Breast Disease Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China.
J Vasc Access. 2022 Mar;23(2):313-317. doi: 10.1177/1129729821989159. Epub 2021 Jan 28.
As an under-reported, severe, and life-threatening complication, catheter-related right atrial thrombosis (CRAT) can appear at any age with any type of central venous catheter (CVC). However, most reports are limited to hemodialysis patients with CVC. Totally implantable venous access port (TIVAP) is widely used for the infusion of high-concentration chemotherapeutic drugs in cancer patients. However, these catheters may cause CRAT.
A 27-year-old female patient with TIVAP was referred for neoadjuvant chemotherapy because of breast cancer. At 60 days after TIVAP implantation, routine transthoracic ultrasound examination confirmed a mass of 3.4 × 2.5 cm in the right atrium (RA). The mass was attached to the atrial wall and close to the catheter tip. Initially, we chose systemic anticoagulation therapy, but it failed. Subsequently, we decided to adopt a combination of systemic thrombolysis and anticoagulation therapy via a cubital vein. After 9 days of treatment, the thrombus disappeared, and the TIVAP was eventually removed.
Systemic thrombolysis and anticoagulation therapy seemed to be safe and effective for asymptomatic patients who had TIVAP-induced CRAT. We should position the catheter tip at the junction of the Superior Vena Cava with the Right Atrium during the implantation procedure in cancer patients undergoing chemotherapy.
导管相关性右心房血栓（CRAT）是一种报道较少、严重且危及生命的并发症，可发生于任何年龄、任何类型的中心静脉导管（CVC）。然而，大多数报告仅限于接受 CVC 的血液透析患者。完全植入式静脉输液港（TIVAP）广泛用于癌症患者输注高浓度化疗药物。然而，这些导管可能会导致 CRAT。
一名 27 岁女性患者因乳腺癌接受 TIVAP 新辅助化疗。在 TIVAP 植入后 60 天，常规经胸超声检查确认右心房（RA）内有一个 3.4×2.5cm 的肿块。该肿块附着于心房壁并靠近导管尖端。最初，我们选择全身抗凝治疗，但失败了。随后，我们决定通过肘静脉联合全身溶栓和抗凝治疗。治疗 9 天后，血栓消失，最终取出 TIVAP。
对于无症状的 TIVAP 引起的 CRAT 患者，全身溶栓和抗凝治疗似乎是安全有效的。我们应在化疗期间接受 TIVAP 的癌症患者的植入过程中，将导管尖端定位在上腔静脉与右心房的交界处。
