Axillary right vein percutaneous ballooning in hemodialysis catheter replacement: A case report

Reliable vascular access remains a key point of hemodialysis therapy although each patient's journey through chronic kidney disease is unique. The 2019 Kidney Disease Outcomes Quality Initiative (KDOQI) vascular access guidelines introduced a patient-centered approach, emphasizing individualized vascular access planning based on each patient's clinical characteristics, comorbidities, life expectancy, and treatment goals. Vascular access troubleshooting is required when the creation of a native arteriovenous fistula or prosthetic graft is not feasible, necessitating the use of tunneled central venous catheters inserted into central veins such as the internal jugular, subclavian, axillary, or femoral ones. The internal jugular vein is generally considered the preferred access site. However, when its use is precluded by thrombosis, stenosis, or unfavorable cervical anatomy, the axillary vein represents a valuable alternative. In this report, we describe the replacement of a tunneled hemodialysis catheter in the right axillary vein following percutaneous balloon angioplasty of an early axillary vein stenosis that had developed 6 months after the first catheter placement. This strategy was adopted because all other upper central venous access sites were unavailable owing to right internal jugular vein stenosis and previous thrombosis of the brachiocephalic vein. Post-procedural chest radiography confirmed the correct positioning of the catheter tip within the right atrium site. The patient successfully resumed maintenance hemodialysis without further catheter dysfunction during follow-up. This case highlights the feasibility of percutaneous balloon angioplasty of a previously cannulated axillary vein to preserve vascular access and facilitate catheter replacement in hemodialysis patients with multiple comorbidities and severely limited central venous access options.