Onishi Keisuke, Nakamura Eisuke, Shiga Takafumi, Shiraishi Aiko, Kunisho Yasushi, Sofue Tadashi, Noma Takahisa, Yamashita Yoichi, Minamino Tetsuo
Department of CardioRenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita-gun, Miki-cho, Kagawa, 761-0793, Japan.
Department of Cardiovascular Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Kita-gun, Miki-cho, Kagawa, 761-0793, Japan.
CEN Case Rep. 2025 Aug 13. doi: 10.1007/s13730-025-01026-w.
This case report highlights the effectiveness of endoluminal balloon dilation for the difficult removal of tunneled dialysis catheters. Recently, the use of tunneled catheters for vascular access has increased, and cases of difficult removal due to prolonged indwelling have been reported. We describe the case of a 66-year-old man on maintenance dialysis with a tunneled dialysis catheter that had been placed in the right internal jugular vein 8 years prior, who presented with post-dialysis fever. The procedure to remove the catheter due to a catheter-related infection using the traditional method was unsuccessful. Catheter adhesion due to the fibrin sheath was suspected. The catheter was removed using endoluminal balloon dilation. The patient had no postoperative fever or other complications. Another tunneled catheter was subsequently inserted into the same internal jugular vein. This case illustrates that prolonged catheter placement can lead to intravascular adhesions due to the formation of a fibrin sheath. Endoluminal balloon dilation is a minimally invasive treatment option that should be considered before surgical removal.
本病例报告强调了腔内球囊扩张术在困难取出隧道式透析导管方面的有效性。近年来，隧道式导管用于血管通路的情况有所增加，并且有因留置时间延长导致取出困难的病例报道。我们描述了一名66岁维持性透析男性患者的病例，其8年前在右颈内静脉置入了一根隧道式透析导管，该患者出现透析后发热。采用传统方法因导管相关感染而取出导管的操作未成功。怀疑是由于纤维蛋白鞘导致导管粘连。使用腔内球囊扩张术取出了导管。患者术后无发热或其他并发症。随后在同一颈内静脉又插入了另一根隧道式导管。该病例表明，导管长期留置可因纤维蛋白鞘的形成导致血管内粘连。腔内球囊扩张术是一种微创治疗选择，在手术取出之前应予以考虑。
