Effective endoluminal balloon dilation for difficult removal of tunneled dialysis catheters with long-term indwelling...

This case report highlights the effectiveness of endoluminal balloon dilation for the difficult removal of tunneled dialysis catheters. Recently, the use of tunneled catheters for vascular access has increased, and cases of difficult removal due to prolonged indwelling have been reported. We describe the case of a 66-year-old man on maintenance dialysis with a tunneled dialysis catheter that had been placed in the right internal jugular vein 8 years prior, who presented with post-dialysis fever. The procedure to remove the catheter due to a catheter-related infection using the traditional method was unsuccessful. Catheter adhesion due to the fibrin sheath was suspected. The catheter was removed using endoluminal balloon dilation. The patient had no postoperative fever or other complications. Another tunneled catheter was subsequently inserted into the same internal jugular vein. This case illustrates that prolonged catheter placement can lead to intravascular adhesions due to the formation of a fibrin sheath. Endoluminal balloon dilation is a minimally invasive treatment option that should be considered before surgical removal.