Emergent Hemodialysis Access: Balloon Venoplasty and Tunneled Catheter Placement in Patients with Exhausted Venous Access – Evaluation of Safety and Patency Determinants

Abstract

Background/Objectives: Central venous occlusion (CVO) presents a significant challenge in providing emergency hemodialysis to patients with end-stage renal disease (ESRD). This study evaluated the feasibility, safety, and effectiveness of percutaneous transluminal balloon venoplasty to restore central venous patency and enable tunneled hemodialysis catheter placement in patients with complete CVO. This study specifically focused on patients with complete occlusion of all central venous pathways, a rare and underreported scenario in the literature. Methods: This retrospective, single-center observational study included 50 dialysis patients with confirmed occlusion of all central veins between November 2015 and September 2024. Balloon venoplasty was performed to recanalize the occluded veins, followed by the placement of a catheter. Patients were monitored for catheter patency and complications, and predictors of catheter dysfunction were analyzed. Results: A 100% technical success rate was achieved. The mean primary patency duration was 4 months (range: 1–37 months). Catheter dysfunction occurred in 11 patients (22%), primarily due to infection or occlusion. Multivariable analysis identified catheter distal tip location as the sole predictor of dysfunction (OR: 0.146, 95% CI: 0.026–0.816, p = 0.028). Catheters with tips in the right atrium demonstrated better patency than those in the inferior vena cava. Minor complications included hematomas (11.3%) and arrhythmias (16.1%). Conclusions: Balloon venoplasty is a safe and effective technique for managing patients with exhausted central venous access, providing emergency hemodialysis, and acting as a bridge to definitive solutions such as AV fistulas, peritoneal dialysis, or renal transplantation. To optimize patency and reduce the risk of dysfunction, catheter tips are recommended to be placed in the right atrium. Further research is needed to refine this approach and extend access longevity.

Keywords

• Central venous occlusion
• Balloon venoplasty
• Tunneled dialysis catheter
• Emergency hemodialysis
• Vascular access
• Central vein recanalization

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