CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 AFRICA 125 Discussion CVCs are frequently used in clinical settings. They are used for blood pressure monitoring, fluid infusion and blood transfusion, particularly in critically ill patients.1 A symptomatic or asymptomatic thrombosis is one of the most serious complications of these devices. Ultrasonography is used during catheter placement because it can improve placement success and reduce the risk of complications. It is rarely used regularly to detect the presence of a thrombus, but ultrasound is another examination that is frequently used to diagnose thrombus.2-5 CVC thrombi can result in infection, pulmonary emboli, right heart thromboemboli and vascular and duct obstructions.4,6 In two to 26% of instances, thrombotic incidents occur.7,8 Asymptomatic CVC-related thrombosis is more prevalent in these patients, but its clinical significance is unknown.9 Although the best therapeutic approach has not been found, LMWH, a safe and effective medication, is useful in treating catheter-related thrombosis.10,11 Platelet aggregation is a key component of thrombus formation.12 In this patient, one could argue that following TAVI, we focused more on thrombosis and infection of the implanted biological valve, as well as the usual antiplatelet and infection treatment. Insufficient attention was paid to a potential thrombosis associated with the CVC because of the patency of the vessel and the patient’s lack of discomfort during catheter use. There seems to be a consensus that even if there is thrombosis, the vessel is usually unobstructed. Therefore, CVC implantation with ultrasound guidance is not advised for routine thrombosis prevention.13,14 This increases the challenge of thrombus identification. Conclusion This case emphasises the need to improve early detection and prompt treatment of CVC-related thrombosis, particularly in those patients with asymptomatic thrombosis. Fig. 3. Doppler ultrasonography revealing a distal floating thrombosis (red arrow) in the distal part of the right internal jugular vein. Fig. 4. Doppler ultrasonography revealing no thrombus in the right internal jugular vein catheterisation. Fig. 5. Ultrasonography revealing no thrombus in the right internal jugular vein. Fig. 2. Ultrasonography revealing a distal floating thrombosis (red arrow) in the distal part of the right internal jugular vein.
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