CT-Guided Superior Vena Cava Puncture: A Solution to Re-Establishing Access in Haemodialysis-Related Central Venous Occlusion Refractory to Conventional Endovascular Techniques.
OBJECTIVE
The purpose of this technical note is to demonstrate the novel use of CT-guided superior vena cava (SVC) puncture and subsequent tunnelled haemodialysis (HD) line placement in end-stage renal failure (ESRF) patients with central venous obstruction refractory to conventional percutaneous venoplasty (PTV) and wire transgression, thereby allowing resumption of HD.


METHODS
Three successive ESRF patients underwent CT-guided SVC puncture with subsequent tract recanalisation. Ultrasound-guided puncture of the right internal jugular vein was performed, the needle advanced to the patent SVC under CT guidance, with subsequent insertion of a stabilisation guidewire. Following appropriate tract angioplasty, twin-tunnelled HD catheters were inserted and HD resumed.


RESULTS
No immediate complications were identified. There was resumption of HD in all three patients with a 100% success rate. One patient's HD catheter remained in use for 2 years post-procedure, and another remains functional 1 year to the present day. One patient died 2 weeks after the procedure due to pancreatitis-related abdominal sepsis unrelated to the Tesio lines.


CONCLUSIONS
CT-guided SVC puncture and tunnelled HD line insertion in HD-related central venous occlusion (CVO) refractory to conventional recanalisation options can be performed safely, requires no extra equipment and lies within the skill set and resources of most interventional radiology departments involved in the management of HD patients.
Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK. mkhalifa@nhs.net.
Mohamed
M
Khalifa
Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK. neeral.patel06@gmail.com.
Neeral R
NR
Patel
Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK. steven.moser@imperial.nhs.uk.
Steven
S
Moser
D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling; D003251:Constriction, Pathologic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008875:Middle Aged; D011677:Punctures / Q000379:methods*; D006435:Renal Dialysis / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*
CT-guided puncture; Central venous occlusion; Dialysis line; End-stage renal failure; Haemodialysis