Abstract: PUB180
Recanalization of Filter-Bearing Inferior Vena Cava Occlusion: Management Conundrum
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Boktor, Ivana, George Walton Comprehensive High School, Marietta, Georgia, United States
- Ali, Ahmed E., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- Varma, Rakesh K., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Almehmi, Ammar, The University of Alabama at Birmingham, Birmingham, Alabama, United States
Introduction
Central venous occlusion is a common complication of long-term hemodialysis catheters that is detrimental to vascular access survival. Occlusion of filter-bearing inferior vena cava (IVC) in dialysis population is life-threatening and often challenging to treat. We report unusual case of a patient with complicated dialysis access history who became catheter-dependent via right femoral vein and presented with total occlusion of IVC below the filter level.
Case Description
A 47-year-old female on chronic hemodialysis presented with poor functioning of her right femoral dialysis permanent catheter. Past medical history was remarkable for end-stage kidney disease 1996 due to pre-eclampsia, systemic lupus erythematosus, multiple deep venous thromboses that required IVC filter placement and chronic oral anticoagulation. After failing peritoneal dialysis and multiple dialysis accesses, she became catheter-dependent via right femoral vein. Notably, she was off dialysis 2009-2015 after receiving kidney transplant.
During this admission, a venogram through the existing catheter demonstrated complete occlusion of IVC accompanied by extensive collateralization (Fig 1-a).
After removing the catheter over the wire, supra-renal IVC was recanalized using stiff guidewire and Kumpe catheter under fluoroscopy guidance. This was followed by sequential balloon angioplasty of the occluded IVC and stent deployment extending from the inferior cavoatrial junction to the superior margin of the IVC filter. Final angiogram demonstrated a wide patent IVC with brisk blood flow into the right atrium (Fig1-b). Dialysis therapy was resumed immediately after intervention and the catheter remains functioning up till now.
Discussion
Treatment of filter-bearing IVC occlusions in dialysis population poses specific technical challenges. Recanalization of these occlusions, such as in our case, is vital, especially among those who exhausted dialysis access options and are not candidates for other treatment modalities such as transplant and peritoneal dialysis.