Abstract: SA-PO973

Clinical Picture: Central Venous Catheter-Related Occlusive Disease

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Wen, Jin, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
  • Yu, Yang, West China Hospital & Sichuan University, Chengdu, Sichuan, China
  • Cui, Tianlei, West China Hospital & Sichuan University, Chengdu, Sichuan, China
Background

The central venous catheter (CVC)-related occlusive disease is a major and serious complication of central venous cannulation, posing a huge challenge to end-stage renal disease (ESRD) patients, especially for the growing group of hemodialysis patients when CVC becomes the only available form of access. Herein, we report a successful case of multiple central venous occlusion and thrombosis by percutaneous superior vena cava (SVC) cannulation technique under cross-located fluoroscopy.

Methods

A 50-year-old male with ESRD for 7 years presented with 3 weeks of hemodialysis catheter dysfunction. Before transferred to our hospital, he had undergone a maintenance hemodialysis via a tunneled right femoral vein catheter for 6 months, when other possible vascular accesses had been tried but failed, unfortunately. Physical examination showed collateral tortuous veins in the right chest wall. CT venography of the chest demonstrated chronic occlusion of the entire right brachiocephalic vein (BCV), left BCV and the distal end of SVC. Meanwhile, venography revealed inferior vena cava (IVC) long segment total occlusion with thrombosis (Fig1). Under this situation, we successfully implanted a new tunneled catheter by percutaneous SVC cannulation technique under cross-located fluoroscopy (Fig2), and then removed the previous malfunctioned catheter. The patient discharged 2 days after the new functional catheter establishment.

Conclusion

The CVC-related occlusive disease is usually so troublesome that leads to increasing mortality of ESRD patients, especially for those who suffer from exhausting hemodialysis vascular access. Although many patients are asymptomatic, some can present with symptoms of venous hypertension, such as edema of upper extremity and collaterals of the chest or abdominal wall, which require our more attention and supervision. However, it remains challenging to deal with such severe CVC-related occlusion when almost all the principal venous are occlusive. Notably, we implanted a new tunneled catheter by percutaneous SVC cannulation technique under cross-located fluoroscopy. Our successful case manifests that this technique may light a new lamp in combating the CVC-related occlusive disease.

Funding

  • Other NIH Support