title: Placement of hemodialysis catheters through stenotic or occluded central thoracic veins.
abstract: A method for hemodialysis catheter placement in patients with central thoracic venous stenosis or occlusion is described and initial results are analyzed. Twelve patients, with a mean age of 63.2 years (42-80 years), with central venous stenosis or occlusion, and who required a hemodialysis catheter were reviewed. All lesions were confirmed by helical CT or phlebography. Five patients had stenosis while seven patients were diagnosed with an occlusion of thoracic central veins. All patients were asymptomatic, without sign of superior vena cava syndrome. After percutaneous transstenotic catheterization or guidewire-based recannalization in occlusions, a balloon dilatation was performed and a stent was placed, when necessary, prior to catheter placement. Technical success was 92%. Three patients had angioplasty alone and nine patients had angioplasty with stent placement. Dialysis catheters were successfully inserted through all recannalized accesses. No immediate complication occurred, nor did any patient develop superior vena cava syndrome after the procedure. The mean follow-up was 21.8 months (range, 8-48 months). Three patients developed a catheter dysfunction with fibrin sheath formation (at 7, 11, and 12 months after catheter placement, respectively). Two were successfully managed by percutaneous endovascular approach and one catheter was removed. In conclusion, for patients with central venous stenosis or occlusion and those who need a hemodialysis catheter, catheter insertion can be reliably achieved immediately after endovascular recannalization with acceptable technical and long-term success rates. This technique should be considered as an alternative procedure for placing a new hemodialysis catheter through a patent vein.
authors.affiliation: Unit of Thoracic and Vascular Surgery, CHUV-University of Lausanne, Rue du Bugnon 46, Lausanne, 1011, Switzerland. claude.haller@rsv-gnw.ch
authors.forename: Claude
authors.initials: C
authors.lastname: Haller
authors.forename: Sébastien
authors.initials: S
authors.lastname: Déglise
authors.forename: Francois
authors.initials: F
authors.lastname: Saucy
authors.forename: Claudine
authors.initials: C
authors.lastname: Mathieu
authors.forename: Erik
authors.initials: E
authors.lastname: Haesler
authors.forename: Francesco
authors.initials: F
authors.lastname: Doenz
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Corpataux
authors.forename: Salah Dine
authors.initials: SD
authors.lastname: Qanadli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D002404:Catheterization; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D006435:Renal Dialysis / Q000295:instrumentation*; D013909:Thorax / Q000098:blood supply*; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000473:pathology*