Back to 2025 Karmody Posters
Successful Removal Of An Irretrievable Hemodialysis Catheter Stuck In The Central Vein Using A Modified Endoluminal Balloon Dilation Technique: A Case Report
Jacob Basil Watson, MD, Alan B. Lumsden, MD, Maham Rahimi, MD, PhD.
Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES:The removal of long-term tunneled hemodialysis catheters (TDC) can be challenging when a fibrin sheath attaches the catheter to the venous wall, making routine removal techniques ineffective. Prior methods, including percutaneous transluminal angioplasty (PTA) (Hong’s technique), surgical cutdown, and thoracotomy, have been proposed to address this issue. This case report introduces a novel modification that enables the successful removal of a stuck TDC without additional surgical incisions or catheter transection.
METHODS: A 69-year-old female patient with end-stage renal disease (ESRD) on hemodialysis via a right internal jugular vein Bard 14.5 French x 19 cm TDC, in place for over five years, presented with a broken clamp on the arterial line of the catheter. Scheduled for TDC exchange in the hybrid operating room, routine attempts at catheter removal were unsuccessful, leading to the implementation of a modified PTA technique.
RESULTS: Following standard preparatory steps, attempts to remove the TDC by experienced physicians failed, resulting in patient chest pain and fluoroscopic evidence of catheter movement within the central veins and heart. To prevent complications, a PTA was performed using two V-18 wires, each with a 4 French 3x120mm Sterling SL balloon, which were incrementally inflated and advanced along the catheter. The modification allowed for the safe removal of the catheter and successful completion of the TDC exchange.
CONCLUSIONS: The modified endoluminal balloon dilation technique presented in this report enhances the safety and effectiveness of removing incarcerated long-term central venous catheters. This approach eliminates the need for additional surgical procedures and reduces the risk of complications, offering a refined method for clinical practice.
Back to 2025 Karmody Posters
