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.