Be Positive: Breaking the Cycle of Recurrent Vascular Access Thrombosis
- Dialysis: Vascular Access
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 803 Dialysis: Vascular Access
- Horgan, Roisin, Galway University Hospitals, Galway, Galway, Ireland
- Kinane, Jenny, Galway University Hospitals, Galway, Galway, Ireland
- Corcoran, Niamh, Galway University Hospitals, Galway, Galway, Ireland
- Lappin, David, Galway University Hospitals, Galway, Galway, Ireland
Vascular access failure is a major cause of morbidity in patients on haemodialysis. Thrombosis and stenosis can occur due to shear stress on the vessel wall and formation of a thrombus or fibrin sheath. Recurrent episodes of vascular access failure in the absence of anatomical factors such as a venous stenosis or haemodynamic factors such as hypotension raise the possibility of an underlying hypercoagulable state.
A 28-year-old Irish male was commenced on haemodialysis via a tunnelled catheter following presentation with severe renal impairment with advanced chronic tubulointerstitial nephritis on biopsy. One year into diagnosis he began to experience repeated episodes of vascular access failure. Over the course of three months, he had five different malfunctioning catheters, including three right internal jugular tunnelled lines, one right internal jugular non-tunnelled line and one right femoral non-tunnelled line. This was despite use of catheter-locking solutions and heparin with dialysis. His left side was being saved for an arteriovenous fistula. He was screened for antiphospholipid syndrome as a cause of recurrent thromboses. He was found to have significant positivity for IgG anticardiolipin antibodies, IgG antibeta2 glycoprotein1 antibodies and lupus anticoagulant, persistent on two occasions more than twelve weeks apart. Triple antiphospholipid antibody positivity is associated with a high risk for thrombosis. He was commenced on warfarin with an INR target of 2-3. Seven months later he has had no further vascular access complications with a functioning right internal jugular tunnelled catheter and recent formation of a left arteriovenous fistula which is maturing well.
In this case a thrombophilia screen critically altered management, halting the cycle of recurrent access failures in a young patient on haemodialysis. It has been reported that there is a higher prevalence of antiphospholipid antibodies in the haemodialysis population and some studies suggest that these are associated with a higher incidence of vascular access thrombosis. Our patient was strongly positive for all three antiphospholipid antibodies, idenitifying him as of particularly high risk. This case highlights the need to consider thrombophilia as a cause of recurrent vascular access failure, particularly in cases without an identifiable stenosis.