Results
A total of 364 TTEs were performed in 290 patients with a venous
catheter visualized in the RA during the study period. Of these 290
patients, 15 (5.2%) had echocardiographic suspicion for RAT. The mean
patient age was 41.7 ± 12.3 years, and 12 (80.0%) were female. Eight
(53.3%) patients had hypertension, six (40.0%) had end-stage renal
disease, four (26.7%) had previous DVT or thrombotic event, four
(26.7%) had a history of acute kidney injury, four (26.7%) patients
had malignancy, and three (20.0%) had hypercholesterolemia.
Characteristics of each case are presented in Table I. Nine (60.0%) of
the catheters were indicated for hemodialysis, four (26.7%) for
chemotherapy, and two (13.3%) for plasmapheresis. Each TTE was
performed for clinical indications rather than as routine surveillance.
Thrombi were detected by TTE in each case with a median interval of 52
days between catheter insertion and thrombus discovery. Eight (53.3%)
thrombi were attached to the RA free wall, four (26.7%) to the
catheter, and three (20.0%) to both. Further imaging was obtained in
ten (66.7%) patients, consisting of TEE in all (100%) and cardiac
magnetic resonance (CMR) imaging in three (20.0%) patients.
A number of strategies were employed in the management of the thrombi.
Anticoagulation was utilized in 13 (86.7%) patients for a mean of 7.9
months. The catheter was removed in eleven (73.3%) patients, and
replaced in four (26.7%) of these patients. The catheter was trimmed to
a shorter length in two (13.3%) patients. Resolution of the thrombus
was confirmed in eleven (73.3%) patients at a mean of 96.1 days after
discovery. One patient experienced a subsegmental pulmonary embolism
attributed to a RAT.