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Catheter-Related Right Atrial Thrombus Requiring Surgical Embolectomy
Temporary central venous hemodialysis (HD) catheters are commonly used in end-stage renal disease (ESRD) patients while awaiting peritoneal dialysis catheter, arterio-venous fistula or graft placement and maturation. Catheter-related right atrial thrombus (CRAT) is a common finding in patients with ...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485875/ https://www.ncbi.nlm.nih.gov/pubmed/34646689 http://dx.doi.org/10.7759/cureus.17641 |
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author | Akanya, Deborah T Parekh, Jay Abraham, Soniya Uche, Sam Lancaster, Gilead |
author_facet | Akanya, Deborah T Parekh, Jay Abraham, Soniya Uche, Sam Lancaster, Gilead |
author_sort | Akanya, Deborah T |
collection | PubMed |
description | Temporary central venous hemodialysis (HD) catheters are commonly used in end-stage renal disease (ESRD) patients while awaiting peritoneal dialysis catheter, arterio-venous fistula or graft placement and maturation. Catheter-related right atrial thrombus (CRAT) is a common finding in patients with central venous catheters (CVCs) and can cause CVC to malfunction. The incidence of CRAT is about 29% with a mortality of 18.3% or greater if not identified and managed appropriately. Two major types of right atrial (RA) thrombi have been identified. Type A thrombus usually originates in the peripheral veins embolizing to the RA. Type B originates within a structurally abnormal RA and is usually attached to the chamber walls or foreign bodies like CVC or intra-cardiac wires. There is a high risk of thrombi embolization leading to pulmonary embolism as in our patient, systemic embolization if a right to left shunt is present and potential hemodynamic compromise. The optimal therapeutic approach is still a subject of discussion, but timely catheter removal with prompt initiation of systemic anticoagulation is key. Surgical management is pursued when medical therapy fails or if the thrombus is greater than 6 cm. Our case is that of a 30-year-old male with CRAT successfully treated with surgical embolectomy after the failure of systemic anticoagulation. This case highlights the importance of early detection of CRAT, initiation of optimal medical therapy and the need for surgical intervention when medical therapy fails. |
format | Online Article Text |
id | pubmed-8485875 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-84858752021-10-12 Catheter-Related Right Atrial Thrombus Requiring Surgical Embolectomy Akanya, Deborah T Parekh, Jay Abraham, Soniya Uche, Sam Lancaster, Gilead Cureus Cardiac/Thoracic/Vascular Surgery Temporary central venous hemodialysis (HD) catheters are commonly used in end-stage renal disease (ESRD) patients while awaiting peritoneal dialysis catheter, arterio-venous fistula or graft placement and maturation. Catheter-related right atrial thrombus (CRAT) is a common finding in patients with central venous catheters (CVCs) and can cause CVC to malfunction. The incidence of CRAT is about 29% with a mortality of 18.3% or greater if not identified and managed appropriately. Two major types of right atrial (RA) thrombi have been identified. Type A thrombus usually originates in the peripheral veins embolizing to the RA. Type B originates within a structurally abnormal RA and is usually attached to the chamber walls or foreign bodies like CVC or intra-cardiac wires. There is a high risk of thrombi embolization leading to pulmonary embolism as in our patient, systemic embolization if a right to left shunt is present and potential hemodynamic compromise. The optimal therapeutic approach is still a subject of discussion, but timely catheter removal with prompt initiation of systemic anticoagulation is key. Surgical management is pursued when medical therapy fails or if the thrombus is greater than 6 cm. Our case is that of a 30-year-old male with CRAT successfully treated with surgical embolectomy after the failure of systemic anticoagulation. This case highlights the importance of early detection of CRAT, initiation of optimal medical therapy and the need for surgical intervention when medical therapy fails. Cureus 2021-09-01 /pmc/articles/PMC8485875/ /pubmed/34646689 http://dx.doi.org/10.7759/cureus.17641 Text en Copyright © 2021, Akanya et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Cardiac/Thoracic/Vascular Surgery Akanya, Deborah T Parekh, Jay Abraham, Soniya Uche, Sam Lancaster, Gilead Catheter-Related Right Atrial Thrombus Requiring Surgical Embolectomy |
title | Catheter-Related Right Atrial Thrombus Requiring Surgical Embolectomy |
title_full | Catheter-Related Right Atrial Thrombus Requiring Surgical Embolectomy |
title_fullStr | Catheter-Related Right Atrial Thrombus Requiring Surgical Embolectomy |
title_full_unstemmed | Catheter-Related Right Atrial Thrombus Requiring Surgical Embolectomy |
title_short | Catheter-Related Right Atrial Thrombus Requiring Surgical Embolectomy |
title_sort | catheter-related right atrial thrombus requiring surgical embolectomy |
topic | Cardiac/Thoracic/Vascular Surgery |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485875/ https://www.ncbi.nlm.nih.gov/pubmed/34646689 http://dx.doi.org/10.7759/cureus.17641 |
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