The role of vascular echography in the management of complications associated with central venous access for hemodialysis in cancer patients: two case reports and literature review

Abstract Central venous catheter implantation for hemodialysis is commonly performed in large centers and its complications are sometimes associated with insufficient training of those who perform it, but may also be related to the patient’s clinical condition. The present study reports two cases of complications related to use of a short-stay catheter for hemodialysis. In the first case, the cannula was inadvertently inserted into the left subclavian artery, causing arterial thrombosis, which was conservatively managed and good collateral perfusion was documented with vascular echography. The second case illustrates an incidental finding of Central Venous Septic Thrombosis in a patient who had used a catheter for a week, which was treated with antibiotic therapy, anticoagulation, and ultrasound control. In both cases, surgical intervention would have been high risk because of the patients' poor prognosis. Vascular ultrasonography enabled monitoring of these clinical situations and use of less aggressive treatments.

摘要 血液透析用中心静脉导管置入术（Central venous catheter implantation for hemodialysis）通常在大型医疗中心开展，其并发症的发生有时与术者操作培训不足相关，但也可能与患者自身的临床状态有关。本研究报道2例血液透析短期留置导管相关并发症病例：首例病例中，导管不慎置入左锁骨下动脉，引发动脉血栓形成；经保守治疗后，血管超声（vascular echography）证实侧支灌注良好。第二例病例为一名导管使用时长达1周的患者，偶然检出中心静脉化脓性血栓形成（Central Venous Septic Thrombosis），经抗生素治疗、抗凝治疗及超声随访后病情得到有效控制。两例患者均因预后不佳，手术干预风险极高。血管超声（vascular ultrasonography）可对上述临床情况进行精准监测，从而得以采用侵袭性更低的保守治疗方案。