Atypical Placement of Hemodialysis Catheters in Patients with Complete and Irreversible Obstruction of Central Venous Vessels

Abstract

Purpose This article describes the approach to atypical placement of central venous catheters (CVC) in dialysis patients with complete untreatable obstruction of central venous vessels. Methods Five patients with complete obstruction of central venous vessels underwent CT venography and digital venous angiography. After ultrasound-guided and radioscopic-assisted cannulation of the internal jugular vein, permanent CVCs were placed in atypical locations: in two patients a preliminary venous angioplasty was performed to facilitate the catheter positioning in a mediastinal enlarged collateral vein and in a persistent left superior vena cava; in three patients the CVC was placed in the azygos vein, enlarged because of the obstruction of the superior vena cava. Results In all cases, we achieved satisfactory morphological and functional immediate results. Hemodialysis (HD) was carried out long term in all patients except one who presented a non-functioning CVC after 4 months. In one case the catheter, still functioning well after 9 months, was removed due to kidney transplantation. The CVC in the left superior vena cava was replaced with a longer one after 12 months, and it is still functioning well 3 months after replacement. The patency of the other two catheters has to date been kept for 9 and 18 months. Conclusions The placement of CVC for HD in atypical sites can be considered a viable option in extreme cases; adequate imaging support is paramount in order to facilitate the procedure and to avoid complications.

The Value of CT Angiography Based on Intelligent Segmentation Algorithm for Survival of Hemodialysis Patients

“…Doppler ultrasound and angiography are important methods for diagnosing central venous vascular dysfunction [ 16 ]. However, due to gas interference, ultrasonic diagnosis of central vein is poor [ 17 ]. Although angiography is the gold standard for the diagnosis of vascular diseases, digital subtraction angiography (DSA) is an invasive examination, which can only show the blood flow in the cavity and cannot show the spatial relationship of adjacent tissue structures [ 18 ].…”

Tunneled‐cuffed catheter implanted into the accessory hemiazygos vein because of occlusion of the left innominate vein

“…Catheter placement into the enlarged azygos vein because of SVC occlusion seems to be a valuable option . In a recently published article by Messina et al., left‐sided approach to the azygos vein has been described …”

Heamodialysis Patients;

“…6,7,8 and sometimes due to stenosis patient has to undergo special and costly imaging to undergo catherization at atypical sites. 9 Few studies conducted on various type of populations has been conducted and data on the prevalence of central venous stenosis following catheterization in Pakistan. Recent studies have thrown the debate of preferred site of insertion into a controversy.…”