Four cases of adhered permanent double lumen hemodialysis catheters (Permcath)

Between September 2010 and January 2012, four patients in our hospital were observed to have permanent dialysis catheters that adhered to either the SVC or right atrium. The first patient underwent intraoperative fluoroscopy and was scheduled for cardiac surgery. Unfortunately due to metabolic disturbances, the patient's condition deteriorated and she died before surgery.  The second patient underwent cardio-thoracic surgery with mid-sternotomy and cardio-pulmonary bypass. The catheter was removed and another access route for hemodialysis was established. The third case was scheduled for interventional venocavagraphic exploration of the adhered Permcath. An endovascular snare was passed through the guide wire, which separated the catheter from the SVC. Finally, the fourth patient was a known case of Von Willebrand disease who was scheduled for interventional angiographic Permcath removal. Unfortunately, a few hours following the attempt at surgical removal of the Permcath, her condition deteriorated and she died. Several methods have been used to manage an adherent Permcath. It is assumed that the longer the catheter is in place, the probability of adhesion to the central veins increases. Histological changes have been demonstrated in the venous wall adjunct to the catheter.  Interventional venacavagraphic exploration of the catheter and snaring the adherent site of the catheter seems to be a valuable option.