Sharp recanalization for long-segment superior vena cava occlusion in a hemodialysis patient with vascular resource exhaustion: a case report

Abstract: Hemodialysis is the lifeline of end-stage renal patients, and the correct choice of vascular access is vital to patients with vascular resource exhaustion. A 57-year-old female was admitted to the hospital due to catheter dysfunction. Color-doppler ultrasound (CDU) showed that the patient’s inferior vena cava (IVC), right brachiocephalic vein, and long segment of the superior vena cava (SVC) were occluded. During surgery, we found that the obstruction of the SVC extended from the opening of the azygous vein to the junction of the SVC and the right atrium and was 6.9 cm in length. Under fluoroscopic guidance, the original tunneled cuffed catheter (TCC) was pulled out, a 4-French sheath was implanted into the right, and a guidewire was inserted to locate the distal end of the SVC. Another puncture needle was inserted from the right brachiocephalic vein into the distal end of the SVC and the steel core of the Rosch-Uchida Transjugular Liver Access Set (RUPS-100) was then inserted through the puncture needle. After correcting the positive and lateral position and determining the way in which the SVC entered the right atrium from the distal end, a 0.035-inch hard guidewire was then inserted into the right atrium through the steel core and a 6-mm balloon was used to dilate the SVC. The end of the catheter was then implanted into the IVC. No surgical complications occurred and at the 30-month follow-up and time of writing, the catheter remained primarily patent. The use of the RUPS-100 for sharp recanalization of an occluded long segment of the SVC can increase the likelihood of patient survival, but the risks during this operation are still not negligible and require precise guidance.