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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.In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients.

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.

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Related in: MedlinePlus

The fluoroscopy of a 65-year-old male patient after contrast media application shows lamellar contrast defects around the tip of the dialysis catheter, as seen with the onset of a fibrin sheath (white arrow)
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Fig9: The fluoroscopy of a 65-year-old male patient after contrast media application shows lamellar contrast defects around the tip of the dialysis catheter, as seen with the onset of a fibrin sheath (white arrow)

Mentions: In dialysis catheters, a fibrin coating can form that wraps around the catheter. A definite cause for the formation of the fibrin sheath is unclear. The fibrin sheath can extend to the catheter end and close it. The intravascular portion of the haemodialysis catheter should be suspected to have a fibrin sheath when it can be rinsed but not aspirated. After the catheter implantation, a fibrin sheath can form after only 24 h, with an incidence of 13–57 % [31]. The treatment measures range from fibrinolysis or stripping of the fibrin sheath to perforation of the fibrin sheath by means of a guide wire. Fibrinolysis is preferable to the stripping of the fibrin sheath because it is not invasive; moreover, it is less expensive and can be administered in a hospital room. This treatment method is often preferred by patients, and it has a lower rate of complications. The success rate of urokinase is reported to be 76–97 %, without adverse complications [32–35]. Mechanical removal (stripping) can be offered to patients as an alternative where fibrinolysis is unsuccessful. Here, the catheter end is grasped through a femoral-inserted sling and is freed by pulling of the fibrin material. The disadvantage here is the high cost of the grasping sling. With an open end in the catheter, catheter function can be restored with perforation of the fibrin sheath by means of a guide wire. If the above measures are not successful, a catheter exchange is imperative for adequate haemodialysis, whereby the existing fibrin layers in the vessel must be severed using an angioplasty balloon [36] (Fig. 10).Fig. 10


Radiological diagnosis of dialysis-associated complications.

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

The fluoroscopy of a 65-year-old male patient after contrast media application shows lamellar contrast defects around the tip of the dialysis catheter, as seen with the onset of a fibrin sheath (white arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig9: The fluoroscopy of a 65-year-old male patient after contrast media application shows lamellar contrast defects around the tip of the dialysis catheter, as seen with the onset of a fibrin sheath (white arrow)
Mentions: In dialysis catheters, a fibrin coating can form that wraps around the catheter. A definite cause for the formation of the fibrin sheath is unclear. The fibrin sheath can extend to the catheter end and close it. The intravascular portion of the haemodialysis catheter should be suspected to have a fibrin sheath when it can be rinsed but not aspirated. After the catheter implantation, a fibrin sheath can form after only 24 h, with an incidence of 13–57 % [31]. The treatment measures range from fibrinolysis or stripping of the fibrin sheath to perforation of the fibrin sheath by means of a guide wire. Fibrinolysis is preferable to the stripping of the fibrin sheath because it is not invasive; moreover, it is less expensive and can be administered in a hospital room. This treatment method is often preferred by patients, and it has a lower rate of complications. The success rate of urokinase is reported to be 76–97 %, without adverse complications [32–35]. Mechanical removal (stripping) can be offered to patients as an alternative where fibrinolysis is unsuccessful. Here, the catheter end is grasped through a femoral-inserted sling and is freed by pulling of the fibrin material. The disadvantage here is the high cost of the grasping sling. With an open end in the catheter, catheter function can be restored with perforation of the fibrin sheath by means of a guide wire. If the above measures are not successful, a catheter exchange is imperative for adequate haemodialysis, whereby the existing fibrin layers in the vessel must be severed using an angioplasty balloon [36] (Fig. 10).Fig. 10

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.In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients.

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