Percutaneous access to the right atrium through the site of superior vena cava occlusion to re-catheterization for a maintenance hemodialysis patient with central venous obstruction

Abstract

Central venous catheters are commonly used for hemodialysis, but prolonged use can lead to complications such as central venous occlusion, resulting in catheter-dependent dialysis patients being unable to undergo dialysis. Herein, we present the case of a 57-year-old female patient who had been dependent on catheter-based hemodialysis for 8 years. Her tunneled central venous catheter (TCC) had been replaced three times and she had developed severe central venous occlusion. For this patient, a procedure was performed involving a percutaneous puncture through the site of superior vena cava occlusion to gain access to the right atrium. The intervention utilized multiple surgical instruments, including a transseptal needle in combination with the stiffening cannula from the RUPS-100 Suite, to facilitate re-catheterization for maintenance hemodialysis. We discuss the feasibility of such procedures as a last-resort option while emphasizing the associated risks.

Keywords

Central venous catheters central venous occlusion superior vena cava occlusion percutaneous superior vena cava puncture

Get full access to this article

View all access options for this article.

References

Lok

Huber

Lee

, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis 2020; 75(4 Suppl 2): S1–S164.

Rice

Rodriguez

Light

RW.

The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore) 2006; 85(1): 37–42.

Toda

Asada

Komiya

Brachiocephalic vein occlusion from a tunneled hemodialysis catheter. Intern Med 2019; 58(22): 3339–3340.

Reindl-Schwaighofer

Matoussevitch

Winnicki

, et al. A novel inside-out access approach for hemodialysis catheter placement in patients with thoracic central venous occlusion. Am J Kidney Dis 2020; 75(4): 480–487.

Zhao

Lin

Yang

, et al. Sharp recanalization of the brachiocephalic vein occlusion through the external jugular vein in hemodialysis patients. Ann Transl Med 2020; 8(10): 640.

Yang

Zhao

, et al. The feasibility and safety of sharp recanalization for superior vena cava occlusion in hemodialysis patients: a retrospective cohort study. Hemodial Int 2020; 24(1): 52–60.

Azizi

Shafi

Shah

, et al. Superior vena cava syndrome. JACC Cardiovasc Interv 2020; 13(24): 2896–2910.

Zhao

Wei

, et al. Percutaneous superior vena cava puncture for hemodialysis catheter placement. J Vasc Surg Venous Lymphat Disord 2023; 11(2): 318–325.

Xiong

Cui

Angled, long-segment central venous occlusion in a hemodialysis patient recanalized by a novel “two-step” strategy based on percutaneous superior vena cava puncture. Ther Apher Dial 2021; 25(5): 712–713.

10.

Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006; 48 Suppl 1: S248–S273.

11.

Kundu

Central venous disease in hemodialysis patients: prevalence, etiology and treatment. J Vasc Access 2010; 11(1): 1–7.

12.

Saran

Robinson

Abbott

, et al. US Renal Data System 2019 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2020; 75(1 Suppl 1): A6–A7.

13.

Rizvi

Kalra

Bjarnason

, et al. Benign superior vena cava syndrome: stenting is now the first line of treatment. J Vasc Surg 2008; 47(2): 372–380.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.21 MB

0.12 MB