Treatment, characteristics and prognosis of central venous occlusion in hemodialysis patients with tunneled cuffed catheter dysfunction.

چکیده اصلی

BACKGROUND: Central venous occlusion (CVO) is a severe complication in hemodialysis patients with tunneled cuffed catheters (TCC), leading to catheter dysfunction and poor outcomes. Optimal treatment remains controversial. METHODS: This retrospective study included 123 hemodialysis patients with TCC dysfunction and CVO between February 2017 and December 2025. Patients underwent either exchange of the existing catheter or placement of a new catheter at a different venous site, with or without concurrent balloon angioplasty or stenting. RESULTS: The cohort had a mean age of 61.02 ± 13.66 years, 29.2% male, with mean hemodialysis vintage of 7.86 years. Brachiocephalic vein occlusion was the most common lesion (74.8%), followed by superior vena cava occlusion (63.4%). Median catheter survival was 735 days. Recurrent dysfunction requiring reintervention occurred in 39.0% of patients (median time 255 days). Atrial thrombus (17.8%) and fibrin sheath (38.2%) were significantly associated with shorter catheter survival (p < 0.05). Most patients had reduced right ventricular basal diameter (98.0%) and increased left ventricular mass index (40.9%). CONCLUSIONS: Catheter exchange and endovascular treatment for central venous occlusion are safe and effective. Percutaneous superior vena cava puncture provides a valuable salvage option for this complex population, supporting durable long-term vascular access. Thrombosis and fibrin sheath predict poorer catheter survival.

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