Solutions to stuck tunneled cuffed catheters in patients undergoing maintenance hemodialysis

2020 ◽  
pp. 112972982092816
Author(s):  
He Yongchun ◽  
Jiang Hua ◽  
Huang Xiaohan ◽  
Chen Jianghua ◽  
Zhang Ping
Keyword(s):  
Success Rate ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Maintenance Hemodialysis ◽  
Central Vein ◽  
Blunt Dissection ◽  
First Choice ◽  
Vein Stenosis ◽  
Percutaneous Transluminal

Objective: To study and discuss treatments for stuck tunneled cuffed catheter in patients undergoing maintenance hemodialysis. Method: Retrospectively analyzing clinical data of 13 patients with stuck tunneled cuffed catheter in the Kidney Disease Center of the First Affiliated Hospital, College of Medicine, Zhejiang University in the period between September 2012 and October 2018. All patients failed to remove hemodialysis catheters by regular technique. The stuck catheters were treated by thoracotomy, endoluminal percutaneous transluminal angioplasty with blunt dissection or embedded and left in situ. Results: In 13 patients, one was successfully treated by thoracotomy, one failed to remove the catheter by regular technique and blunt dissection, and the stump of the catheter was clamped and buried in the subcutaneous fascia of the neck, and the other 11 were treated by endoluminal percutaneous transluminal angioplasty with blunt dissection. The average time of catheter removal procedure is 25 min, the overall success rate is 92.3%, and the success rate of percutaneous transluminal angioplasty is 100%. Conclusion: Thoracotomy is an efficient way to treat stuck catheter but is limited by its high risk and complications. Leaving part of catheter in situ may increase the risk of central vein stenosis. Comparing to the former two, endoluminal percutaneous transluminal angioplasty is a safe, efficient, and practical way for stuck catheters and should be recommended as the first choice.

scholarly journals Central vein rupture during percutaneous transluminal angioplasty for central vein stenosis or occlusion in haemodialysis patients

2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Young J. Kim ◽  
Seung B. Yang ◽  
Woong H. Lee ◽  
Yong J. Kim ◽  
Jae M. Lee ◽  
...  
Keyword(s):  
Percutaneous Transluminal Angioplasty ◽  
Guide Wire ◽  
Transluminal Angioplasty ◽  
Central Vein ◽  
Chi Square ◽  
Central Venous Stenosis ◽  
Chi Square Test ◽  
Vein Stenosis ◽  
Percutaneous Transluminal ◽  
Central Vein Stenosis

Background: Endovascular treatments such as percutaneous transluminal angioplasty (PTA) and stent placements are becoming the standard method in managing haemodialysis access failure. Venous rupture is the most common complication during endovascular procedures. Complications during endovascular treatments of central venous stenosis or occlusion have been rarely reported.Objectives: To investigate the incidence and management of central vein rupture while performing PTA for central vein stenosis or occlusion in haemodialysis patients.Method: Between 1998 and 2013, PTA was performed using various techniques in haemodialysis patients for central vein stenoses (n = 2437) and occlusions (n = 666). When the guide wire passed through the stenosis or the occlusion, PTA was performed regardless of the presence of a venous rupture. The incidence of central vein rupture was analysed using the chi-square test according to the gender, location, right versus left, presence of thrombosis and stenosis versus occlusion. Percutaneous management of central vein rupture was also evaluated.Results: Central vein rupture occurred in 12 cases (0.39%). All ruptures occurred in the cases with occlusion. Only stenosis versus occlusion reflected a significant correlation (p < 0.001) with central vein rupture. Central vein ruptures were managed by low-pressure balloon tamponade (n = 2), stent/stent-graft (n = 5) and balloon-mediated haemostasis blocking venous inflow followed by the observation (n = 5).Conclusion: Central vein rupture is a rarely occurring complication while performing PTA for central vein stenosis and occlusion, and the majority can be successfully managed by percutaneous techniques.

Percutaneous Transluminal Angioplasty in Chronic Total Subclavian Venous Stenosis Using Coronary Guidewire: A Case Report

2021 ◽  
Author(s):  
Todung D. A. Silalahi ◽  
Christopher S. Suwita
Keyword(s):  
Success Rate ◽  
Subclavian Vein ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Alternative Technique ◽  
Stent Deployment ◽  
Total Occlusion ◽  
Venous Stenosis ◽  
Lower Success Rate ◽  
Percutaneous Transluminal

AbstractArteriovenous fistula is the best permanent vascular access for hemodialysis (HD). However, in our country, HD catheter in jugular or subclavian vein is more commonly found because our patients prefer to hold HD until the complications are unbearable. The catheter increases risk of venous stenosis on site and in surrounding vessels, resulting in access loss. Percutaneous transluminal angioplasty (PTA), combined with stent deployment, can be utilized as main treatment for such stenosis in subclavian vein. This method dated back to two decades ago with high success rate. Nevertheless, reports or studies of angioplasty in total occlusion are scarce, mainly because of lower success rate and the need of smaller penetrating wire. We describe our experience in performing PTA and stent deployment using coronary wire to penetrate total occlusion in subclavian venous stenosis after vein cannulation. We hope that we can give an alternative technique to avoid surgery in such cases.

scholarly journals The Reconstructions for Vertebral Artery Stenosis at the Origin

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 237-242 ◽  
Author(s):  
K. Yoshino ◽  
Y. Terai ◽  
S. Fujimoto ◽  
I. Kamata ◽  
K. Kinugasa ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Percutaneous Transluminal Angioplasty ◽  
Transluminal Angioplasty ◽  
Surgical Reconstruction ◽  
Invasive Treatment ◽  
First Choice ◽  
Long Term Follow Up ◽  
Percutaneous Transluminal

To date in our hospital, surgical reconstructions and percutaneous transluminal angioplasty (PTA) were carried out in 168 patients with vertebral artery (VA) stenosis at the origin. In this article, we discuss the comparison between surgical reconstructions and PTA, especially regarding long term follow up, patency and complications. PTA is a less invasive treatment for VA stenosis at the origin than surgical reconstructions. However, restenosis after PTA occurred in 20% of the patients. On the other hand, restenosis after surgical reconstructions did not emerge even in long term follow up. An embolism after PTA occurred in 2.6% of the cases. However, the embolism occurred in only the first 10 patients of our series, after that there was no embolism. We concluded that PTA was the first choice for VA stenosis at the origin, if the angiogram did not reveal any PTA difficulty. If restenosis after PTA was performed, we selected surgical reconstruction for VA stenosis at the origin.

scholarly journals Current state of dialysis treatment and vascular access management in Japan

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 10-14 ◽  
Author(s):  
Takashi Sato ◽  
Hiroshi Sakurai ◽  
Kentaro Okubo ◽  
Risa Kusuta ◽  
Takeshi Onogi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Percutaneous Transluminal Angioplasty ◽  
Japanese Society ◽  
Transluminal Angioplasty ◽  
Access Management ◽  
Dialysis Therapy ◽  
Arteriovenous Fistulae ◽  
First Choice ◽  
Dialysis Outcomes ◽  
Percutaneous Transluminal

According to the data from the Japanese Society for Dialysis Therapy, the number of dialysis patients was about 330,000 at the end of 2016. The mean age of newly initiated patients was 69.4 years and that of maintenance was 68.2 years. And, diabetic nephropathy is the most common primary disease, with an incidence rate of 43.2%. These results mean that the systemic vascular condition is getting worse. In spite of these backgrounds, the patients of 97.3% were treated by hemodialysis; therefore, careful management of vascular access is essential to better maintain the condition of patients. The Dialysis Outcomes and Practice Patterns Study shows that vascular access modalities are an important factor in determining prognoses of patients and that prognosis in Japan is one of the best worldwide. In Japan, the use of arteriovenous fistulae accounts for 95% of vascular access modalities. However, a statistic by Japanese Society for Dialysis Therapy suggests that the use of arteriovenous graft has been increasing. In 2005, Japanese Society for Dialysis Therapy Guidelines recommended percutaneous transluminal angioplasty be the first choice for the treatment of vascular access stenosis. Since then, percutaneous transluminal angioplasty has become an important procedure for long-term maintenance of the morphology and function of vascular access. In Japan, approximately 60% of percutaneous transluminal angioplasty are conducted by nephrologists and urologists; in addition, arteriovenous fistulae creation procedures are also performed by them. According to my private opinion, such conditions above show that even in the absence of standardized training on vascular access management, doctors on site perform their duties in an appropriate manner. However, the problems of how we evaluate the specificity in Japan and pass it down the generations still remain.

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