Kd. Bolz et al., CATHETER MALFUNCTION AND THROMBUS FORMATION ON DOUBLE-LUMEN HEMODIALYSIS CATHETERS - AN INTRAVASCULAR ULTRASONOGRAPHIC STUDY, American journal of kidney diseases, 25(4), 1995, pp. 597-602
Intravascular ultrasound imaging (IVUS) is a new method that permits i
n vivo visualization of central venous catheters with hitherto unknown
image resolution. It provides information not only about thrombus for
mation, but also about catheter movement, catheter malposition, and ve
ssel wall injuries. In the present investigation the method was applie
d to evaluate the frequency of thrombus formation on double-lumen hemo
dialysis catheters and its significance for catheter malfunction. In 1
4 patients who had a double-lumen hemodialysis catheter for temporary
or long-term vascular access, IVUS of the catheter and the mediastinal
vein stems was performed. Mean indwelling duration at the time of the
ultrasound investigation was 101 days (range. 3 to 730 days; median,
58 days). Four patients had catheter-related thrombotic complications:
IVUS failed to detect an intracatheter thrombus in one case; a cathet
er thrombus and superior vena cava stenosis were found in a catheter w
ith normal function in one case; in one case with catheter malfunction
, a combined catheter-mural thrombus was found; and in the remaining c
ase, a catheter thrombus and a mural superior vena cava thrombus were
found in a patient with normal catheter function and pulmonary emboli.
Thus, two of 12 patients with well-functioning catheters (16%) had th
rombotic complications demonstrated by IVUS, and one of two patients w
ith catheter malfunction had thrombus identified by IVUS. It is conclu
ded that thrombus formation is less likely in patients without signs o
f catheter malfunction. At present the main value of IVUS is as a rese
arch tool, but with more experience and a larger patient population it
may become a valuable alternative or supplemental method in the diagn
osis of catheter malfunction. (C) 1995 by the National Kidney Foundati
on, Inc.