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一名终末期肾病患者出现不可取出的血液透析导管的罕见病例。

An unusual case of an irretrievable hemodialysis catheter in a patient with end stage renal disease.

作者信息

Ghahremani-Ghajar Mehrdad, Jin Anna, Borghei Peyman, Chen Joline L T

机构信息

Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, Orange, USA.

Nephrology Section, Medical Health Care Group, Tibor Rubin Veteran Affairs Medical Center, Long Beach Veteran Affairs Healthcare System, Long Beach, California, USA.

出版信息

Hemodial Int. 2018 Jan;22(1):E1-E5. doi: 10.1111/hdi.12584. Epub 2017 Aug 30.

Abstract

Hemodialysis catheters are associated with higher risks of complications compared to arteriovenous fistulas and grafts. Some common complications of dialysis catheters include infection, thrombus formation, central venous stenosis, and mechanical dysfunction. Rarely, catheters can become firmly adhered to a vessel wall. Catheter adhesion is a serious complication that can impact the delivery of safe and effective dialysis to affected patients. Adherent catheters commonly present insidiously with no overt diagnostic signs and symptoms or antecedent catheter malfunction. Prognosis is variable, but can be potentially fatal depending on the severity of adhesion, and sequelae of complications. There are no standardized methods of therapy and treatment strategies are anecdotally reported by interventional radiology, vascular, and cardiothoracic surgery. We hereby describe a case of hemodialysis catheter that has become firmly embedded within the superior vena cava wall. We review the available literature on the epidemiology, risk factors, long-term sequelae, and known management strategies of adherent catheters. The development of preventative measures will be of great importance given serious complications and limited treatment options. Clinical awareness and understanding of this rare condition is imperative to the prevention and management of adherent catheters.

摘要

与动静脉内瘘和移植物相比,血液透析导管相关并发症的风险更高。透析导管的一些常见并发症包括感染、血栓形成、中心静脉狭窄和机械功能障碍。导管很少会牢固地附着在血管壁上。导管粘连是一种严重的并发症,会影响向受影响患者提供安全有效的透析治疗。粘连的导管通常隐匿出现,没有明显的诊断体征和症状,也没有先前的导管故障。预后各不相同,但根据粘连的严重程度和并发症的后遗症,可能会有潜在的致命风险。目前尚无标准化的治疗方法,介入放射学、血管外科和心胸外科有一些非正规报道的治疗策略。我们在此描述一例血液透析导管牢固嵌入上腔静脉壁的病例。我们回顾了关于粘连导管的流行病学、危险因素、长期后遗症和已知管理策略的现有文献。鉴于严重的并发症和有限的治疗选择,制定预防措施非常重要。临床对这种罕见情况的认识和理解对于粘连导管的预防和管理至关重要。

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