Cut-down method for perm catheter insertion in patients with completely occluded internal jugular vein

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Background:

• Internal jugular vein (IJV) is the preferred site for hemodialysis catheter insertion, followed by the left IJV and subclavian vein.
• Femoral veins are an alternative but carry a higher infection risk, limiting their use to short durations.
• Occluded central veins pose a challenge for hemodialysis access, necessitating alternative recanalization techniques.

Purpose of the Study:

• To evaluate the efficacy and safety of a surgical cut-down recanalization method for hemodialysis catheter insertion in completely occluded IJVs.
• To compare the surgical recanalization approach with the percutaneous technique for hemodialysis access.

Main Methods:

• A cut-down surgical technique was employed for permcath insertion through a completely occluded IJV.
• The outcomes were compared with existing percutaneous recanalization methods.

Main Results:

• Successful hemodialysis catheter insertion was achieved using the surgical cut-down method in cases of completely occluded IJV.
• The surgical recanalization method demonstrated advantages in terms of cost and safety compared to the percutaneous approach.

Conclusions:

• Surgical recanalization of occluded IJVs is a superior alternative to percutaneous methods for hemodialysis catheter insertion.
• The cut-down technique offers a safe and cost-effective solution for complex hemodialysis access cases.