Caruana R J, Raja R M, Zeit R M, Goldstein S J, Kramer M S
Am J Kidney Dis. 1987 Jun;9(6):497-501. doi: 10.1016/s0272-6386(87)80076-8.
A new double-lumen silicone-rubber dialysis catheter, designed to be placed surgically in central veins, is now available. There is little published data concerning the long-term use of this catheter for hemodialysis, but a review of the literature suggests that pericatheter thrombus formation with or without occlusion of major veins has been a complication of chronic central venous catheterization with a variety of catheters, in both dialysis and nondialysis settings. We had this catheter placed in four diabetic patients who had severe problems related to maintenance of adequate vascular access. Two of the four patients underwent venography within 3 months of catheter placement because of impaired catheter function and were found to have thrombi on the outside of their catheters. These thrombi could not be dissolved with fibrinolytic agents, and the catheters were removed surgically without incident. The other two patients have no radiologic evidence of thrombus formation 4 and 7 months, respectively, after catheter placement. We suggest that proper selection of patients for this type of vascular access should be the subject of future studies and that patients with malfunctioning catheters undergo venography to rule out the presence of significant catheter related thrombosis.
一种新型的双腔硅胶透析导管现已问世，该导管设计用于通过手术放置在中心静脉中。关于这种导管长期用于血液透析的已发表数据很少，但文献综述表明，无论有无主要静脉闭塞，导管周围血栓形成一直是各种导管在透析和非透析环境中进行慢性中心静脉置管的并发症。我们将这种导管置入了四名患有严重血管通路维持问题的糖尿病患者体内。四名患者中有两名因导管功能受损在置管后3个月内接受了静脉造影，结果发现导管外部有血栓形成。这些血栓无法用纤维蛋白溶解剂溶解，随后通过手术顺利取出导管。另外两名患者在置管后分别4个月和7个月，没有血栓形成的影像学证据。我们建议，未来的研究应关注此类血管通路患者的正确选择，并且导管功能异常的患者应接受静脉造影以排除严重的导管相关血栓形成。
