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Article ; Online: [Cost analysis of haemodialysis catheter related bloodstream infection through the DRG system, "on behalf of Project Group of Vascular Access of Italian Society of Nephrology"].

Mandolfo, Salvatore / Maggio, Milena / Forneris, Giacomo / Galli, Franco

Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia

2019 Volume 36, Issue 1

Abstract: Catheter related bloodstream infections (CRBSI) represent a complication that often requires hospitalization and the use of economic resources. In Italy, there is no literature that considers the costs of CRBSI for tunneled catheters (CVCt). The aim of ... ...

Abstract	Catheter related bloodstream infections (CRBSI) represent a complication that often requires hospitalization and the use of economic resources. In Italy, there is no literature that considers the costs of CRBSI for tunneled catheters (CVCt). The aim of this work is to evaluate the relative costs of CRBSI through the DRG system. From 2012 to 2017 we examined 2.257 hospital discharge forms, 358 of which relating to haemodialysis patients. Patients with CVCt (167), compared to FAVs (157), on average stay in hospital longer (10 vs. 8 days), entail higher costs (+8.5%) and higher admissions rate for infections (+114%). The incidence of CRBSI was 0.67 episodes per 1000 CVCt/days. CRBSI accounts for 23% of the cases of hospitalization of patients with CVCt and 5.2% of total hospitalization costs. Complicated CRBSI involve a 9% increase in average costs compared to simple ones, with patients staying in hospital three times longer. The cost of a CRBSI varies from €4,080 up to €14,800, with an average cost of €5,575. The costs calculated here are less than a third of that reported in American literature but this can be explained by the different reimbursement rates systems. The methodology of CRBSI costs through DRGs appears simple, and its main limit is the correct compilation of the discharge form. This is a reminder that discharge forms are an integral part of the medical record and can become important in recognizing the cost of the medical services provided.
MeSH term(s)	Anti-Bacterial Agents/economics ; Catheter-Related Infections/economics ; Catheter-Related Infections/epidemiology ; Catheter-Related Infections/microbiology ; Central Venous Catheters/adverse effects ; Central Venous Catheters/statistics & numerical data ; Costs and Cost Analysis ; Diagnosis-Related Groups/economics ; Hospitalization/economics ; Hospitalization/statistics & numerical data ; Humans ; Incidence ; Italy/epidemiology ; Nephrology ; Patient Discharge/economics ; Renal Dialysis/economics ; Renal Dialysis/statistics & numerical data ; Renal Insufficiency, Chronic/therapy ; Sepsis/economics ; Sepsis/epidemiology ; Sepsis/microbiology ; Societies, Medical ; Time Factors
Chemical Substances	Anti-Bacterial Agents
Language	Italian
Publishing date	2019-02-21
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1237110-5
ISSN	1724-5990 ; 0393-5590
ISSN (online)	1724-5990
ISSN	0393-5590
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Zs.A 4313: Show issues

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Article ; Online: Vascular access for hemodialysis in Italy: What a national survey reveals.

Napoli, Marcello / Guzzi, Francesco / Morale, Walter / Lomonte, Carlo / Galli, Franco / Lodi, Massimo / Bonforte, Giuseppe / Bonucchi, Decenzio / Brunori, Giuliano / Buzzi, Laura / Forneris, Giacomo / Gallieni, Maurizio / Meola, Mario / Pirozzi, Nicola / Sessa, Concetto / Spina, Monica / Tazza, Luigi

The journal of vascular access

2024 , Page(s) 11297298231217318

Abstract: Background: Since in Italy there are no official data on vascular access (VA) for hemodialysis the Vascular Access Project Group (VAPG) of the Italian Society of Nephrology (SIN) designed a national survey.: Methods: A 35-question survey was designed ...

Abstract	Background: Since in Italy there are no official data on vascular access (VA) for hemodialysis the Vascular Access Project Group (VAPG) of the Italian Society of Nephrology (SIN) designed a national survey. Methods: A 35-question survey was designed and sent it to the Italian facilities through the SIN website. The basic questions were the prevalence, the location, and the surveillance of VA, the bedside use of ultrasound, the use of fluoroscopy for central venous catheter (CVC) placement, and of buttonhole technique, the role of nephrologist in the access creation. Result: The questionnaire was completed in June 2022 by 161 facilities. The survey registered 15,499 patients, approximately one-third of the Italian dialysis population. The prevalence of arteriovenous fistula (AVF), arteriovenous Graft (AVG), and CVC were 61.8%, 3.7%, and 34.5% respectively. The AVF location was 50% in distal forearm, 20% in meanproximal forearm, 30% in upper arm. For AVF creation, nephrologists were involved in 72% of facilities while for CVC placement in 62%. As regards VA monitoring, 21% of the facilities did not have a surveillance protocol; 60% did not register AVF thrombosis and 53% did not register CVC infections. Most of facilities use the fluoroscope during CVC placement, 37% when needed, and 22% never. Ultrasound-guided puncture of complex AVFs was used by 80% of facilities. Buttonhole puncture was used in 5% of patients. Conclusions: Some considerations emerge from the survey data: (1) The increasing CVC prevalence compared to DOPPS 5 study. (2) The low rate of AVG prevalence. (3) The nephrologist is the operator in many VA procedures. (4) The fluoroscopy for CVC placement and the US-guide puncture of the complex AVF are widely used in most facilities. (5) The practice of the buttonhole is not widespread. (6) When the operator is the nephrologist more distal fistulas are performed.
Language	English
Publishing date	2024-01-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2252820-9
ISSN	1724-6032 ; 1129-7298
ISSN (online)	1724-6032
ISSN	1129-7298
DOI	10.1177/11297298231217318
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Zs.A 6414: Show issues

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Article ; Online: High success rate in salvage of catheter-related bloodstream infections due to

Mandolfo, Salvatore / Anesi, Adriano / Maggio, Milena / Rognoni, Vanina / Galli, Franco / Forneris, Giacomo

The journal of vascular access

2019 Volume 21, Issue 3, Page(s) 336–341

Abstract: Background: Catheter-related bloodstream infections caused by : Methods: A protocol based on early, prompt diagnosis and treatment has been utilized in our renal unit since 2012 in an attempt to salvage infected tunnelled central venous catheters. We ...

Abstract	Background: Catheter-related bloodstream infections caused by Methods: A protocol based on early, prompt diagnosis and treatment has been utilized in our renal unit since 2012 in an attempt to salvage infected tunnelled central venous catheters. We prospectively observed 247 tunnelled central venous catheters in 173 haemodialysis patients involving 167,511 catheter days. Results: We identified 113 catheter-related bloodstream infections (0.67 episodes per 1000 days/tunnelled central venous catheter). Forty were caused by Conclusion: Our data lead us to believe that it is possible to successfully treat catheter-related bloodstream infection caused by
MeSH term(s)	Aged ; Aged, 80 and over ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/adverse effects ; Bacteremia/diagnosis ; Bacteremia/drug therapy ; Bacteremia/microbiology ; Catheter-Related Infections/diagnosis ; Catheter-Related Infections/drug therapy ; Catheter-Related Infections/microbiology ; Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/instrumentation ; Catheters, Indwelling/adverse effects ; Central Venous Catheters/adverse effects ; Clinical Protocols ; Device Removal ; Early Diagnosis ; Female ; Humans ; Italy ; Male ; Middle Aged ; Prospective Studies ; Recurrence ; Risk Factors ; Staphylococcal Infections/diagnosis ; Staphylococcal Infections/drug therapy ; Staphylococcal Infections/microbiology ; Time Factors ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-09-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2252820-9
ISSN	1724-6032 ; 1129-7298
ISSN (online)	1724-6032
ISSN	1129-7298
DOI	10.1177/1129729819875323
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Article ; Online: Percutaneous Transanastomotic Stent Graft Deployment to Salvage Dysfunctional Native Forearm Radiocephalic Fistulae: Feasibility and Primary Patency at 12 Months.

Quaretti, Pietro / Leati, Giovanni / Moramarco, Lorenzo Paolo / Cionfoli, Nicola / Corti, Riccardo / Tinelli, Carmine / Fiorina, Ilaria / Galli, Franco

Journal of vascular and interventional radiology : JVIR

2018 Volume 29, Issue 7, Page(s) 986–992

Abstract: Purpose: To evaluate feasibility and efficacy of transanastomotic self-expandable polytetrafluoroethylene stent graft placement for salvage of radiocephalic arteriovenous fistulae (RCAVFs).: Materials and methods: From 2008 to 2016, 26 patients (21 ... ...

Abstract	Purpose: To evaluate feasibility and efficacy of transanastomotic self-expandable polytetrafluoroethylene stent graft placement for salvage of radiocephalic arteriovenous fistulae (RCAVFs). Materials and methods: From 2008 to 2016, 26 patients (21 male; age, 38-80 y) with dysfunctional RCAVFs for juxtaanastomotic lesions that were unresponsive to angioplasty underwent transanastomotic stent graft placement. Stenotic and thrombotic lesions were included. All were deemed unsuitable for surgical revision. Patency rates were calculated per Kaplan-Meier method. A Cox analysis was used to identify influencing factors. Results: Thirty-two stent grafts (6 patients had 2 stents) were deployed. Anatomic and clinical success were achieved in all patients; no major complications occurred. Mechanical and/or pharmacologic thrombolysis was performed in 6 cases before stent graft deployment. During follow-up (median, 34.7 mo; range, 1.9-102.7 mo), 17 repeat interventions were required in 10 patients (43 procedures overall), for an endovascular intervention rate of 0.27 per year. At 3, 6, 12, and 24 months, primary patency (PP) rates were 96% ± 4 (95% CI, 75%-99%), 83% ± 7 (95% CI, 61%-93%), 78% ± 8 (95% CI, 55%-90%), and 69% ± 10 (95% CI, 46%-84%). The corresponding assisted PP rates were 96% ± 4 (95% CI, 76%-99%), 96% ± 4 (95% CI, 76%-99%), 92% ± 5 (95% CI, 71%-98%), and 82% ± 8 (95% CI, 60%-93%). Five AVFs were ultimately abandoned. Per Cox analysis, arterial diameter ≥ 4 mm was associated with better PP (P = .032). Conclusions: Transanastomotic stent graft placement for RCAVF salvage is feasible and safe, providing patency rates comparable with historical endovascular and surgical data. Its role should be evaluated in larger studies.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Arteriovenous Shunt, Surgical/adverse effects ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/instrumentation ; Chi-Square Distribution ; Collateral Circulation ; Feasibility Studies ; Female ; Forearm/blood supply ; Graft Occlusion, Vascular/diagnostic imaging ; Graft Occlusion, Vascular/etiology ; Graft Occlusion, Vascular/physiopathology ; Graft Occlusion, Vascular/surgery ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Phlebography ; Polytetrafluoroethylene ; Proportional Hazards Models ; Prosthesis Design ; Radial Artery/diagnostic imaging ; Radial Artery/physiopathology ; Radial Artery/surgery ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Stents ; Time Factors ; Treatment Outcome ; Vascular Patency ; Veins/diagnostic imaging ; Veins/physiopathology ; Veins/surgery
Chemical Substances	Polytetrafluoroethylene (9002-84-0)
Language	English
Publishing date	2018-05-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1137756-2
ISSN	1535-7732 ; 1051-0443
ISSN (online)	1535-7732
ISSN	1051-0443
DOI	10.1016/j.jvir.2018.02.028
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Zs.A 3720: Show issues

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Article: New therapeutic options provided by off-label deployment of stent graft for tailored arteriovenous access salvage: Two cases.

Corti, Riccardo / Quaretti, Pietro / Galli, Franco / Moramarco, Lorenzo Paolo / Cionfoli, Nicola / Leati, Giovanni / Corbetta, Riccardo / Tozzi, Matteo

SAGE open medical case reports

2017 Volume 5, Page(s) 2050313X17741827

Abstract: A tailored therapy to patient requirements by combining endovascular and surgical steps can be necessary to prolong the life of a vascular access. Stent grafts play a growing role for the therapy of dialytic access complications. Randomized multi-center ... ...

Abstract	A tailored therapy to patient requirements by combining endovascular and surgical steps can be necessary to prolong the life of a vascular access. Stent grafts play a growing role for the therapy of dialytic access complications. Randomized multi-center trials, however, support the on-label use of stent grafts in the treatment of graft venous outflow and in-stent restenosis. The main contraindication to their use is an ongoing infection. We report two cases of new off-label application of Viabahn (Gore, flagstaff, USA) stent graft. In the first case, the failure of a radiocephalic early cannulation graft was treated by stent graft placement on the arterial inflow anastomosis, when emergent angiographic examination revealed the previously unknown high takeoff of the radial artery from the axillary artery. At 13-month follow-up, the target lesion remained untreated. In the second case, elbow stent graft occlusion with extended thrombosis occurred in a right radiocephalic fistula after 3 years of unassisted patency. Being the last option for vascular access, successful endovascular recanalization was carried out. After 3 months, however, the clinical setting relapsed. A two-stage hybrid strategy with vascular surgeon was arranged due to ongoing signs of local infection. Flow was restored by emergent thromboaspiration associated with a new stent graft placement as a endovascular bridge to subsequent surgical treatment. After 2 days, the overlapped stent grafts were excised as planned. Surgical rerouting was completed by polytetrafluoroethylene prosthetic bridge implantation across the elbow. At 4 months, the follow-up remained uneventful. In selected instances, the off-label use of stent grafts may expand the therapeutic options of the vascular access team.
Language	English
Publishing date	2017-11-14
Publishing country	England
Document type	Case Reports
ZDB-ID	2736953-5
ISSN	2050-313X
ISSN	2050-313X
DOI	10.1177/2050313X17741827
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Article ; Online: DIGESTIBLE LYSINE LEVELS BASED IN THE IDEAL PROTEIN CONCEPT FOR BROILER CHICKENS IN THE STARTER PERIOD NÍVEIS DE LISINA DIGESTÍVEL EM DIETAS BASEADAS NO CONCEITO DE PROTEÍNA IDEAL PARA FRANGOS DE CORTE NA FASE INICIAL

Alice Eiko Murakami / José Rodrigo Galli Franco / Paulo Segatto Cella

Ciência Animal Brasileira, Vol 10, Iss 1, Pp 101-

2009 Volume 106

Abstract: The experiment was carried out in order to evaluate rations with different levels of digestible lysine, maintaining ratio with met+cys, threonine and tryptophan amino acids, for broilers chickens in the starter period (one to 21 days of age). Four ... ...

Abstract	The experiment was carried out in order to evaluate rations with different levels of digestible lysine, maintaining ratio with met+cys, threonine and tryptophan amino acids, for broilers chickens in the starter period (one to 21 days of age). Four hundred male broilers chickens Cobb Vantress were used in experimental design completely randomized with four treatments (1.14%; 1.18%; 1.22% and 1.26% of digestible lysine), four replicates and 25 birds per experimental unit. It was observed quadratic effect (P<0.05) of lysine levels on weight gain and feed conversion of birds, being the better level 1.183% and 1.190% of digestible lysine, respectively. It was not verified effect of treatments on feed intake, abdominal fat, corporal chemical composition, uric acid levels on blood and litter moisture and nitrogen rate. According to the performance results, can be concluded that the digestible lysine requirements for male broiler chickens in the period from 1 to 21 days of age were of 1.19%. KEY WORDS: Broiler chickens, digestible lysine, ideal protein. O experimento foi desenvolvido com o objetivo de avaliar rações com diferentes níveis de lisina digestível, mantendo sua relação com os aminoácidos met+cys, treonina e triptofano, para pintos de corte machos na fase de 1 a 21dias de idade. Utilizaram-se quatrocentos pintos de corte, Cobb Vantress, em delineamento experimental inteiramente casualizado, com quatro tratamentos (1,14; 1,18; 1,22 e 1,26% de lisina digestível), quatro repetições e 25 aves por unidade experimental. Observou-se efeito quadrático (P<0,05) dos níveis de lisina sobre o ganho de peso e conversão alimentar das aves, sendo o melhor nível de 1,183% e 1,190% de lisina digestível, respectivamente. Não foi constatado efeito dos tratamentos no consumo de ração, gordura abdominal, composição química corporal, nível de ácido úrico no sangue e umidade e taxa de nitrogênio na cama. Com base nos resultados de desempenho, conclui-se que a exigência de lisina digestível, para pintos de corte, machos, no ...
Keywords	pintos de corte ; lisina digestível ; proteína ideal ; Agriculture ; S ; Animal culture ; SF1-1100
Language	English
Publishing date	2009-04-01T00:00:00Z
Publisher	Universidade Federal de Goiás
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: NÍVEIS DE LISINA DIGESTÍVEL EM DIETAS BASEADAS NO CONCEITO DE PROTEÍNA IDEAL PARA FRANGOS DE CORTE NA FASE INICIAL

Paulo Segatto Cella / Alice Eiko Murakami / José Rodrigo Galli Franco

Ciência Animal Brasileira, Vol 10, Iss

2009 Volume 1

Abstract: O experimento foi desenvolvido com o objetivo de avaliar rações com diferentes níveis de lisina digestível, mantendo sua relação com os aminoácidos met+cys, treonina e triptofano, para pintos de corte machos na fase de 1 a 21dias de idade. Utilizaram-se ... ...

Abstract	O experimento foi desenvolvido com o objetivo de avaliar rações com diferentes níveis de lisina digestível, mantendo sua relação com os aminoácidos met+cys, treonina e triptofano, para pintos de corte machos na fase de 1 a 21dias de idade. Utilizaram-se quatrocentos pintos de corte, Cobb Vantress, em delineamento experimental inteiramente casualizado, com quatro tratamentos (1,14; 1,18; 1,22 e 1,26% de lisina digestível), quatro repetições e 25 aves por unidade experimental. Observou-se efeito quadrático (P
Keywords	pintos de corte ; lisina digestível ; proteína ideal ; Agriculture ; S ; Animal culture ; SF1-1100
Language	English
Publishing date	2009-04-01T00:00:00Z
Publisher	Universidade Federal de Goiás
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Stent Grafts Provided Superior Primary Patency for Central Venous Stenosis Treatment in Comparison with Angioplasty and Bare Metal Stent: A Retrospective Single Center Study on 70 Hemodialysis Patients.

Quaretti, Pietro / Galli, Franco / Moramarco, Lorenzo Paolo / Corti, Riccardo / Leati, Giovanni / Fiorina, Ilaria / Tinelli, Carmine / Montagna, Giovanni / Maestri, Marcello

Vascular and endovascular surgery

2016 Volume 50, Issue 4, Page(s) 221–230

Abstract: Purpose: To compare patency in dialysis patients following different endovascular treatment of symptomatic central venous stenosis.: Materials and methods: A 10-year retrospective evaluation in 70 patients (32 men) dialyzing through vascular access ( ... ...

Abstract	Purpose: To compare patency in dialysis patients following different endovascular treatment of symptomatic central venous stenosis. Materials and methods: A 10-year retrospective evaluation in 70 patients (32 men) dialyzing through vascular access (33, 47%) and tunneled catheters (37, 53%) was made. Three cohorts were compared: angioplasty alone (22), bare metal stent (28), and stent graft (20). Patencies were described with Kaplan-Meier method, and Cox uni- and multivariate models were analyzed to find factors associated. Results: All patients had a favorable anatomical and clinical outcome. Restenosis occurred in 22 (31%) of 70 patients requiring 41 additional interventions; 34 of 70 patients died (median follow-up 19.4 months). Primary patency at 3, 6, 12, and 24 months was 100%, 100%, 100%, and 84% for stent graft versus 90%, 79%, 58%, and 43% for angioplasty (P = .014) versus 84%, 80%, 75%, and 46% for bare-metal stent (P = .062). The overall comparison was more favorable for stent graft (P = .020) when the sites of lesions were matched. Patencies for angioplasty and bare-metal stents were equivalent (P = .141). A lower risk of restenosis (hazard rate [HR] 0.20, confidence interval [CI] 0.06-0.7) and fewer reinterventions (P < .01) were associated with stent graft, whereas age (HR 1.04, CI 1.001-1.08) and cardiovascular disease (HR 2.26, CI 1.06-4.84) influenced the overall survival. No difference in assisted primary patency was found. Conclusion: Stent graft seems to improve primary patency for central venous stenosis and requires fewer reinterventions in a dialysis population with a high prevalence of long-term catheters.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon/adverse effects ; Angioplasty, Balloon/instrumentation ; Arteriovenous Shunt, Surgical/adverse effects ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/instrumentation ; Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/instrumentation ; Catheters, Indwelling ; Central Venous Catheters ; Chi-Square Distribution ; Constriction, Pathologic ; Female ; Humans ; Italy ; Kaplan-Meier Estimate ; Male ; Metals ; Middle Aged ; Multivariate Analysis ; Phlebography ; Proportional Hazards Models ; Prosthesis Design ; Recurrence ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Stents ; Time Factors ; Treatment Outcome ; Vascular Diseases/diagnostic imaging ; Vascular Diseases/etiology ; Vascular Diseases/physiopathology ; Vascular Diseases/therapy ; Vascular Patency
Chemical Substances	Metals
Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2076272-0
ISSN	1938-9116 ; 1538-5744
ISSN (online)	1938-9116
ISSN	1538-5744
DOI	10.1177/1538574416639149
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Zs.A 622: Show issues

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Article ; Online: Dialysis catheter-related superior vena cava syndrome with patent vena cava: long term efficacy of unilateral Viatorr stent-graft avoiding catheter manipulation.

Quaretti, Pietro / Galli, Franco / Moramarco, Lorenzo Paolo / Corti, Riccardo / Leati, Giovanni / Fiorina, Ilaria / Maestri, Marcello

Korean journal of radiology

2014 Volume 15, Issue 3, Page(s) 364–369

Abstract: Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome ...

Abstract	Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.
MeSH term(s)	Aged ; Brachiocephalic Veins ; Central Venous Catheters/adverse effects ; Constriction, Pathologic/etiology ; Female ; Humans ; Jugular Veins ; Renal Dialysis/instrumentation ; Stents ; Superior Vena Cava Syndrome/etiology ; Superior Vena Cava Syndrome/therapy ; Vena Cava, Superior
Language	English
Publishing date	2014-04-29
Publishing country	Korea (South)
Document type	Case Reports ; Journal Article
ZDB-ID	2046981-0
ISSN	2005-8330 ; 1229-6929
ISSN (online)	2005-8330
ISSN	1229-6929
DOI	10.3348/kjr.2014.15.3.364
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Zs.A 5591: Show issues

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Article ; Online: A refinement of Hong's technique for the removal of stuck dialysis catheters: an easy solution to a complex problem.

Quaretti, Pietro / Galli, Franco / Fiorina, Ilaria / Moramarco, Lorenzo Paolo / Spina, Monica / Forneris, Giacomo / Torresi, Mario / Bellazzi, Roberto

The journal of vascular access

2014 Volume 15, Issue 3, Page(s) 183–188

Abstract: Aim: A long-term tunneled hemodialysis catheter can be difficult or impossible to pull out if a fibrin sleeve has attached it to the venous wall. We report the outcome of a refinement of Hong's technique for removing incarcerated catheters aimed at ... ...

Abstract	Aim: A long-term tunneled hemodialysis catheter can be difficult or impossible to pull out if a fibrin sleeve has attached it to the venous wall. We report the outcome of a refinement of Hong's technique for removing incarcerated catheters aimed at improving its feasibility and safety. Methods: We applied a modification of Hong's technique in four patients (two males, age ranging from 51 to 68 years) with jugular twin hemodialysis catheters (five of eight lines incarcerated). Hong pioneered the technique of endoballooning to expand a stuck central venous catheter, thus freeing it from adhesions. In our technical refinement, we cut the catheter close to its venous entry point in order to facilitate pullout and inserted a valved introducer as access for guide wires as well as for inflations of the catheter balloon. A stiff guide wire was placed in the inferior vena cava to avoid potential damage to heart cavities. Dilation was monitored under fluoroscopy with constrictions showing points where the catheter was incarcerated. If adhesions persisted through the same introducer, endoluminal dilations were repeated with a larger diameter balloon until the catheter was released. New catheters can be positioned using the stiff guide wire already in place. All removals were carried out under local anesthesia in an angiographic room by interventional radiologists. Results: All catheters were successfully removed without complications. Average fluoroscopy time for removal was 12 minutes. In the case of a Tesio catheter removed after 12 years because of infection, a computed tomography scan 2 months later revealed persistence of a calcified fibrin sleeve in the vessel. Conclusions: Hong's technique was confirmed to be a simple, safe and highly effective way to remove incarcerated long-term central venous catheters. The refinements we adopted made the procedure more flexible and possibly less prone to complications. By properly using ordinary tools available anywhere, Hong's technique could be considered Columbus' egg in this previously risky field.
MeSH term(s)	Aged ; Angioplasty, Balloon ; Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/instrumentation ; Catheters, Indwelling ; Central Venous Catheters ; Device Removal/methods ; Equipment Design ; Equipment Failure ; Female ; Humans ; Jugular Veins/diagnostic imaging ; Male ; Middle Aged ; Phlebography/methods ; Radiography, Interventional ; Renal Dialysis/adverse effects ; Renal Dialysis/instrumentation ; Tissue Adhesions ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2014-05
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2252820-9
ISSN	1724-6032 ; 1129-7298
ISSN (online)	1724-6032
ISSN	1129-7298
DOI	10.5301/jva.5000186
Database	MEDical Literature Analysis and Retrieval System OnLINE

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