Transvenous extraction of tunnelled dialysis catheters: a cardiology experience
Z Akhtar, M M Gallagher, C Kontogiannis, A Bajpai, M SohalAbstract
Background
Dialysis for patients with chronic kidney disease (CKD) is often performed using tunnelled dialysis catheters. Despite their effectiveness, these lines are are prone to blockages and exposed to infections, necessitating their removal. Although most catheters can be removed with manual traction without sequalae by renal physicians, a small number require further intervention via the percutaneous approach by interventional radiology or an ‘open’ surgical removal which carries additional risk. Cardiologists experienced in Transvenous lead extraction (TLE) may provide an additional percutaneous strategy.
Purpose
To evaluate the techniques and outcomes of tunnelled dialysis catheter extraction performed by Cardiologists experienced in TLE at a high-volume extraction centre.
Method
All consecutive patients referred to cardiologists between 1/10/2016 – 1/10/25 for extraction of tunnelled dialysis catheters following an unsuccessful attempt by non-cardiologists, were included in this series. Procedural outcomes were evaluated for safety and efficacy.
Results
Twenty-five patients (56% male), aged 62.1±14.7 years with a body mass index of 27.5±6 kg/m2 were referred for tunnelled dialysis catheter extraction for non-functioning lines (72%) with a 52±20.4 months dwell time. Of the 25 dialysis patients, hypertension (n=5) was the most frequent CKD aetiology followed by focal segmental glomerulosclerosis (n=4) and diabetes (n=3). In total, 25 tunnelled catheters (left side n=13) were completely extracted (100%) under local anaesthesia (88%) in a procedure lasting 40.1±26.54 minutes and requiring 1.17±2.5 minutes of fluoroscopy. Twenty-two patients (88%) underwent complete removal with manual traction alone whilst 3 cases (12%) required the use of a rotational dissecting tool; 8 (32%) cases utilised a 0.035 stiff J-tip wire. From the 25 cases, 23 had a failed previous attempt by non-cardiologists. There were no procedural complications or procedural mortality; there was zero 30-day mortality but 44% of the dialysis-dependent patients died within 337.5±395.1 days post extraction from their underlying disease.
Conclusion
Tunnelled dialysis catheter extraction performed by cardiologists is safe and efficacious especially in tunnelled lines of prolonged dwell time; experience in TLE is vital. Referral to cardiologists with expertise in TLE may provide an additional strategy for dialysis catheter removals.