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“Immured” dialysis catheter

A clinical case of removal of a permanent dialysis catheter by balloon dilatation. A 37-year-old female patient complains of general weakness, dizziness, fever up to 38.5 °C.

Medical history: in 2016, after angina, rapidly progressive glomerulonephritis developed with an outcome in nephrosclerosis. She has been receiving substitution therapy by hemodialysis since 2016 at the Regional Nephrology Center 3 times a week for 4 hours, and periodically receives Recormon. The permanent catheter in the left jugular vein, installed 3 years ago, stopped functioning for about 2 weeks. For hemodialysis, a second permanent catheter was installed through the right egular vein.

About a week ago, an attempt was made to remove the catheter on the left in another hospital in an open way, by traction. Surgical access to the left jugular vein was used. When an attempt is made, the patient develops a pain syndrome in the form of severe pain in the chest. When traction was performed, the visible part of the catheter was found to be mucous. The attempt was completed by suturing the infected part of the catheter with interrupted sutures. This caused a septic condition in the patient and raised the question of removing the dialysis catheter as soon as possible due to the risk of sepsis.

Through the first lumen of the dialysis catheter, a guidewire was passed through it, a 5 mm balloon was inserted, a phased dilatation of the lumen with a pressure of 16 atm (photo 1).

Photo 1

The idea behind dilatation is to destroy the fibrous cage around the catheter so that it can be removed freely. The catheter could not be removed (photo 2).

Photo 2

Then, a 3.5×80 mm balloon was inserted through the second lumen of the dialysis catheter, stage-by-stage dilatation of both lumens simultaneously with a pressure of 14 and 16 atm (photo 3). Again unsuccessfully.

Photo 3

Change to a 6.0×80 mm balloon, step-by-step dilatation of both lumens simultaneously with two balloons (6.0 and 3.5 mm) at a pressure of 14 and 15 atm (photo 4).

Photo 4
Done! No anesthesia! No cut! No pain!
Control angiography with the right dialysis catheter: everything is in order.