Complex central venous catheter for dialysis: interventional radiology experience in insertion and management of their complications

• Published in: The journal of vascular access Vol. 25; no. 1; pp. 149 - 157
• Main Authors: Patanè, Domenico, Morale, Walter, Bonomo, Stefania, Failla, Giovanni, Santonocito, Serafino, Camerano, Francesco, Arcerito, Flavio, Coniglio, Giovanni, Calcara, Giacomo, Malfa, Pierantonio, Stefano, Alessandro
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-01-2024
• Subjects: Aged; Aged, 80 and over; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - methods; Central Venous Catheters; Humans; Male; Middle Aged; Radiology, Interventional; Renal Dialysis; Retrospective Studies; dialysis; venous CT-angio; techniques and procedures; interventional radiology; Catheters; ultrasonography – Doppler evaluation
• ISSN: 1129-7298; 1724-6032
• DOI: 10.1177/11297298221103209

Background:
CVCs are defined ‘complex’ when they are inserted through non-conventional accesses or positioned in non-usual sites or substituted by IR endovascular procedures. We report our experience in using diagnostic and interventional radiology techniques for complex CVC insertion and management; we recommend some precautions and techniques that could lead to long-term availability of central venous access and to avoid non-conventional sites CVC insertion.
Methods:
We retrospectively evaluated 617 patients, between January 2010 and December 2019, (mean age 71 ± 13; male 448/617), treated in our department for insertion of tunnelled CVC for haemodialysis.
Results:
Among 617 patients, 241 cases (39%) are considered ‘complex’ because they required either a PTA with or without stenting to restore/maintain venous access or had an unusual positioning site or required unconventional access. A direct correlation between CT angiography and PTA (r = 0.95; p-value <0.001) and an inverse correlation between CT angiography and unconventional ‘rescue’ access (r = −0.92; p-value <0.001) were found.
Conclusions:
Precise pre-operative planning of treatment in a multidisciplinary setting and diagnostic and interventional radiology procedures knowledge allows reducing complex catheterisms in haemodialysis patient.