A case of a split-tip hemodialysis catheter-related right atrial thrombus requiring open heart surgery

Abstract

A hemodialysis catheter-related right atrial thrombus (RAT) is a rare complication with a poor prognosis. We describe a case of a hemodialysis catheter-induced RAT, which was successfully treated with open heart surgery. A 77-year-old female started undergoing hemodialysis for end-stage renal failure caused by autosomal dominant polycystic kidney disease. Due to frequent vascular access problems and the progression of dementia, a tunneled cuffed catheter with a self-centering split-tip (Centros FLO) was inserted into the right atrium via the left jugular vein. A part of the subcutaneous tunneled catheter became exposed, prompting the patientʼs hospitalization. She was diagnosed with a catheter infection. Thus, we decided to remove the catheter. Echocardiography and computed tomography scans demonstrated a thrombus at the catheter tip in the right atrium. The catheter and thrombus were removed by open heart surgery. The patientʼs postoperative course was uneventful. In conclusion, when extracting cuffed catheters with a split-tip, it is useful to check for a RAT through imaging examinations, such as echocardiography.