RIGHT ATRIAL THROMBUS FORMATION FOLLOWING INTERNAL JUGULAR VEIN CATHETERIZATION : A CASE SERIES

8 Feb 2025 12 a.m. 12 a.m.

WCN25-AB-1873, Poster Board= SAT-306

Introduction:

The ideal vascular access for hemodialysis is arterio-venous fistula (AVF). AVF creation is recommended as early as stage 3b of chronic kidney disease, still there are many cases who require internal jugular vein (IJV) cannulation for hemodialysis as many patients are crash-landers and many patients are having multi-vascular access failures.

Right atrial thrombus formation is a rare but potentially life-threatening complication of central venous catheterization, particularly following IJV cannulation. We report 5 cases from 2017 to 2024 who developed a right atrial thrombus after IJV catheter placement for hemodialysis, highlighting the clinical implications, diagnostic methods, and management strategies.

Methods:

2D Echocardiographic image showing Thrombus in Right Atrium Unable to pass guidewire through arterial limb due to thrombus at the tip in the same patient as shown in the CT scan image

We collected data of the patients who developed right atrial thrombus following IJV cannulation for hemodialysis purpose from 2017 to 2024. Clinical presentation varied from asymptomatic presentation to fever with chills, breathlessness, palpitations and/or poor blood flow during hemodialysis. Right atrial thrombus was detected on transthoracic 2D echocardiography screening and subsequently confirmed via CT scan / MR Imaging if required. Cardio-thoracic surgeons’ opinions were taken and patients were managed medically by anticoagulation and if advised, they underwent mechanical thrombectomy via thoracotomy for thrombus removal.

CT scan showing catheter tip located just proximal to cavo-atrial junction in another patient

Results:

intra op picture of stuck catheter to posterior wall of SVC Sccessful removal of the catheter along with part of SVC Data table showing patient characteristics, clinical presentation, findings on imaging, management and outcomes of the patients with RIght Atrial Thrombus

Patients were aged between 25-39 years at presentation, native kidney disease were undetermined in 3 patients, 1 had diabetic kidney disease and 1 had lupus nephritis.

4 out of 5 patients had fever with chills, 1 out of 5 had breathlessness and palpitations, 1 out of 5 had poor blood flow during dialysis and 1 patient was asymptomatic and was detected to have right atrial thrombus on 2D echocardiography for pre-transplant workup.

Out of 5, 1 patient recovered from thrombus by medical management with anticoagulation only, 2 patients underwent mechanical thrombectomy via sternotomy due to non resolution of thrombus by anticoagulation only, 1 patient had right atrial thrombus with catheter tip stuck at superior vena cava – right atrial junction : underwent sternotomy and thrombus along with catheter removal with posteromedial SVC wall followed by autologus pericardial patch reconstruction and 1 patient who had developed fungal endocarditis, had thrombus adherent to tricuspid valve and TCC, died of cardiac arrest before he could be taken for the surgical intervention for thrombectomy and valvular replacement.

Conclusions:

This case series illustrates the need for heightened awareness of the risk of thrombus formation in patients with central venous catheters. Early recognition and appropriate management can significantly improve patient outcomes. Systemic anticoagulation is vital in management strategy along with the need of surgical interventions as indicated on a case by case basis. Further research is warranted to develop effective prevention and treatment protocols for catheter-related thrombotic events.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.