Assessment of Venographic Abnormalities during Replacement of Dysfunctional Tunneled Hemodialysis Catheters and Outcome of Endovascular Salvage Techniques

Pae Sun Suh; Seon Young Park; Jinoo Kim; Chang Kwon Oh; Je Hwan Won

doi:10.3348/jksr.2018.79.3.152

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Suh, Park, Kim, Oh, and Won: Assessment of Venographic Abnormalities during Replacement of Dysfunctional Tunneled Hemodialysis Catheters and Outcome of Endovascular Salvage Techniques

Original Article

J Korean Soc Radiol 2018;79(3):152-160.

Published online: 19 January 2018

DOI: https://doi.org/10.3348/jksr.2018.79.3.152

Assessment of Venographic Abnormalities during Replacement of Dysfunctional Tunneled Hemodialysis Catheters and Outcome of Endovascular Salvage Techniques

Pae Sun Suh, MD¹, Seon Young Park, MD¹, Jinoo Kim, MD¹, Chang Kwon Oh, MD², Je Hwan Won, MD^1,

¹Department of Radiology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea

²Department of Surgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea

^∗Corresponding author: Je Hwan Won, MD Department of Radiology, Ajou University School of Medicine, 164 Worldcup-ro, Yongtong-gu, Suwon 16499, Korea. Tel. 82-31-219-5863 Fax. 82-31-219-5862 E-mail:wonkwak@ajou.ac.kr

Received 9 January 2018 Revised 10 May 2018 Accepted 16 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the venographic findings of central venous abnormalities before exchanging dysfunctional tunneled hemodialysis catheters and the outcome of endovascular salvage techniques.

Materials and Methods

A total of 110 episodes of tunneled hemodialysis catheter dysfunction in 78 patients undergoing catheter-directed hemodialysis treatment from January 2011 to December 2015 were retrospectively evaluated. Venography was performed before catheter exchange, and the following procedures were conducted according to the venographic findings: balloon disruption of a fibrin sheath, angioplasty for central vein stenosis, or stent insertion. Technical success was defined as at least one successful session of hemodialysis with the exchanged catheter. Patients were followed until the study endpoints or the last hospital visit.

Results

Venography showed abnormalities in patients with 67 of the 110 exchanged catheters, including central vein stenosis (n = 27), fibrin sheath formation (n = 17), and thrombus formation (n = 12). Technical success was confirmed in all cases. The estimated 30-day catheter patency for all assessable catheters was 61.7%. Nine catheters were removed during the follow-up period because of suspected catheter-related infections.

Conclusion:

In approximately 60% of cases of dysfunctional tunneled hemodialysis catheter, abnormal venographic findings were observed in the patients. Following appropriate endovascular techniques could be helpful in improving catheter patency with a low risk of procedure-related complications.

Keywords: Renal Dialysis, Catheters, Venography, Endovascular Procedures

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Fig. 1

Normal venography findings in 75-year-old male. The patient was managed with simple catheter exchange over the wire without additional intervention.

Fig. 2

A 68-year-old female. A. Venography reveals central vein stenosis at junction of superior vena cava-right atrium. B. The patient was managed with catheter exchange over the wire with adjustment of catheter tip position, avoiding the site of central vein stenosis.

Fig. 3

A 51-year-old female. A. Venography reveals fibrin sheath limiting contrast flow along the catheter insertion pathway. B, C. Balloon angioplasty was performed to rupture the fibrin sheath using a 14 mm × 4 cm Atlas percutaneous transluminal angioplasty dilatation catheter (Bard peripheral Vascular). Note the waist formation at the balloon during partial inflation (arrow). D. Repeated venography after the intervention no longer visualizes contrast flow limitation.

Fig. 4

A 45-year-old female. A. Venography reveals central vein stenosis at SVC level. B. Balloon angioplasty was performed at the level of stenotic central vein using a 12 mm × 8 cm Mustang balloon (Boston Scientific Corporation). C. Repeated venography after the intervention reveals improved stenosis at SVC level. SVC = superior vena cava

Fig. 5

A 81-year-old female. A. Venography reveals complex findings of central vein stenosis at SVC level (arrow) with fibrin sheath along catheter insertion pathway (arrowheads). B. Stenosis of SVC remained after several sessions of balloon angioplasty (not seen), and a 20 mm x 6 cm Palmaz Genesis peripheral stent (Cordis) was placed in the SVC despite the fact the patient had cardiac pacemaker installed. C. Repeated venography after the intervention reveals improved stenosis and disappearance of fibrin sheath. D. New catheter was inserted over the wire and lasted for 47 days. SVC = superior vena cava

Table 1.

Venography Findings

Venography findings	n (n = 110)	%
Abnormal	67	60.9
Central vein stenosis	27	40.3
Fibrin sheath formation	17	25.4
Thrombus formation	12	17.9
Complex∗	9	13.4
In-stent restenosis	2	3
Normal	43	39.1
With mechanical problem	4	9.3
Without mechanical problem	39	90.7

Two or more combined findings of central vein stenosis, fibrin sheath formation, thrombus formation.

Table 2.

Reason for Catheter Removal

Reason for removal	n (n = 67)	%
Dysfunction	31	46.3
Arteriovenous fistula maturation	11	16.4
nfection	9	13.4
Mechanical problem∗	7	10.4
Patient death	5	7.5
Others^†	4	6.0
Catheter dislodgement, injury, and leakage.

Patient refusal, renal transplantation, and recovery of native kidney function.

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