Yoshida Shun, Sato Yasuyo, Naganuma Tsukasa, Nukui Ikuo, Wakasugi Masakiyo, Nakashima Ayumu
Department of Nephrology, Yamanashi Prefectural Central Hospital, Yamanashi 400-8506, Japan.
Department of Nephrology, University of Yamanashi Hospital, Yamanashi 400-8506, Japan.
J Clin Med. 2024 Dec 13;13(24):7579. doi: 10.3390/jcm13247579.
: Complications, namely, catheter-related thrombosis (CRT) and venous stenosis, are associated with non-cuffed hemodialysis catheters used for emergency vascular access. However, only a few reports have demonstrated changes in the venous lumen and intravenous thrombosis after catheter removal. In this study, we comprehensively investigated the risk factors for residual thrombus 1 month after hemodialysis catheter removal. : This prospective observational study was conducted from June 2021 to October 2022. We included patients with end-stage kidney disease who underwent hemodialysis catheter placement in the internal jugular vein (IJV). After catheter removal, we observed the IJV using vascular ultrasound and evaluated the thrombus and vein properties. Furthermore, we observed thrombosis 1 month after catheter removal, and investigated the risk factors for residual thrombus 1 month after catheter removal. : A thrombus was observed at the site of catheter removal in all the cases. Of the 37 patients who were followed up, 11 exhibited a residual thrombus 1 month after catheter removal. Patients with arteriovenous (AV) access dysfunction and enlarged lymph nodes during catheter removal were significantly more likely to have a residual thrombus 1 month after catheter removal. These associations remained significant even after adjusting for age, sex, and diabetes status. : In 29.7% of the patients, CRT persisted even 1 month after the removal of the non-cuffed hemodialysis catheter. The provision of early intervention in patients with AV access dysfunction and enlarged lymph nodes during catheter removal may prevent CRT persistence.
并发症，即导管相关血栓形成（CRT）和静脉狭窄，与用于紧急血管通路的无袖套血液透析导管相关。然而，只有少数报告显示了导管拔除后静脉腔和静脉内血栓形成的变化。在本研究中，我们全面调查了血液透析导管拔除后1个月残留血栓的危险因素。 ：这项前瞻性观察性研究于2021年6月至2022年10月进行。我们纳入了在颈内静脉（IJV）置入血液透析导管的终末期肾病患者。导管拔除后，我们使用血管超声观察IJV，并评估血栓和静脉特性。此外，我们观察了导管拔除后1个月的血栓形成情况，并调查了导管拔除后1个月残留血栓的危险因素。 ：所有病例在导管拔除部位均观察到血栓。在37例接受随访的患者中，11例在导管拔除后1个月出现残留血栓。在导管拔除期间存在动静脉（AV）通路功能障碍和淋巴结肿大的患者在导管拔除后1个月出现残留血栓的可能性显著更高。即使在调整年龄、性别和糖尿病状态后，这些关联仍然显著。 ：在29.7%的患者中，无袖套血液透析导管拔除后1个月CRT仍持续存在。对在导管拔除期间存在AV通路功能障碍和淋巴结肿大的患者进行早期干预可能会预防CRT持续存在。
