Abstract | OBJECTIVE: Central venous occlusion (CVO) refractory to endovascular angioplasty is a critical challenge that threatens hemodialysis vascular access. In the present study, we evaluated the efficacy and safety of tunneled, cuffed central venous catheter ( tCVC) placement via percutaneous superior vena cava (SVC) puncture in patients with refractory CVO. METHODS: Patients requiring maintenance hemodialysis with refractory CVO who had undergone percutaneous SVC puncture and tCVC insertion at a university-affiliated hospital from January 2016 to June 2020 were included. The patients were followed up until May 2021. The demographic information, complications, and catheter patency were analyzed. RESULTS: A total of 205 patients (105 women [51.2%]; mean age, 61 ± 15 years) were included. The SVC puncture and tCVC insertion were successfully performed in 194 patients, for a technical success rate of 94.6%. One patient had experienced a pleura injury and hemothorax and had required urgent thoracotomy. A total of 37 patients had presented with mild chest pain and were prescribed oral nonsteroidal anti-inflammatory drugs. During follow-up of the 194 patients with a successful procedure, catheter dysfunction due to thrombosis had occurred in 66 patients, catheter malposition had occurred in 5 patients, and catheter-related blood stream infection had developed in 6 patients. The 3-year primary patency rate was 64.2%, and the 3-year secondary patency rate was 76.3%. CONCLUSIONS: A tCVC placed through a percutaneous SVC puncture had a satisfactory technical success rate and long-term patency rate in patients requiring hemodialysis, providing an optional vascular access for those with exhausted central vein resources. SVC puncture also avoided the use of left-sided catheters and preserved central vein resources. Caution should be given to avoid potential complications such as pleura injury and hemothorax.
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Authors | Yuliang Zhao, Qiuyan Zhao, Wei Wei, Letian Yang, Yang Yu, Li Zhou, Ping Fu, Tianlei Cui |
Journal | Journal of vascular surgery. Venous and lymphatic disorders
(J Vasc Surg Venous Lymphat Disord)
Vol. 11
Issue 2
Pg. 318-325
(03 2023)
ISSN: 2213-3348 [Electronic] United States |
PMID | 36179787
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- S-(1,2,2-trichlorovinyl)-L-cysteine
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Topics |
- Humans
- Female
- Middle Aged
- Aged
- Vena Cava, Superior
- Hemothorax
- Central Venous Catheters
- Renal Dialysis
- Punctures
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