FROM OCCLUSION TO FLOW: CENTRAL VENOPLASTY FOR SUCCESSFUL TUNNELED CATHETER PLACEMENT IN VASCULAR ACCESS FAILURE

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FROM OCCLUSION TO FLOW: CENTRAL VENOPLASTY FOR SUCCESSFUL TUNNELED CATHETER PLACEMENT IN VASCULAR ACCESS FAILURE

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Co-author 1

Sumiran Mahajan drsumiranmahajan@gmail.com Institute of nephro-urology, Bangalore Nephrology Bangalaore India *

Co-author 2

Gireesh Reddy ggireeshreddy9@gmail.com Institute of nephro-urology, Bangalore Nephrology Bangalore India -

Co-author 3

Sahil Arora arorasahil1990@yahoo.com Institute of nephro-urology, Bangalore Nephrology Bangalore India -

Co-author 4

Cherin Josi cherin.josi@gmail.com Institute of nephro-urology, Bangalore Nephrology Bangalore India -

Co-author 5

Ayesha Nishad ayeshanishadmp@yahoo.in Institute of nephro-urology, Bangalore Nephrology Bangalore India -

Co-author 6

Nidila Mohan nidilamohan@gmail.com Institute of nephro-urology, Bangalore Nephrology Bangalore India -

Co-author 7

Dwarak Sampathkumar drsdwarak@gmail.com Institute of nephro-urology, Bangalore Nephrology Bangalore India -

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Central venous obstruction is a common cause of vascular access failure in hemodialysis patients. When arteriovenous access are exhausted, tunneled cuffed catheters (TCC) frequently remain the only viable access, but central vein stenosis or occlusion may pose a challenge for its placement. Central venoplasty can restore patency and enable TCC insertion. This study evaluated its technical success, safety, and medium-term outcomes. The aim of the study is to assess the feasibility, safety, and outcomes of central venoplasty performed to facilitate TCC placement in patients with vascular access failure due to central venous obstruction.

Methods

A retrospective single-center study of 27 hemodialysis patients undergoing central venoplasty with TCC insertion was conducted. Data on demographics, lesion distribution, stenosis severity, balloon parameters, complications (CIRSE classification), and follow-up outcomes were analyzed. Kaplan–Meier survival analysis was used to estimate primary catheter patency.

Results

Technical success with TCC placement was achieved in all 27 patients (100%). Lesions involved the right brachiocephalic vein in all patients (100%), with extensions into the right subclavian (11.1%), right internal jugular (7.4%), and superior vena cava (7.4%). Mean baseline stenosis severity was 85 ± 12%. Balloon parameters: mean diameter 12.7 ± 2.3 mm (range 8–18), mean inflation pressure 31.1 ± 2.9 atm, and mean inflation duration 166 ± 24 s. No stents were used. Complications occurred in 2 patients (7.4%), both minor. Primary catheter patency was 85% at 3 months and 70% at 6 months. Four patients (14.8%) required re-intervention (repeat venoplasty with TCC exchange) at 80–184 days (median 117 days) for catheter dysfunction.

Technical success	27 / 27 (100%)
Lesion distribution	RBCV 100%, Subclavian 11.1%, RIJV 7.4%, SVC 7.4%
Mean stenosis severity	85 ± 12 %
Balloon diameter	12.7 ± 2.3 mm (8–18 mm)
Inflation pressure	31.1 ± 2.9 atm
Inflation duration	166 ± 24 sec
Stent use	None
Complications	2 (7.4%), both minor
Re-intervention	4 (14.8%), all TCC exchange
Primary patency	85% @ 3 mo; 70% @ 6 mo

Conclusion

Central venoplasty is a safe and effective method to restore central venous patency and facilitate TCC placement in patients with vascular access failure, with excellent technical success, minimal complications, and satisfactory medium-term patency.

Kewords