Clinical value of interventional radiology in hemodialysis patients with stuck tunnel dialysis catheter / 中华肾脏病杂志

ABSTRACT

Objective To evaluate clinical value of interventional radiology in difficult extraction of stuck tunnel hemodialysis catheter (TCC).Methods Maintenance hemodialysis patients who required removal of stuck TCC in our hospital from June 2015 to June 2017 were enrolled.Medical history and preoperative examinations were carefully evaluated.Patients were pulled rotationally the catheter under the fluoroscopy guidance and exchanged the TCC.The information and procedure-related complication were recorded.Balloon dilation or snare technique would be used when failed to remove the stuck catheter.Results A total of 22 patients were enrolled,with an average age of (67.2±18.5) years,a median dialysis time of 54(18,106) months,and catheter indwelling time of 37(14,82) months.All patients were successfully removed the stuck catheter,among which 18 cases (81.8％) had fibrin sheath and 13 cases with sheath calcification.TCC mainly stuck in the junction of internal jugular vein and innominate vein,middle and lower innominate vein and middle part of superior vena cava.No procedure-related major complication occurred.Sixteen cases (72.7％) complained of transient substernal extraction pain and 1 case occurred groin hematoma during operation.Conclusions Catheter incarceration problem should be alert to the hemodialysis patients with catheter indwelling time of more than 2-3 years.The minimally invasive interventional techniques including rotationally pull-out under fluoroscopy guidance and balloon angioplasty are safe and effective in removal of the stuck TCC.