Transvenous removal of adherent hemodialysis catheters and venous ports - experience of a reference center.

Introduction: Removal of adherent intravascular catheters (hemodialysis catheters and venous ports) is still an unsolved clinical problem lying at the intersection of vascular surgery, anesthesiology, cardiac surgery and cardiology. Analysis of resistant removals of adherent catheters when simple traction was unsuccessful. Description of the technique and effectiveness of catheter removal using mechanical dilatation and dedicated tools. Methods: Retrospective review of a prospectively maintained computerized database at the reference center. One hundred eleven transvenous catheter extractions (TCE), including 71 hemodialysis catheters and 40 venous ports. Results: A procedure for removing adherent catheters using mechanical dilatation is described. All catheters were removed in their entirety, there was one major complication (embolization). It is difficult to identify predictors of the need for mechanical dilatation. The main indication for catheter removal is malfunction most frequently due to fibrous encapsulation at catheter tips or adherence of catheter tips to the cardiac structures. The second is catheter-related infection. Most dysfunctional and infected catheters are implanted with improper positioning of the catheter tip beyond the right atrium. Half of seemingly adherent catheters can be removed with simple traction, which is not predictable before the procedure. Moreover, 50% of catheters require dissection of fibrous tissue using additional specialized tools. The effects of mechanical dilatation are very good, if the procedure is performed with participation of operators experienced with transvenous lead extraction. TCE of adherent hemodialysis catheters and venous ports is a safe and effective procedure. Conclusion: The final result of mechanical dilatation is very good if the procedure is performed with collaboration of operators experienced with transvenous lead extraction. Transvenous removal of adherent hemodialysis catheters and venous ports is safe and effective.