Efficacy of angioplasty for tunneled cuffed catheter placement in hemodialysis patients with superior vena cava occlusion / 中华肾脏病杂志

ABSTRACT

Objective:To evaluate the efficacy of angioplasty on percutaneous superior vena cava occlusion in hemodialysis patients with tunnel-cuffed catheter (TCC) under digital subtraction angiography (DSA) guidance.Methods:A total of 62 hemodialysis patients with TCC in the First Affiliated Hospital of Sun Yat-sen University from December 2017 to June 2020 were enrolled retrospectively. According to the patency of the superior vena cava, the patients were divided into experiment group ( n=20) and control group ( n=42) in this study. Hemodialysis patients with superior vena cava occlusion in the experiment group received angioplasty, including balloon angioplasty, stenting and sharp recanalization, and catheterization with TCC under DSA guidance, while hemodialysis patients without superior vena cava occlusion in the control group only underwent catheterization with TCC under DSA guidance. The 1-year TCC patency rate, postoperative TCC blood flow and treatment-related complications between the two groups were compared. Results:In the experiment group, a total of 11 patients were treated only by percutaneous transluminal angioplasty, while 9 patients were treated combined percutaneous transluminal angioplasty with stent placement. In addition, 3 patients underwent sharp recanalization of superior vena cava occlusion. A total of 9 stents and 29 balloons were used. The course of dialysis in experiment group was longer than that in control group ( P<0.05). There were no significant differences in the 1-year TCC patency rate (85.0% vs 95.2%, P>0.05), postoperative TCC blood flow [(257.83±16.55) ml/min vs (251.90±18.79) ml/min, P>0.05] and incidence of treatment-related complications (grade 1-2, 30.0% vs 35.7%, P>0.05) between the two groups, respectively. Patients in the two groups had none of serious operation-related complications, and only some patients had mild clinical manifestations, such as postoperative pain and bleeding at the puncture point. Conclusions:For patients with longer duration of hemodialysis and superior vena cava stenosis and occlusion treated with angioplasty, the clinical effect of TCC within one year is equivalent to that of hemodialysis patients without angioplasty.