title: A novel technique for tethered dialysis catheter removal using the laser sheath.
abstract: Traction and cutdown techniques can successfully remove a tunneled dialysis catheter (TDC) in a great majority of patients. However, these methods may not be successful in patients with catheters that are tethered or attached to the central veins or the atrium. A forceful application of traction can lead to catheter breakage with subsequent retention of the broken piece and carries a potential risk of vascular and atrial wall avulsion. Open thoracotomy has been employed to remove an attached TDC. However, this procedure is invasive and bears a significant morbidity. This report presents three cases of tethered TDCs that underwent laser sheath extraction. The TDCs had been in place for an average of 26 months. The patients underwent initial unsuccessful removal attempt using the traction method with surgical exploration all the way to the venotomy site. The laser technique that is used to remove pacemaker/implantable cardioverter defibrillator leads was then applied to these stuck catheters. All three catheters were successfully removed without any damage to the catheter, central veins, or the right atrium. There were no retained catheter fragments left in the central veins or the atrium. One patient demonstrated a significant thrombus that extended from the tip of the catheter all the way to the right ventricle. The external sheath of the laser device successfully aspirated the thrombus. There were no procedure-related complications. In this small series, a laser sheath successfully extracted tethered dialysis catheters. The study found the procedure to be effective, easy to perform, and minimally invasive. We suggest that this approach be considered for the removal of tethered catheters that cannot be removed using traditional approaches.
authors.affiliation: Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida 33125, USA. rcarrillo@med.miami.edu
authors.forename: Roger G
authors.initials: RG
authors.lastname: Carrillo
authors.forename: Juan D
authors.initials: JD
authors.lastname: Garisto
authors.forename: Loay
authors.initials: L
authors.lastname: Salman
authors.forename: Donna
authors.initials: D
authors.lastname: Merrill
authors.forename: Arif
authors.initials: A
authors.lastname: Asif
mesh_terms: D000328:Adult; D016121:Brachiocephalic Veins; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D020878:Device Removal / Q000295:instrumentation*; D004452:Echocardiography; D004868:Equipment Failure; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D007601:Jugular Veins; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation*; D013350:Subclavian Vein; D000267:Tissue Adhesions / Q000209:etiology / Q000628:therapy*; D014683:Vena Cava, Superior