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ÇOCUK HASTADA KATETER İLE İLİŞKİLİ TROMBOZA BAĞLI OLARAK GELİŞEN BİR VENA KAVA SUPERİOR SENDROMU OLGUSU

A VENA CAVA SUPERIOR SYNDROME SECONDARY TO CATHETER RELATED THROMBOSIS IN A CHILD (A CASE REPORT)

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2005

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty 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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  • 3
81-84
  • Turkish

REFERENCES

References: 

1. Aitken ML, Tonelli MR. Complications of indwelling catheters
in cystic fibrosis. Chest 2000; 118:1598-1602.
2. Brandt ML, Goldstein S. Vascular access in children. In: Nissenson
AR. and Fine RH (eds). Dialysis Therapy. Hanley and Belfus
Medical Publishers. Philadelphia,USA, 3rd ed., 2002; pp.
455-457.
3. Corrigan JJ. Hemorrhagic and Thrombotic Disease. In: Nelson
WE, Behrman RE, Kliegman RM, Arvin AM (eds). Textbook of
Pediatrics. W.B. Saunders Company. Philadelphia,USA, 15th
ed., 1996; pp. 1422-1438.
4. Grote J, Lufft V, Nikutta P, van der Lieth H, Bahlmann J, Daniel
WG. Transesophageal echocardiographic assessment of superior
vena cava thrombosis in patients with long-term central venous
hemodialysis catheters. Clin Nephrol 1994; 42:183-188.
5. Halevy A, Leonov Y, Lewinsohn G, Witz E, Orda R. Thrombosis
of superior vena cava during total parenteral nutrition, managed
succesfully with low dose streptokinase. Intensive Care Med
1988; 14:72-73.
6. Haqqie SS, Roth M, Low CL, Bailie GR. Superior vena cava
syndrome from central venous hemodialysis. Clin Nephrol
1994; 42:341-342.
7. Harmon WE, Jabs KL. Hemodialysis. In: Barratt TM, Avner ED,
Harmon WEB (eds). Pediatric Nephrology. Lippincott Williams
and Wilkins. Baltimore, USA, 4th ed., 1999; pp 1267-1288.
8. Hemphill DJ, Sniderman KW, Allard JP. Management of total
parenteral nutrition-related superior vena cava obstruction with
expandable metal stents. JPEN J Parenter Enteral Nutr 1996; 20:
222-227.
9. Mickley V. Subclavian artery to right atrium haemodialysis bridge
graft for superior vena caval occlusion. Nephrol Dial Transplant
1996; 11:1361-1362.
10. Oderich GS, Treiman GS, Schneider P, Bhirangi K. Stent placement
for treatment of central and peripheral venous obstruction:
A long-term multi-institutional experience. J Vasc Surg 2000;
32:760-769.
11. Peters M, Beath SV, Puntis JW, John P. Superior vena cava
thrombosis causing respiratory obstruction successfully resolved
by stenting in a small bowel transplant candidate. Arch Dis Child
2000; 83:163-164.
12. Pop A, Cutler AF. Bleending downhill esophageal varices: a
complication of upper extremity hemodialysis access. Gastrointest
Endosc Mar 1998; 47:299-303.
13. Richardson MW, Allen GA, Monahan PE. Thrombosis in children:
current perspective and distinct challenges. Thromb Haemost
2002; 88:900-11.
14. Salonvaara M, Riikonen P, Kekomaki R, Heinonen K. Clinically
symptomatic central venous catheter-related deep venous thrombosis
in newborns. Acta Paediatr 1999; 88: 642-646.
15. Shapiro MA, Johnson M, Feinstein SB. A retrospective experience
of right atrial and superior vena caval thrombi diagnosed by
transesophageal echocardiography. J Am Soc Echocardiogr
2002; 15:76-79.

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