Abstract: SA-PO0465
Endothelialization of the Distal End of Vascular Access to the Superior Vena Cava in a Patient on Hemodialysis
Session Information
- Dialysis: Vascular Access
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Medina Hernandez, Elba Onelida, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, Mexico
- Reyes, Irving Jesús, Instituto Politecnico Nacional, Mexico City, Mexico
- Cortes, Cutberto M., Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, Mexico
Introduction
Effective hemodialysis depends on efficient, durable, and safe vascular access. access failure is a frequent problem. Vascular access exhaustion for hemodialysis is increasingly common. Patients reach this situation due procoagulant factors, poor vascular access management, and lack of resources, among others.
Endothelialization refers to the process of lining the microchannel lumen with a 3-dimensional monolayer of endothelial cells. Catheter endothelization in patient with a percutaneous tunneled hemodialysis catheter is rarely.
Case Description
A 59 year old patient with T2D, arterial hypertension and ESKD diagnosis 9 years ago. Renal replacement therapy with peritoneal dialysis for 2 years and since 7 years ago she undergoing hemodialysis three times a week. Renal replacement therapy with catheters had been attempted throughout his history, including 7 vascular access. A tunneled left jugular vein catheter had been for 2 years, she presented in critical condition due to catheter dysfunctional, diagnostic fluoroscopy was performed with flows less than 100 cc/min. The image showed the distal end of the catheter in the superior vena cava, confirming its dysfunction and justifying its removal and repositioning.The interventional radiology service attempted to remove the tunneled left jugular vein catheter using advanced instrumental maneuvers. Controlled traction was performed under fluoroscopy, followed by the introduction of an intravascular guidewire and subsequently the use of an intravascular snare (Snare). However, due to the persistent adherence of the distal end of the catheter to the superior vena cava—attributed to epithelialization and probable endothelialization—the maneuvers were unsuccessful due to the risk of vascular injury cardiothoracic surgery and angiology service who considered that attempting to remove the epithelialized catheter had a high risk of complications. It was then decided to leave the endothelialized remnant in situ.
Discussion
The diagnostic reasoning focused on chronic epithelialization of the jugular vein tract with adherent fibrosis, mechanical dysfunction of the subclavian catheter due to stenosis, and anatomical exhaustion of functional vascular access, which explains both the dialysis dysfunction and the resistance to standard interventional maneuvers.