In Reply to: 597 04 -- Catheter-related SVC thrombosis posted by Editor on May 15, 1997 at 17:01:43:
In this case, given the clot burden, I would have infused urokinase also. Did you check the catheter during the 18 hour infusion or was this a late afternoon case that ran through the night?
The catheters I've seen with such thrombus have usually responded well to a 6 hour infusion, not necessitating overnight admission. That assumes, of course, they found the problem at dialysis in the morning and then got the patient to you soon after.
Most of the dysfunctional catheters we've seen have looked more like fibrin sheaths than such clear big clots. Those are the cases, depending upon how you've been convinced, that are better treated with stripping or exchanges. Because of the data that Ziv refers to, I'm a fan of exchanges.
I wonder if part of the poor durable response to stripping PermCaths is the geometry of the tip. I usually get a nice response to rounded Hickman tips. I suspect the tapered knobby PermCath tip doesn't get a "close shave" concentrically with a snare.