Abstract
Catheter related thrombosis (CRT) is a commonly encountered entity fraught with substantial risk for mortality secondary to various complications including pulmonary embolism (PE), tricuspid regurgitation, endocarditis, right sided heart failure, and cardiogenic and septic shock. CRT carries a mortality rate of 18% in hemodialysis patients and more than 40% in nonhemodialysis patients. Management strategies include systemic anticoagulation, systemic thrombolysis, surgical evacuation, and percutaneous retrieval with no established guidelines. Ultrasound assisted catheter directed thrombolysis emerges as promising modality with a relatively lower risk of hemorrhage compared to systemic thrombolysis. We report a case of a 75-year-old man with dialysis catheter related thrombosis without PE for which ultrasound assisted catheter directed thrombolysis was used successfully as an alternative therapy.
Highlights
Catheter-related thrombosis (CRT) is a known complication of central venous catheters (CVC) with a reported incidence of 5–62% in asymptomatic thrombosis and 28% for symptomatic thrombosis
We present a case of CRT for which ultrasound assisted catheter directed thrombolysis with an EKOS catheter was used as an alternative therapy
A 75-year-old gentleman with a past medical history of diabetes (DM), hypertension (HTN), prostate cancer status postprostatectomy, and end stage renal disease (ESRD) on hemodialysis was admitted from his dialysis center for an elective thrombectomy of his clotted left upper extremity arteriovenous graft (AVG)
Summary
Catheter-related thrombosis (CRT) is a known complication of central venous catheters (CVC) with a reported incidence of 5–62% in asymptomatic thrombosis and 28% for symptomatic thrombosis. CRT carries a mortality rate of 18% in hemodialysis patients and more than 40% in nonhemodialysis patients [1]. Treatment options include systemic anticoagulation, systemic thrombolysis, surgical evacuation, and percutaneous retrieval with no established guidelines. We present a case of CRT for which ultrasound assisted catheter directed thrombolysis with an EKOS catheter was used as an alternative therapy
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