切作用仍不清楚。在制定管理策略时，应向所有将接受透析的患者提供有关血管通路不同选择和可能的导管相关并发症的信息，并与他们讨论终末期肾病的其他替代治疗方案。
