Surgical management of a hemodialysis catheter-induced right atrial thrombus.
The placement of hemodialysis catheters are widely performed by vascular surgeons and surgical residents for use in both the hospital and the outpatient setting. Although long-term complications of this type of vascular access are relatively uncommon, an appreciation is warranted for the life-threatening complication of right atrial thrombus (RAT). Once recognized, medical or surgical management is mandatory to prevent further consequences from RAT. The optimal treatment for catheter-induced RAT is still controversial. Our case and review illustrates how the routine placement of a malpositioned hemodialysis catheter in a young man can lead to the serious complication of RAT that necessitated cardiac surgery after thrombolysis failed. We describe the successful surgical management of a hemodialysis catheter-induced RAT and suggest that in cases of large, mobile RATs with adherence to both atrial wall and catheter, suspicion or evidence of pulmonary embolus (PE), and low-risk surgical candidates, open thrombectomy may be an optimal and definitive treatment.
Lalor
Peter F
PF
Department of Surgery, Lankenau Hospital, Wynnewood, Pennsylvania 19096, USA. petelalor@hotmail.com
Sutter
Francis
F
D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*