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Gameiro J, Outerelo C, Fortes A. Endovascular treatment of the stuck hemodialysis catheter: A report of two cases and literature review. J Vasc Access 2022; 24:11297298221074449. [PMID: 35090352 DOI: 10.1177/11297298221074449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A considerable number of patients present with stuck CVC after long-use of CVC, which is thought to result from the adhesion of the fibrous sheath, formed over the CVC, to the vessel or atrial wall. The removal of these catheters is a difficult and risky procedure. Hong reported a minimally invasive technique through endoluminal balloon dilation, which successfully breaks the adhesions and expands the vein, thus allowing for an easy removal of the CVC. The authors present two cases of a variant method of Hong's technique, and provide a literature review on stuck catheters. Our experience is that balloon angioplasty dilation is a safe and practical option. We highlight the role of experienced interventional nephrologists or radiologists in the management of this complication as endovascular treatment is the first line treatment.
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Affiliation(s)
- Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Cristina Outerelo
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Alice Fortes
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
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Passaro G, Pittiruti M, La Greca A. The fibroblastic sleeve, the neglected complication of venous access devices: A narrative review. J Vasc Access 2020; 22:801-813. [PMID: 32830599 DOI: 10.1177/1129729820951035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The presence of a vascular access device (or of any intravascular foreign body) inside the bloodstream is often associated with the formation of a connective tissue sleeve around the catheter (often named-erroneously-"fibrin sleeve"). Such sleeve is usually a physiological phenomenon with little or no clinical relevance, but its pathogenesis is still unclear, so that it is frequently confused with venous thrombosis; also, its relationship with other major catheter-related complications, such as venous thrombosis and bloodstream infection, is uncertain. This narrative review tries to convey in a systematic form the current knowledge about pathogenesis, incidence, clinical manifestations, diagnosis, and management of this phenomenon.
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Affiliation(s)
- Giovanna Passaro
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Antonio La Greca
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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Perandini S, Lucarelli A, Beleù A, Montemezzi S. Totally percutaneous endoluminal ballooning of stuck hemodialysis catheters: One-year experience of a referral center. J Vasc Access 2019; 21:395-398. [DOI: 10.1177/1129729819878622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The stuck catheter is an uncommon but dreaded complication of dialysis line placement. It always finds the operator unaware and often requires procedure modification or reschedule. Hong pioneered the technique of endoballooning to expand a stuck central venous catheter, thus freeing it from wall adhesions. The purpose of the current study was to present a totally percutaneous variation of endoluminal stuck catheters ballooning, along with our experience in terms of safety and feasibility. A major difference presented in respect to previous techniques is that this modification does not require isolation of the distal line stump at the venous entry point by tissue dissection, thus reducing procedural time and difficulty. We presented a case series of five lines that were ballooned by navigating low-profile material directly from the cutaneous exit of the lines, with optimal results (100% success). The findings of this investigation provide additional evidence with respect to the safety and effectiveness of endoluminal ballooning of Tesio lines and offer a new variation of endoluminal ballooning which we found easy to perform, safe, and effective.
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Affiliation(s)
- Simone Perandini
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonio Lucarelli
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessandro Beleù
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Xu LY, Qi F, Chen L, Chen DJ, Liu MM. Removal of a Stuck Tunneled Central Venous Catheter with the Assistance of Endoluminal Double Balloon Dilatation. Cardiovasc Intervent Radiol 2018; 41:360-362. [DOI: 10.1007/s00270-017-1804-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 09/21/2017] [Indexed: 11/30/2022]
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Comments on a stripping method to remove stuck catheter and a plea to adopt large size hemodialysis catheters. J Vasc Access 2017; 19:103-104. [PMID: 29147996 DOI: 10.5301/jva.5000814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Endoluminal Dilation Technique to Remove Stuck Port-A-Cath: A Case Report. Ann Vasc Surg 2017; 43:317.e1-317.e3. [DOI: 10.1016/j.avsg.2017.04.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 11/23/2022]
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Aworanti OM, Linnane N, Tareen F, Mortell A. Incidence and outcome of retained Port-A-Cath fragments during removal. Pediatr Surg Int 2017; 33:777-781. [PMID: 28584903 DOI: 10.1007/s00383-017-4103-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Port-A-Cath devices are frequently used for long-term venous access. We postulate that long-term use predisposes them to getting stuck and retained in a central vein at the time of removal. We aim to report the incidence and outcome of this complication. METHODS Between January 2006 and July 2016, a retrospective review of all Port-A-Cath removals that were performed at our centre was conducted. At the time of removal, catheters that could not be removed from the vein were considered retained. RESULTS During the study period, 107 children had 174 episodes of silicone Sitimplant (Vygon, Ecouen, France) Port-A-Cath insertions. These children required 135 removal episodes and there were 3 (2.2%) instances whereby the catheter fragment was retained. These episodes of retained catheters only occurred in children with factor VIII deficiency (4.1% incidence in this cohort). For each episode of catheter insertion and removal, the catheters had been left in situ for a mean duration of 43 months in children with factor deficiency and no retained fragments, and the mean duration was 91 months in children with factor deficiency and retained catheter fragments (p = 0.0011). CONCLUSIONS Port-A-Caths that are retained after attempted removal is a complication encountered predominantly in catheters that have been in use for a prolonged duration. Furthermore, factor replacement therapy in haemophiliacs may be a risk factor for this complication.
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Affiliation(s)
- Olugbenga Michael Aworanti
- Children's University Hospital, Temple street, Dublin, Ireland. .,Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
| | - Niall Linnane
- Children's University Hospital, Temple street, Dublin, Ireland
| | - Farhan Tareen
- Children's University Hospital, Temple street, Dublin, Ireland
| | - Alan Mortell
- Children's University Hospital, Temple street, Dublin, Ireland.,Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
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Talreja H, Ryan SE, Graham J, Sood MM, Hadziomerovic A, Clark E, Hiremath S. Endoluminal dilatation for embedded hemodialysis catheters: A case-control study of factors associated with embedding and clinical outcomes. PLoS One 2017; 12:e0174061. [PMID: 28346468 PMCID: PMC5367692 DOI: 10.1371/journal.pone.0174061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With the increasing frequency of tunneled hemodialysis catheter use there is a parallel increase in the need for removal and/or exchange. A small but significant minority of catheters become embedded or 'stuck' and cannot be removed by traditional means. Management of embedded catheters involves cutting the catheter, burying the retained fragment with a subsequent increased risk of infections and thrombosis. Endoluminal dilatation may provide a potential safe and effective technique for removing embedded catheters, however, to date, there is a paucity of data. OBJECTIVES 1) To determine factors associated with catheters becoming embedded and 2) to determine outcomes associated with endoluminal dilatation. METHODS All patients with endoluminal dilatation for embedded catheters at our institution since Jan. 2010 were included. Patients who had an embedded catheter were matched 1:3 with patients with uncomplicated catheter removal. Baseline patient and catheter characteristics were compared. Outcomes included procedural success and procedure-related infection. Logistic regression models were used to determine factors associated with embedded catheters. RESULTS We matched 15 cases of embedded tunneled catheters with 45 controls. Among patients with embedded catheters, there were no complications with endoluminal dilatation. Factors independently associated with embedded catheters included catheter dwell time (> 2 years) and history of central venous stenosis. CONCLUSION Embedded catheters can be successfully managed by endoluminal dilatation with minimal complications and factors associated with embedding include dwell times > 2 years and/or with a history of central venous stenosis.
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Affiliation(s)
- Hari Talreja
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen Edward Ryan
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet Graham
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adnan Hadziomerovic
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Clark
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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Application of Hong's technique for removal of stuck hemodialysis tunneled catheter to pacemaker leads. Radiol Case Rep 2016; 12:97-101. [PMID: 28228889 PMCID: PMC5310388 DOI: 10.1016/j.radcr.2016.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/22/2016] [Indexed: 11/22/2022] Open
Abstract
The term “stuck catheter” refers to situations where a central venous catheter cannot be removed from the central veins or right atrium using standard technique, usually due to development of a fibrin sheath leading to adherence to SVC or right atrial wall. Endoluminal dilatation is an interventional radiology technique that has been previously reported in the removal of stuck hemodialysis catheters, and to the best of our knowledge, this case describes the first application of the technique to remove a hemodialysis catheter that was adherent to SVC wall and transvenous pacemaker leads.
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Garcarek J, Gołębiowski T, Letachowicz K, Kusztal M, Szymczak M, Madziarska K, Jakuszko K, Zmonarski S, Guziński M, Weyde W, Klinger M. Balloon Dilatation for Removal of an Irretrievable Permanent Hemodialysis Catheter: The Safest Approach. Artif Organs 2015; 40:E84-8. [DOI: 10.1111/aor.12643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jerzy Garcarek
- Department of Radiology; Wroclaw Medical University; Wroclaw Poland
| | - Tomasz Gołębiowski
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Katarzyna Jakuszko
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Sławomir Zmonarski
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
| | - Maciej Guziński
- Department of Radiology; Wroclaw Medical University; Wroclaw Poland
| | - Wacław Weyde
- Department of Faculty of Dentistry; Wroclaw Medical University; Wroclaw Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wroclaw Poland
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Forneris G, Savio D, Quaretti P, Fiorina I, Cecere P, Pozzato M, Trogolo M, Roccatello D. Dealing with stuck hemodialysis catheter: state of the art and tips for the nephrologist. J Nephrol 2014; 27:619-25. [DOI: 10.1007/s40620-014-0150-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
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A Refinement of Hong's Technique for the Removal of Stuck Dialysis Catheters: An Easy Solution to a Complex Problem. J Vasc Access 2013; 15:183-8. [DOI: 10.5301/jva.5000186] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 11/20/2022] Open
Abstract
Aim 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.
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