Clinical application analysis of balloon dilatation angioplasty in the re-catheterization of hemodialysis cuffed catheter

Objective To evaluate the safety and efficacy of balloon dilatation angioplasty in patients with central venous stenosis (CVS) undergoing the re-catheterization of tunneled-cuffed hemodialysis catheter. Methods We retrospectively analyzed 16 patients with the cuffed hemodialysis catheters placed in the internal jugular vein who had insufficient dialysis flow from October 2014 to December 2017 in our department. CVS was indicated using preoperative angiography in these patients. The intraoperative catheter was withdrawn and the angiography was performed, then the balloon was placed along the guide wire to the infarcted stenosis to perform the balloon dilatation, and a new catheter was re-inserted. When patients had the incarcerated cuffed hemodialysis catheter which could not be pulled out, the catheter should be removed with the aid of the balloon. Venous end angiography via the new catheter was performed to investigate the catheter position and the presence of pulmonary embolism.Results There were 3 cases of catheter adhesion incarceration during operation, and successful extubation after balloon dilatation. In all 16 patients, the tunneled-cuffed hemodialysis catheter was successfully replaced. Two patients had the insufficient catheter flow after surgery, in this case, we re-adjusted the end to the catheter to the inferior vena cava, and then the flow could be back to normal. No pulmonary embolism or central venous rupture was found in all patients. The paired t-test analysis showed that the blood flow immediate, 3 months and 6 months after operation was compared with the preoperative flow, and difference was significant. Conclusions In patients with CVS undergoing the tunneled-cuffed hemodialysis catheter re-catheterization, the intracavitary balloon dilatation may effectively solve catheter incarceration, expand the narrow central vein, and destroy the fibrin sheath around the original catheter, with the characteristics of small trauma, high success rate and safety.