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Percutaneous superior vena cava puncture for hemodialysis catheter placement

Yuliang Zhao1, Qiuyan Zhao2, Wei Wei1

  • 1Division of Nephrology, Kidney Research Institute and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.

Journal of Vascular Surgery. Venous and Lymphatic Disorders
|September 30, 2022
PubMed

Insights

Tunneled, cuffed central venous catheter (tCVC) placement via superior vena cava (SVC) puncture offers a viable option for hemodialysis patients with central venous occlusion (CVO). This technique demonstrates good long-term patency and technical success, preserving other venous resources.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Central venous occlusion (CVO) poses a significant challenge for maintaining hemodialysis vascular access.
  • Endovascular angioplasty is often insufficient for refractory CVO, necessitating alternative access strategies.
  • Preserving central venous resources is crucial for patients requiring long-term hemodialysis.

Purpose of the Study:

  • To evaluate the efficacy and safety of tunneled, cuffed central venous catheter (tCVC) placement using percutaneous superior vena cava (SVC) puncture.
  • To assess the technical success and long-term patency rates of tCVC insertion via SVC puncture in patients with refractory CVO.
  • To identify potential complications associated with this interventional approach.

Main Methods:

  • Retrospective analysis of 205 patients undergoing percutaneous SVC puncture and tCVC insertion for refractory CVO.
  • Data collected included demographic information, procedural success rates, complications, and catheter patency.
  • Follow-up extended to May 2021 to determine long-term outcomes.

Main Results:

  • Technical success rate for SVC puncture and tCVC insertion was 94.6% (194/205 patients).
  • Three-year primary and secondary patency rates were 64.2% and 76.3%, respectively.
  • Complications included one case of pleura injury/hemothorax requiring thoracotomy and manageable chest pain in 37 patients.

Conclusions:

  • Percutaneous SVC puncture for tCVC placement is a technically successful and effective option for hemodialysis patients with refractory CVO.
  • This method provides satisfactory long-term patency and preserves central vein options.
  • Careful attention to potential complications like pleura injury is warranted.
Abstract

Keywords:
Central venous occlusionHemodialysis catheterSuperior vena cava puncture

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