Grote J, Lufft V, Nikutta P, van der Lieth H, Bahlmann J, Daniel W G
Department of Cardiology, Hannover Medical School, Germany.
Clin Nephrol. 1994 Sep;42(3):183-8.
In some patients with end-stage renal failure, arteriovenous fistulas cannot be created due to poor vessel conditions. Alternatively, hemodialysis (HD) can be performed using long-term central venous catheters. However, these dialysis catheters are associated with a presently unknown risk of superior vena cava (SVC) thrombosis. We examined 20 patients (11 female, 9 male, age 29-83 years) 1-48 (mean 15) months after transjugular insertion of a permanent single lumen silicone rubber HD catheter. All patients underwent both transthoracic (TTE) and biplane transesophageal (TEE) echocardiography. TTE visualized the catheter only when its tip was localized in the right atrium (2 patients), but did not succeed in adequate imaging of the SVC. In contrast, TEE allowed high quality imaging of the SVC in all patients and detected a SVC thrombosis in 6 patients; in 3 of them, caval thrombosis was subtotal. One additional patient showed a thrombus attached to the catheter tip alone. Dwelling time of catheters since insertion in the SVC was not significantly different in patients with and without thrombosis. Reduced blood flow during HD was observed in 5 of 7 patients with catheter-associated thrombi but also in 4 of 13 patients without evidence for caval thrombosis by TEE. It is concluded that thrombotic occlusion of the SVC is frequent in patients with long-term central venous access; it does not necessarily correlate with clinical signs but can easily be detected by TEE. Patients with long-term central venous hemodialysis catheters should undergo transesophageal echocardiography at regular intervals.
在一些终末期肾衰竭患者中，由于血管条件差无法建立动静脉内瘘。作为替代方案，可以使用长期中心静脉导管进行血液透析（HD）。然而，这些透析导管与目前尚不清楚的上腔静脉（SVC）血栓形成风险相关。我们对20例患者（11例女性，9例男性，年龄29 - 83岁）进行了研究，这些患者在经颈内静脉插入永久性单腔硅胶橡胶HD导管后1 - 48（平均15）个月。所有患者均接受了经胸（TTE）和双平面经食管（TEE）超声心动图检查。仅当导管尖端位于右心房时，TTE才能看到导管（2例患者），但未能成功对上腔静脉进行充分成像。相比之下，TEE能够对所有患者的上腔静脉进行高质量成像，并在6例患者中检测到上腔静脉血栓形成；其中3例患者的腔静脉血栓形成是不完全性的。另外1例患者仅显示血栓附着于导管尖端。导管在上腔静脉中的留置时间在有血栓形成和无血栓形成的患者中无显著差异。7例与导管相关血栓形成的患者中有5例在血液透析期间观察到血流量减少，但在13例经TEE未发现腔静脉血栓形成证据的患者中也有4例出现这种情况。得出的结论是，长期中心静脉通路的患者中，上腔静脉血栓形成闭塞很常见；它不一定与临床体征相关，但可通过TEE轻松检测到。长期使用中心静脉血液透析导管的患者应定期接受经食管超声心动图检查。
