A long-term tunneled hemodialysis catheter can be difficult or impossible to pull out if a fibrin sleeve has attached it to the venous wall. We report the outcome of a refinement of Hong's technique for removing incarcerated catheters aimed at improving its feasibility and safety.
Methods
We applied a modification of Hong's technique in four patients (two males, age ranging from 51 to 68 years) with jugular twin hemodialysis catheters (five of eight lines incarcerated). Hong pioneered the technique of endoballooning to expand a stuck central venous catheter, thus freeing it from adhesions. In our technical refinement, we cut the catheter close to its venous entry point in order to facilitate pullout and inserted a valved introducer as access for guide wires as well as for inflations of the catheter balloon. A stiff guide wire was placed in the inferior vena cava to avoid potential damage to heart cavities. Dilation was monitored under fluoroscopy with constrictions showing points where the catheter was incarcerated. If adhesions persisted through the same introducer, endoluminal dilations were repeated with a larger diameter balloon until the catheter was released. New catheters can be positioned using the stiff guide wire already in place. All removals were carried out under local anesthesia in an angiographic room by interventional radiologists.
Results
All catheters were successfully removed without complications. Average fluoroscopy time for removal was 12 minutes. In the case of a Tesio catheter removed after 12 years because of infection, a computed tomography scan 2 months later revealed persistence of a calcified fibrin sleeve in the vessel.
Conclusions
Hong's technique was confirmed to be a simple, safe and highly effective way to remove incarcerated long-term central venous catheters. The refinements we adopted made the procedure more flexible and possibly less prone to complications. By properly using ordinary tools available anywhere, Hong's technique could be considered Columbus’ egg in this previously risky field.
EthierJ., MendelssohnD.C., ElderS.J.. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study.Nephrol Dial Transplant.2008; 23(10): 3219–3226.
2.
VatsH.S.. Complications of catheters: tunneled and nontunneled.Adv Chronic Kidney Dis.2012; 19(3): 188–194.
3.
SequeiraA., SachdevaB., AbreoK.. Uncommon complications of long-term hemodialysis catheters: adhesion, migration, and perforation by the catheter tip.Semin Dial.2010; 23(1): 100–104.
4.
SchonD., WhittmanD.. Managing the complications of long-term tunneled dialysis catheters.Semin Dial.2003; 16(4): 314–322.
5.
KanadaD.J., JungR.C., IshiharaS.. Superior vena cava syndrome due to a retained central venous pressure catheter.Chest.1979; 75(6): 734–735.
6.
ForauerA.R., TheoharisC.. Histologic changes in the human vein wall adjacent to indwelling central venous catheters. J 15.Vasc Interv Radiol.2003; 14(9 Pt 1): 1163–1168.
WilsonG.J.P., Van NoeselM.M., HopW.C.J., Van der VenC.. The catheter is stuck: complications experienced during removal of a totally implantable venous access device. A single center study in 200 children.J Pediatr Surg.2006; 41(10): 1694–1698.
9.
HongJ.H.. A breakthrough technique for the removal of a hemodialysis catheter stuck in the central vein: endoluminal balloon dilatation of the stuck catheter.J Vasc Access.2011; 12(4): 381–384.
FarooqA., JonesV., AgarwalS.. Balloon dilatation: a helpful technique for removal of a stuck dialysis line.Cardiovasc Interv Radiol.2012; 35-6(6): 1528–1530.
12.
HassanA., KhalifaM., Al-AkraaM., LordR., DavenportA.. Six cases of retained central venous haemodialysis access catheters.Nephrol Dial Transplant.2006; 21(7): 2005–2008.
RozmusG., DaubertJ.P., HuangD.T., RoseroS., HallB., FrancisC.. Venous thrombosis and stenosis after implantation of pacemakers and defibrillators.J Interv Cardio Electro-physiol.2005; 13(1): 9–19.
15.
McIntyreC.W., TaalM.W., FluckR.J., HinwoodD.. Adherence of tunnelled haemodialysis catheter to superior vena caval stent: successful percutaneous removal.Nephrol Dial Transplant.2003; 18(2): 432–433.
16.
AshizawaA., KimuraG., SanaiT.. Idiopathic left innominate vein stenosis manifested following the creation of arteriovenous fistula in uremia.Am J Nephrol.1994; 14(2): 142–144.
17.
FieldM., PughJ., AsquithJ., DaviesS., PherwaniA.D.. A stuck hemodialysis central venous catheter.J Vasc Access.2008; 9(4): 301–303.
18.
TheinH., RatanjeeS.K.. Tethered hemodialysis catheter with retained portions in central vein and right atrium on attempted removal.Am J Kidney Dis.2005; 46(3): e35–e39.
HongJ.H.. An easy technique for the removal of a hemodialysis catheter stuck in central veins.J Vasc Access.2010; 11(1): 59–62.
21.
CarrilloR.G., GaristoJ.D., SalmanL., MerrillD., AsifA.. A novel technique for tethered dialysis catheter removal using the laser sheath.Semin Dial.2009; 22(6): 688–691.
22.
AkgunS., AkK., TugrularS., CivelekA., IsbirC., ArsanS.. Median sternotomy for an unexpected complication of permanent hemodialysis catheters: ‘stuck catheter’.VASA.2008; 37(3): 293–296.
