title: New method of forced implantation of permanent catheters for hemodialysis into critically stenosed or occluded central veins.
abstract: The aim of the study was to report a novel technique of forced implantation of catheters for hemodialysis into critically stenosed or occluded central veins, without preceding angioplasty or stenting.
  
  
  METHODS
  Sixteen patients with central venous occlusive disease, requiring urgent hemodialysis underwent this procedure. Catheterization of stenosis - occlusion was initially performed with soft guidewire, subsequently exchanged to stiff guidewire. Forced insertion of dilators, peel-off sheath throughout the stenosis or occlusion and finally implantation of the catheter completed the procedure. Our technique does not require pre-procedural angioplasty or stent deployment.
  
  
  RESULTS
  In all patients postoperative hemodialysis was managed with satisfactory adequacy. No early or late complications related to the procedure occurred. We did not observe any clinically significant aggravation of symptoms of central vein stenosis or occlusion. Complications, not-related to the procedure included one, late skin entry site infection and one, late catheter thrombosis. These were managed without the necessity of catheter exchange.
  
  
  CONCLUSIONS
  Our technique of forced implantation of catheters for hemodialysis into critically stenosed or occluded central veins without previous balloon predilatation or stenting is simple and diminishes the total cost of the procedure. Provides quick vascular access for hemodialysis in life threatening situations.
authors.forename: Stanisław
authors.initials: S
authors.lastname: Przywara
authors.forename: Marek
authors.initials: M
authors.lastname: Iłżecki
authors.forename: Piotr
authors.initials: P
authors.lastname: Terlecki
authors.forename: Tomasz
authors.initials: T
authors.lastname: Zubilewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016121:Brachiocephalic Veins / Q000601:surgery; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D054059:Coronary Occlusion / Q000150:complications* / Q000628:therapy*; D023921:Coronary Stenosis / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000601:surgery; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome