Abstract: SA-PO959
A Hybrid Technique in Recanalization of Multiple Central Venous Occlusions in Hemodialysis Patients: A Cohort Study
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Zhao, Yuliang, Division of Nephrology, West China Hospital, Sichuan University, Chengdu, China
- Fu, Ping, Division of Nephrology, West China Hospital, Sichuan University, Chengdu, China
Background
The management to multiple central venous occlusions (CVO) in hemodialysis patients remains difficult. This present study aims to assess the feasibility and safety of a hybrid technique in recanalizing multiple CVO in hemodialysis population.
Methods
From January 2014 to November 2017, hemodialysis patients with multiple CVO were enrolled. Under DSA guidance, patients received a hybrid technique combining direct puncture, sharp transversal, and balloon dilation of the SVC, followed by tunneled cuffed catheter implantation (figure). The demographic information and clinical outcomes were recorded.
Results
A total of 16 patients were involved in this study. The procedure was successfully performed in 15 cases and failed in 1 patient due to full-length obstruction of the SVC. 1 patient presented with transient cardiac arrest. 2 patients suffered mild pericardial tamponade, both stabilized afterwards. All 14 patients with successful catheter implantation had satisfactory patency after the procedure.
Conclusion
This hybrid technique could be performed effectively in selected hemodialysis patients with multiple CVO. It could be a viable alternative for hemodialysis catheterization in the setting of an exhausted central venous system with multiple CVO.
Figure: the procedure of the hybrid technique
(Under DSA guidance, patients with SVC occlusion (arrow head) with dilated azygos vein (triangle) were identified (figure A, B). The distal part of SVC was directly punctured (figure C), as verified by contrast. Under guidance in anterior-posterior view and lateral view of DSA, we penetrated the occlusive SVC segment and then advance guide wire through the SVC into the IVC (figure D). The occlusive lesion was dilated with balloon (figure E), which enabled successful tunneled cuffed catheter implantation (figure F).)