Endovascular Closure of an Acquired Vascular Fistula, an Uncommon Complication of a Tunneled Hemodialysis Catheter: A Case Report.

IF 1.7 2区医学 Q3 PERIPHERAL VASCULAR DISEASE Journal of Endovascular Therapy Pub Date : 2024-12-01 Epub Date: 2023-03-25 DOI:10.1177/15266028231161243

Carlos Ivan Soledispa-Suarez, Stephanie Susana Alberca-Bonilla

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Abstract

Purpose: The objective of this case is to report an endovascular occlusion of an acquired vascular fistula using an Amplatzer Vascular Plug II. Also, it is to review the available literature on risk factors, pathophysiology, and related management strategies about complications of the tunneled central venous catheter (TCVC).

Case report: The case was a 40-year-old man with a chronic kidney disease (CKD) on dialysis and with a history of several previous TCVC placements, along with recurrent infections. The last TCVC developed a fistula between the superior vena cava and the right pulmonary artery, shown by computed tomography (CT). We decided to remove a long-term TCVC and occluded the fistula applying an endovascular embolic device, an Amplatzer Vascular Plug II, subsequently. The patient was given parenteral treatment during 10 days of hospitalization. Over 9 months of follow-up, the device was appropriately positioned and did not obstruct the vascular flow.

Conclusion: Tunneled central venous catheters are frequently used for hemodialysis in patients in the last stage of CKD who do not have an arteriovenous fistula. Occasionally, delayed complications such as adherence or catheter migration occur. This case illustrates an endovascular treatment with excellent results and low risk of morbidity and mortality.

Clinical impact: The purpose of this work is to present an endovascular occlusion by means of an Amplatzer® Vascular Plug II in a residual fistula. The endovascular way is decided in situations, for instance, once the cardiothoracic surgeons argue that the patient is not in general conditions to tolerate surgery, the surgical procedure would be complex, or, in a surgical approach with a difficult-to-resolve hemorrhage. We explain the technique and the materials we used for an excellent result and a low risk of complications. This case is intended to serve as an aid in the treatment of similar events.

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隧道式血液透析导管并发后天性血管瘘的血管内闭合术：病例报告。

目的：本病例旨在报告一例使用 Amplatzer Vascular Plug II 血管内塞闭后天性血管瘘的病例。此外，还回顾了有关隧道式中心静脉导管（TCVC）并发症的风险因素、病理生理学和相关处理策略的现有文献：该病例是一名 40 岁的男性，患有慢性肾病（CKD），正在接受透析治疗，既往曾多次置入 TCVC，并有反复感染的病史。最后一次 TCVC 在上腔静脉和右肺动脉之间形成了瘘管，计算机断层扫描（CT）显示了这一情况。我们决定移除长期放置的 TCVC，随后使用血管内栓塞装置 Amplatzer Vascular Plug II 封堵了瘘管。患者在住院 10 天期间接受了肠外治疗。在 9 个月的随访中，该装置位置适当，没有阻碍血管流动：结论：隧道式中心静脉导管常用于没有动静脉瘘的慢性肾脏病晚期患者的血液透析。偶尔也会出现粘连或导管移位等延迟并发症。本病例说明了一种效果极佳、发病率和死亡率风险较低的血管内治疗方法：临床影响：本文旨在介绍一种通过 Amplatzer® Vascular Plug II 对残余瘘管进行血管内闭塞的方法。在某些情况下，例如心胸外科医生认为患者一般情况下无法耐受手术、手术过程复杂，或者在手术方法中出现难以解决的大出血时，就会决定采用血管内方法。我们解释了我们所使用的技术和材料，以获得极佳的效果和较低的并发症风险。本病例旨在为类似事件的治疗提供帮助。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Endovascular Therapy 医学-外科

CiteScore

5.30

自引率

15.40%

发文量

203

审稿时长

6-12 weeks

期刊介绍： The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.