A VENA CAVA SUPERIOR SYNDROME SECONDARY TO CATHETER RELATED THROMBOSIS IN A CHILD (A CASE REPORT)
Journal Name:
- İstanbul Tıp Fakültesi Dergisi
Keywords (Original Language):
| Author Name | University of Author | Faculty of Author |
|---|---|---|
Abstract (2. Language):
In hemodialysis patients, subclavian or jugular venous catheters have been used in order to supply a permanent vascular
access. Although partial thrombosis is seen in catheterized patients, complete central venous thrombosis rarely
occurs and is an important complication. Symptomatic vena cava superior syndrome (VCSS) secondary to catheter
related thrombosis has been reported as a very rare complication in the literature.
A12 year old girl with end stage renal disease (ESRD) who has been undergoing hemodialysis for 6 years was reported
here. Subclavian or juguler venous catheters had been performed several times for hemodialysis in the patient.
After a left brachial arterio-venous fistula operation, increased jugular venous pressure and edema in her face
and in both of her arms occurred. She had chest pain, lethargy, confusion and increased edema in her face at each
hemodialysis session. Bilateral brachiocephalic and subclavian complete venous thrombosis was revealed by venography.
This clinic condition was accepted as VCSS secondary to catheter related thrombosis. Systemic anticoagulant
therapy was started and surgical procedure was planned. Systemic signs significantly regressed during preparation
to surgery, and collateral circulation was established by control venography. Surgical procedure was postponed
because of diminishing edema in her face and arms, vanishing cyanosis and chest pain during hemodialysis.
She had no clinical signs related to VCSS and thrombosis at the last evaluation.In conclusion, we suggest that hemodialysis patients with central venous catheter should be regularly followed up
by Doppler ultrasound, because the venous thrombosis may be seen as a VCSS, a life-threatenning complication.
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Abstract (Original Language):
Hemodiyaliz hastalar›nda kal›c› damar yolunun sa¤lanmas› amac›yla kullan›lan subklavian veya juguler
venöz kateterler nedeniyle hastalarda asemptomatik trombozlar s›k görülür; ancak tam t›kay›c› santral
venöz tromboz geliflimi nadirdir. Kateter ile iliflkili tromboz nedeniyle geliflen semptomatik vena kava
süperior sendromu (VKSS) ise literatürde çok nadir olarak bildirilmektedir. Klini¤imizde 6 y›ld›r son dönem
böbrek yetmezli¤i nedeniyle hemodiyaliz tedavisi gören ve daha önce damar eriflim yolunu sa¤lamak
amac›yla bir çok kez subklavian ve juguler venöz kateterizasyon yap›lm›fl olan 12 yafl›ndaki k›z olguda,
sol brakial arterio-venöz fistül aç›lmas›ndan sonra boyun venlerinde dolgunluk, yüzünde ve her iki
kolunda ödem geliflti¤i görüldü. Hemodiyaliz seanslar›nda yayg›n gö¤üs a¤r›s› olan, letarji ve konfüzyon
tablosu geliflen ve yüzdeki ödemi belirgin olarak artan hastada bilateral brakiosefalik trunkus ve
subklavian venlerde tam t›kay›c› trombus varl›¤› gösterildi. Tüm hematolojik tetkikleri normal bulunan
hastan›n klinik tablosu santral venöz kateterizasyonlar sonras› geliflen tam t›kay›c› venöz tromboz ve buna
ba¤l› VKSS olarak kabul edildi. Sistemik antikoagülan tedavi baflland› ve rekonstrüktif cerrahi giriflim
planland›. Operasyon haz›rl›¤› s›ras›nda sistemik bulgular›nda gerileme olan hastan›n tekrarlanan
venografisinde kollateral geliflimi oldu¤u saptand›. Yüzünde ve kollar›ndaki ödemin azalmas›, hemodiyaliz
s›ras›nda siyanoz ve gö¤üs a¤r›s›n›n olmamas›, genel durumunun belirgin olarak düzelmifl olmas›
ve ailenin iste¤i nedeniyle operasyon ertelendi. Tedavinin 18. ay›nda yap›lan son de¤erlendirmede,
VKSS ve tromboz ile iliflkili hiçbir klinik bulgusu mevcut de¤ildi. Sonuç olarak, santral venöz kateter
uygulanan hastalarda s›k görülen venöz trombozlar nadir olarak yaflam› tehdit eden VKSS fleklinde de
karfl›m›za ç›kabilece¤inden hastalar›n aral›kl› Doppler ultrasonografi ile izlenerek erken tedavi yaklafl›-
m›nda bulunulmas› gerekti¤ini düflünmekteyiz.
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