December 22, 2008

Balloon Angioplasty of venous lesions to facilitate placement of Tunneled Cuffed Catheters for hemodialysis.

Anil Hingorani, M.D., enrico ascher, md, natalie marks, md rvt, alexander shiferson, d.o., nirav patel, d.o., kapil gopal, md, theresa jacob, phd.
Maimonides Medical Center, Brooklyn, NY, USA.

With implementation of the K-DOQI guidelines, more patients are in need of long term dialysis catheters until obtaining arteriovenous fistula maturation. However on occasion, when placing a tunneled cuffed catheters for hemodialysis, we have encountered difficulty with passing the guidewire in spite of demonstration of a patent cervical portion of the internal jugular vein on duplex. Herein, we review our experience with this issue. Methods. Of the 1147 Tesio catheters placed since 1997 by our service, 35 venograms were performed due to difficulty encountered with placement of the guidewire. Results. Patent veins were all crossed with the use of angle guiding catheters, angled glidewires and a torque vise. Once chronically occluded intrathoracic veins were identified, an alternate site was selected for placement of the Tesio catheter. In 19 cases of stenosis of the intrathoracic veins, balloon angioplasty with an 8 mm balloon was successfully performed with placement of a functional Tesio catheter. In one additional case the catheter was not able to be placed. Venograms demonstrated a patent but tortuous vein in 9, chronically occluded intrathoracic veins in 5, and severe stenosis of the intrathoracic veins in 20. Seven lesions that underwent balloon angioplasty were in the innominate vein. 9 were in the proximal internal jugular vein, and two were in the SVC. Three sites were not able to be retrieved from the databases. Conclusions. Endovascular techniques can be used to maintain options for the site of access for tunneled cuffed catheters and may be necessary to assist with placement of long term cuffed dialysis catheters.

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