Endovascular technique for revision of excess catheter length in subcutaneous implanted venous access devices.

To describe the implementation of a technique to trim the excess length of a central venous catheter via a process of endovascular snaring without exposing or changing the device. We report on the outcome of this technique in 3 patients. The technique was successful in two cases and successful with a modification in the remaining case. The technique is useful to salvage an implanted venous access device. It appears to be less invasive with reduced procedure time and less patient discomfort than other techniques.

Why do grafts clot despite access blood flow surveillance?

PURPOSE: To look in more detail at those grafts that clot despite access blood flow (ABF) surveillance and the outcome of radiological thrombectomy in those grafts. METHODS: Retrospective review was carried out of all polytetrafluoroethylene grafts that clotted from September 1, 1998 to October 30, 2000. During this period, each graft had ABF measured monthly and was referred for prophylactic angioplasty if flow fell below 600 ml/min or by 25%. RESULTS: Thirty-one of 62 monitored grafts clotted (0.44 episodes per patient per month). Five were surgically thrombectomized and 19 were radiologically thrombectomized. The last available ABF prior to graft thrombosis averaged 804 +/- 108 ml/min and ranged from 215 to 2497 ml/min. Nine of the 23 grafts failed to trigger either of the ABF criteria prior to initial thrombosis. All but one of the 17 grafts thrombolysed radiologically showed evidence of significant (>50%) venous stenoses, though additional lesions were found in nine. Thrombolysis was successful in 14 grafts, with ABF rising from 693 +/- 96 to 941 +/- 135 ml/min (p <0.05). Six additional grafts reclotted and were lost (6-month graft survival 37%). CONCLUSION: (1) A significant proportion (40%) of graft thromboses that occur despite ABF surveillance occur in grafts with preserved ABF (>600 ml/min); (2) over 70% can be successfully thrombectomized/angioplastied with about 35% long-term (6 months) survival.

Percutaneous transrenal hemodialysis catheter insertion.

During the course of providing adequate access for hemodialysis, the majority of patients with end-stage renal disease will encounter episodes of catheter dependency. Although catheter-based dialysis is inferior to that obtained through native or synthetic arteriovenous conduits, it is often the only way to provide durable venous access into the central venous circulation system for large volume exchanges. Traditional sites for venous access such as internal/external, subclavian, and common femoral veins will eventually occlude. When alternative percutaneous access sites such as translumbar, transhepatic, and transazygous fail or become less desirable, other approaches become necessary. The authors report a successful case of transrenal access into the renal vein with consequent insertion of a tunneled catheter for hemodialysis in a patient with limited options.