TRANSESOPHAGEAL ECHOCARDIOGRAPHIC ASSESSMENT OF SUPERIOR VENA-CAVA THROMBOSIS IN PATIENTS WITH LONG-TERM CENTRAL VENOUS HEMODIALYSIS CATHETERS

In some patients with end-stage renal failure, arteriovenous fistulas cannot be created due to poor vessel conditions. Alternatively, hemodi alysis (HD) can be performed using long-term central venous catheters. However, these dialysis catheters are associated with a presently unk nown risk of superior vena cava (SVC) thrombosis. We examined 20 patie nts (11 female, 9 male, age 29-83 years) 1-48 (mean 15) months after t ransjugular insertion of a permanent single lumen silicone rubber HD c atheter. All patients underwent both transthoracic (TTE) and biplane t ransesophageal (TEE) echocardiography. TTE visualized the catheter onl y when its tip was localized in the right atrium (2 patients), but did not succeed in adequate imaging of the SVC. In contrast, TEE allowed high quality imaging of the SVC in all patients and detected a SVC thr ombosis in 6 patients; in 3 of them, caval thrombosis was subtotal. On e additional patient showed a thrombus attached to the catheter tip al one. Dwelling time of catheters since insertion in the SVC was not sig nificantly different in patients with and without thrombosis. Reduced blood flow during HD was observed in 5 of 7 patients with catheter-ass ociated thrombi but also in 4 of 13 patients without evidence for cava l thrombosis by TEE. It is concluded that thrombotic occlusion of the SVC is frequent in patients with long-term central venous access; it d oes not necessarily correlate with clinical signs but can easily be de tected by TEE, Patients with long-term central venous hemodialysis cat heters should undergo transesophageal echocardiography at regular inte rvals.