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Radiological diagnosis of dialysis-associated complications.

Zandieh S, Muin D, Bernt R, Krenn-List P, Mirzaei S, Haller J - Insights Imaging (2014)

Bottom Line: In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications.The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis.Teaching Points • The occurrence of venous stenosis in haemodialysis patients is up to 41 %. • Catheters usually have a fibrin sheath that can be rinsed but not aspirated. • The steal phenomenon occurs in 75-90 % of patients with a shunt system. • Arterial pseudoaneurysms can cause a number of complications.

View Article: PubMed Central - PubMed

Affiliation: Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Vienna, EU, Austria, shahin.zandieh@chello.at.

ABSTRACT
In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications. The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis. In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients. Teaching Points • The occurrence of venous stenosis in haemodialysis patients is up to 41 %. • Catheters usually have a fibrin sheath that can be rinsed but not aspirated. • The steal phenomenon occurs in 75-90 % of patients with a shunt system. • Arterial pseudoaneurysms can cause a number of complications.

No MeSH data available.


Related in: MedlinePlus

Fluoroscopy of a 78-year-old male patient after contrast media application. The contrast media builds up in the superior vena cava around the catheter, indicating a larger thrombus formation that could occlude the superior vena cava (black arrow). The contrast media outflow from the arterial leg occurs distally via the hemiazygos vein (black arrow)
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Fig7: Fluoroscopy of a 78-year-old male patient after contrast media application. The contrast media builds up in the superior vena cava around the catheter, indicating a larger thrombus formation that could occlude the superior vena cava (black arrow). The contrast media outflow from the arterial leg occurs distally via the hemiazygos vein (black arrow)

Mentions: The activation of blood coagulation occurs through dialysis catheters, which represent an intravascular foreign object. The incidence of catheter-associated thrombosis depends on numerous risk factors. Catheter material, catheter diameter, and a complication-rich catheter implantation with consecutive endothelial damage predispose patients to the formation of venous thrombosis. The incidence of catheter-associated pulmonary embolism is 15–25 % [28]. Primary thromboprophylaxis has a dubious value in oncological patients and no significant benefit [29]. Occasionally, catheter-associated thrombosis may cause pressure-sensitive swelling of the affected extremity. Sonography or a phlebography is required for diagnostics. The catheter should be removed in the case of symptomatic thrombosis. If the catheter tip is free of thrombotic deposits, the catheter can remain in place. The thrombosis of the catheter-bearing vein should be treated. Therapy with anticoagulation is essential to prevent progression of the deposits. Oral anticoagulation for up to 6 months with an optimal level of 2 to 3 of the international normalised ratio (INR) is recommended. In severe cases, thrombolytic therapy should be initiated. A fibrinolytic applied directly into the thrombus has an advantage over systemic or regional thrombolysis because less fibrinolytic agent is needed and thus fewer side effects occur [30]. Mechanical thrombectomy should occur either surgically or by means of percutaneous aspiration thrombectomy or fragmentation catheters (Figs. 8 and 9).Fig. 8


Radiological diagnosis of dialysis-associated complications.

Zandieh S, Muin D, Bernt R, Krenn-List P, Mirzaei S, Haller J - Insights Imaging (2014)

Fluoroscopy of a 78-year-old male patient after contrast media application. The contrast media builds up in the superior vena cava around the catheter, indicating a larger thrombus formation that could occlude the superior vena cava (black arrow). The contrast media outflow from the arterial leg occurs distally via the hemiazygos vein (black arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4195842&req=5

Fig7: Fluoroscopy of a 78-year-old male patient after contrast media application. The contrast media builds up in the superior vena cava around the catheter, indicating a larger thrombus formation that could occlude the superior vena cava (black arrow). The contrast media outflow from the arterial leg occurs distally via the hemiazygos vein (black arrow)
Mentions: The activation of blood coagulation occurs through dialysis catheters, which represent an intravascular foreign object. The incidence of catheter-associated thrombosis depends on numerous risk factors. Catheter material, catheter diameter, and a complication-rich catheter implantation with consecutive endothelial damage predispose patients to the formation of venous thrombosis. The incidence of catheter-associated pulmonary embolism is 15–25 % [28]. Primary thromboprophylaxis has a dubious value in oncological patients and no significant benefit [29]. Occasionally, catheter-associated thrombosis may cause pressure-sensitive swelling of the affected extremity. Sonography or a phlebography is required for diagnostics. The catheter should be removed in the case of symptomatic thrombosis. If the catheter tip is free of thrombotic deposits, the catheter can remain in place. The thrombosis of the catheter-bearing vein should be treated. Therapy with anticoagulation is essential to prevent progression of the deposits. Oral anticoagulation for up to 6 months with an optimal level of 2 to 3 of the international normalised ratio (INR) is recommended. In severe cases, thrombolytic therapy should be initiated. A fibrinolytic applied directly into the thrombus has an advantage over systemic or regional thrombolysis because less fibrinolytic agent is needed and thus fewer side effects occur [30]. Mechanical thrombectomy should occur either surgically or by means of percutaneous aspiration thrombectomy or fragmentation catheters (Figs. 8 and 9).Fig. 8

Bottom Line: In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications.The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis.Teaching Points • The occurrence of venous stenosis in haemodialysis patients is up to 41 %. • Catheters usually have a fibrin sheath that can be rinsed but not aspirated. • The steal phenomenon occurs in 75-90 % of patients with a shunt system. • Arterial pseudoaneurysms can cause a number of complications.

View Article: PubMed Central - PubMed

Affiliation: Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Vienna, EU, Austria, shahin.zandieh@chello.at.

ABSTRACT
In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications. The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis. In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients. Teaching Points • The occurrence of venous stenosis in haemodialysis patients is up to 41 %. • Catheters usually have a fibrin sheath that can be rinsed but not aspirated. • The steal phenomenon occurs in 75-90 % of patients with a shunt system. • Arterial pseudoaneurysms can cause a number of complications.

No MeSH data available.


Related in: MedlinePlus