Role of computed tomographic angiography in central venous catheter related complications in dialysis patients

Abstract

Background: The central venous catheter (CVC) is broadly used in medical practice. However, its use constitutes an invasive procedure with morbidity. Objectives: To assess the role of computed tomographic angiography (CTA) in CVC related complications and the mid-term outcome of dialysis patients after their treatment. Methods: This is a retrospective analysis of prospectively collected data of dialysis patients treated for CVC-related complications and their monitoring during a midterm follow-up. Results: From 2012 - 2014, eight patients (mean age 59±1.2 years; 6 males) with CVC related complication were treated. All complication were diagnosed and verified by a CTA (100%). Two patients presented with local hematoma, 3 with major bleeding, 2 with a retained guide-wire, and 1 with a disconnected part of a port-catheter. The direct repair of an arterial or venous wall injury was undertaken in 7 patients, with the simultaneous removal of a retained guide-wire in 2 and the removal of a misplaced CVC in 1 of them. One patient had the endovascular approach with the removal of the disconnected part. No death or major complication occurred during the procedures. During the follow-up (range =12 - 24 mon), no re-intervention, clinical episode of venous thromboembolism, or death was recorded. Conclusions: Invasive treatment of dialysis patients for CVC related complications is effective and durable during mid-term follow up with no re-intervention, clinical episode of VTE or death. CTA is a reliable mean for the diagnosis of CVC related complications.