Percutaneous Transluminal Angioplasty of a Dysfunctional Central Vein Caused by a Tunnel-cuffed Catheter

Abstract Background: For patients without arteriovenous fistula and with dysfunctional central veins caused by long indwelling tunnel-cuffed catheter (TCC), no consensus on how to achieve functional hemodialysis access has been reached. This study investigated the value of percutaneous transluminal angioplasty (PTA) of a dysfunctional central vein caused by a TCC under digital subtraction angiography (DSA) guidance. Methods: In total, thirteen patients with indwellingTCC-related complications were admitted to our institution. The TCC indwelling duration was 35.2 months (range, 6 to 70 months). The failed TCCs were removed under the support of a stiff guide wire,and an angiogram showed central vein stenosis (CVS) or occlusion. PTA was performed to recanalize the central vein, and new TCCs were placed in situ or in another central vein under DSA guidance. Results: TCCs were successfully removed in twelve patients. TCC removal failed in one patient due to severe adhesion of the TCC and the left innominate vein 4 years after implantation. PTA of central veins, including the right internal jugular vein, innominate vein, superior vena cava, and right iliac vein, was performed, and new TCCs were successfully placed in all patients. No stents were implanted in any patients. The mean follow-up was 12.9 months (range, 3 to 36 months). The new TCCs functioned well in all patients. Conclusions: Under DSA guidance, recanalization of TCC-related CVS or occlusion by PTA and implantation of anew TCC catheter in situor another central vein can establish dialysis access for patients with poorly functioning TCCs successfully.