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Abstract: TH-PO293

Application of Percutaneous Transluminal Angioplasty in the Replacement of Tunnel-Cuffed Catheter in Maintenance Hemodialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access


  • Ding, Hao, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Ye, Hong, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Bian, Xueqin, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • Luo, Yuan, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China

One of the emerging complications of tunnel-cuffed catheter (TCC) is the stuck catheter which is the condition that a catheter is not removable from a central vein using standard techniques. This article focuses on outcome and security of percutaneous transluminal angioplasty (PTA) in replacement of TCC in maintenance hemodialysis (MHD) patients.


The clinical data of 62 MHD patients with dysfunctional catheter from January 2015 to January 2021 admitted to the Second Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. All patients underwent digital subtraction angiography (DSA) to identify superior vena cava stenosis and were treated with suitable balloon under the guidance of DSA. The technique of PTA was used to replace the stuck catheters and was also used to disrupt the fibrin sheaths or to dilate the occlusive vein. The pathological manifestations of the fibrin sheath around the catheter were then determined, and the complications during the operation and the function of the catheter were observed and follow up for 6 months.


TCC was successfully replacement in 62 patients with treatment of superior vena cava stenosis by PTA under the guidance of DSA and no serious complications such as balloon rupture, severe bleeding, pulmonary embolism and malignant arrhythmia occurred during and after surgery. The dialysis blood flow of after surgery is about 220- 280ml/min and the primary catheter site patency rate was 85% at 3 months and 70% at 6 months.The stuck catheter in the superior vena cave were found in six cases which were successfully removed with the technique of PTA. Among them, 3 cases showed severe calcified fibrin sheath, and another 3 cases showed severe superior vena cava stenosis. The pathological showed the inner layer of fibrin sheath is composed of lymphocytes, plasma cells, neutrophils, macrophages and other inflammatory cells. The outer layer of fibrin sheath is composed of collagen and fibroblasts.


Endothelial injury, activation of inflammatory pathways and fibrin sheath formation caused by inflammatory cell aggregation during catheter placement are important pathophysiological mechanisms of catheter dysfunction. Embedded catheters can be successfully managed by PTA which shows advantages of minimal complications, lesser trauma and better tolerance.


  • Government Support – Non-U.S.