Endovascular Removal of Long-Term Hemodialysis Catheters

Abstract

Central venous catheters that have been in place for a long time can become fixed to the vein wall, making them impossible to pull out. Leaving them in situ is undesirable because of the risk that they could act as a nidus for thrombosis. Moreover, inserting new catheters alongside the old ones might compromise flow in the superior vena cava, further predisposing to thrombosis. Surgical removal is likewise undesirable, as this would necessitate thoracotomy with the attendant risks. We describe a novel technique, which we were able to use to remove retained long-term hemodialysis catheters in a patient who needed new catheters and who would have been a high-risk candidate for surgery. The right internal jugular vein was punctured adjacent to the site of insertion and a guide wire was used to form a snare, which was passed around the catheters and used to saw through the fibrous attachments to the vein wall. The midsection of one catheter could not be freed but the snare was used to cut off the proximal and distal ends, which could then be removed, the latter via the femoral vein. New catheters were then inserted via the left internal jugular vein. This technique enabled successful catheter extraction and replacement in a patient who would have been a poor candidate for cardiothoracic surgery.

Difficult central venous access removal: case reports of the use of endovascular snare shearing of endothelialized tetherings

“…Importantly, these advanced techniques for endocardial lead extraction continue to be performed in the operating room because of the risk of lifethreatening complications as well as the possibility of failure, necessitating a more invasive surgical approach. In a single-case report, a tethered long-standing hemodialysis catheter was removed by an endovascular technique [12]. In this case, the authors described a "sawing to-and-fro motion" using a snare between the fibrin sheath and the venous wall.…”

Dealing with stuck hemodialysis catheter: state of the art and tips for the nephrologist

“…The wire that is placed around the catheter by a to and fro motion cuts the line free from the sidewall of the vein. Despite the relative speed of the procedure (15'), Foley et al report incomplete removal of the catheter with a residual fragment left in situ (21). Although no consequences are reported regarding this case, there is still the possibility of long term and potentially life-threatening complications (22).…”

Clinical case of a stuck central venous catheter left in situ

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“…In un precedente articolo (1) abbiamo descrittoduecasididifficoltosarimozione diunCVCpesottolineatocomeilsuouso sempre più esteso, sarà associato a un aumentoditaleproblematica (2)(3)(4)(5).…”