The value of transesophageal echocardiography in the assessment of complications associated with hemodialysis tunneled cuffed catheters in the superior vena cava.

PURPOSE

To explore the value of transesophageal echocardiography(TEE) in the assessment of complications associated with hemodialysis tunneled cuffed catheters (TCC) in the superior vena cava (SVC).

METHODS

A retrospective analysis was conducted on patients who underwent haemodialysis with TCC in SVC and developed catheter-related complications from 1 March 2020 to 31 July 2024 at Xuzhou Central Hospital. TEE and digital subtraction angiography (DSA) were performed on these patients at the same time. With DSA as a gold standard, sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TEE results were analyzed. Receiver operating characteristic(ROC) curve and area under ROC curve(AUC) were employed for examining the accuracy of TEE and verifying the consistency of two inspection results.

RESULTS

A total of 86 patients were included in the study, with a mean duration of TCC retention of 65.46 ± 24.58 months, and a site of TCC retention in the right internal jugular vein in 81 cases (94.19%) and in the left internal jugular vein in 5 case (5.81%).In the cohort of 86 patients, 57 (66.28%) exhibited positive findings on TEE examination. DSA was positive in 52 patients, representing a proportion of 60.47%. A total of 47 patients exhibited positive results on both the TEE and DSA examinations, while 24 patients demonstrated negative results in both tests. TEE has a sensitivity of 90.38%, a specificity of 70.59%, a positive predictive value of 82.46%, a negative predictive value of 82.76%, and a false positive rate of 29.41% in comparison to DSA. The false negative rate was 9.62%, the diagnostic accuracy was 82.56%, and the Youden index was 0.61. The Kappa value was 0.626, with P < 0.0001, indicating consistency between the TEE and DSA examination results. The area under the ROC curve was 0.805 [95% CI: 0.702-0.908], with P < 0.0001, indicating consistency between TEE and DSA examination results.

CONCLUSIONS

TEE is an invaluable tool for the assessment of complications associated with TCC in SVC. The non-invasive, cost-effective and convenient nature renders it an advantageous method for guiding treatment.