#5245 SUCCESSFUL THROMBOLYSIS OF AN ATRIAL TUNNELED DIALYSIS CATHETER AS A LAST RESORT VASCULAR ACCESS

Abstract

Abstract Background and Aims The prolonged survival of patients on dialysis has resulted in a higher frequency of complications and failure related to vascular access. As a result, the situation of depleted vasculature in hemodialysis is becoming increasingly prevalent. The use of an atrial tunneled dialysis catheter (ATDC) has been reported as an effective solution for vascular access in these patients, but limited data is available on the associated complications, particularly thrombosis. Method This study reports the experience of a single nephrology center in Tunis with thrombosis of an ATDC as a last resort vascular access for dialysis. Results A 32-year-old patient with undetermined tubulo-interstitial nephropathy receiving dialysis presented in November 2022 with depleted vasculature. An ATDC was inserted as a final solution for vascular access, with an initial complication of a catheter-related bloodstream infection, which was resolved with broad-spectrum antibiotics with favorable results. One month later, dialysis could not be initiated through the ATDC. Catheter thrombosis was diagnosed as a guidewire was unable to pass through the catheter's lumen. The patient was successfully treated with thrombolysis using 50 mg of Alteplase, allowing dialysis to be resumed with a blood flow of 300 mL/min. Conclusion ATDC is a lifesaving and safe option for patients with depleted vasculature, with only 51 cases reported since 1999 [1]. The treatment of catheter thrombosis is not well defined, and to the best of our knowledge, no thrombolysis protocol has been established. This successful case may contribute to filling the knowledge gap in this field.