Long-Term Outcomes after Percutaneous Transluminal Angioplasty for Hemodialysis Catheter Placement

Background: Percutaneous transluminal angioplasty (PTA) is the treatment of central vein stenosis or occlusion, it has been applied during hemodialysis catheter placement. However, data came from case reports or small series, and the long-term outcome has rarely been reported. This retrospective study aims to observe the application of PTA for hemodialysis catheter placement and the Long-term outcomes after surgery. Methods: Retrospective analysis of patients who underwent digital subtraction angiography (DSA) guided tunneled cuffed catheter (TCC) placement surgery from March 1, 2015 to August 31, 2023. When there was central vein stenosis (CVS) or occlusion, or fibrin sheath, PTA was performed to dilate the central vein or disrupt the fibrin sheath (Figure 1). Then, a new catheter was inserted. The Kaplan-Meier method was used to investigate the survival rates of the catheters. Results: A total of 149 TCCs were placed in 125 patients, of which 106 cases were underwent PTA. There were 98 cases (66%) of fibrin sheath formation, 76 cases (51%) of CVS, 20 cases (13%) of central vein occlusion, and 6 cases (4%) of central vein thrombosis. The technical success was 98.7% (147 of 149), and the clinical success with resumption of at least one session of normal dialysis occurred in 145 cases (97.3%). The median follow-up was 21.9 months (range, 1–90 months). The survival rates of the catheters at 12, 24, 36, and 60 months were 87%, 84%, 72%, and 46%, respectively. (Figure 2) Conclusion: PTA is safe and effective for hemodialysis catheter placement when there was CVS or central vein occlusion or fibrin sheath formation.