Abstract
We experienced 2 chronic dialysis patients in whom large thrombus formed in the right atrium at the tip of an indwelling dialysis catheter. In both patients, the catheters and thrombus were successfully removed by the open heart surgery. Case 1 was a 66-year old woman. She started hemodialysis at age 64 because of chronic glomerulonephritis. Due to frequent vascular access problems, an indwelling catheter (Perm Cath®) was used for further dialysis treatment. The catheter was inserted from the right subclavian vein and the catheter tip was located at the right atrium level. One month later, the patient developed cellulitis in the left leg followed by MRSA bacteremia. Occasionally blood drawing through the dialysis catheter became totally impossible, trans-esophageal echogram demonstrated the formation of a large thrombus in the right atrium. Chest CT showed multiple pulmonary embolisms. Open heart surgery was explored for removal of the catheter and thrombus. The post surgical course was uneventful and CAPD was started. Case 2 was a 58-year old woman who started hemodialysis at age 55 due to chronic glomerulonephritis. Indwelling dialysis catheter (Perm Oath®) was inserted to the right atrium through the left jugular vein. However, blood flow through the catheter soon became impossible and a central venous line was used for total parenteral nutrition treatment for anorexia nervosa. Ten months later, she developed hypotension with dehydration and a trans thoracic wall echocardiogram obtained at that time demonstrated a large thrombus formation in the right atrium. The thrombosis moved back and forth through the tricuspid valve into the right ventricle. Catheter and thrombus were removed by open heart surgery. Several risk factors might have promoted thrombus formation in these two patients. In case 1, the patient was complicated by malignant lymphoma, deep venous thrombosis and adrenal deficiency. In case 2, the patient had prolonged chronic anorexia nervosa and was chronically dehydrated. We diagnosed atrial thrombus by echocardiography and after open heart surgery, the patients each had a good clinical course. Thrombosis related to long-term dialysis catheter is a rare complication, but catheter tip thrombosis should be considered if catheter malfunction is encountered.
