Percutaneous Mechanical Thrombectomy of a Superior Vena Cava and Right Atrial Thrombus Complicating a Malfunctioning Tunneled Dialysis Catheter.

Tunneled dialysis catheters are a mainstay of hemodialysis access but are complicated over time by central venous stenosis and catheter-related thrombus, both of which can impair catheter function and threaten future access. We describe the case of a 77-year-old woman who required hemodialysis for acute kidney injury on underlying chronic kidney disease and, within weeks of placement of her first right internal jugular tunneled dialysis catheter, developed superior vena cava (SVC) stenosis and an organized thrombus at the cavoatrial junction extending into the right atrium (RA). The thrombus caused catheter malfunction with low flow and clotting. Cardiac computed tomography confirmed the SVC/RA thrombus. In a single percutaneous session, mechanical thrombectomy, SVC angioplasty, and catheter exchange achieved complete thrombus clearance and a widely patent SVC, and restored catheter function without thrombolysis or open surgery. This case illustrates thrombolytic-free mechanical thrombectomy as an effective, thrombolytic-free treatment option for catheter-associated SVC/RA thrombus that preserves dialysis access in a single sitting.