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All Journal Journal of Indonesia Vascular Access
Prasetyo Edi
Cardiothoracic Vascular Surgeon, Sentra Medika Cisalak Hospital – Depok
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology

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Case report of a stuck hemodialysis central venous catheter: from endovascular intervention to median sternotomy Reza Eka Putra; Prasetyo Edi; Andreas Andri Lensoen
Journal of Indonesia Vascular Access Vol. 3 No. 1 (2023): (Available Online: June 2023)
Publisher : Indonesian Vascular Access Association (IVAA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jinava.v3i1.27

Abstract

Background: Extended uses of hemodialysis catheters is often associated with thrombosis and fibrosis of the central vein around the catheter. The removal becomes complex when the catheter is stuck in a central vein. This case report presented a complex stage of removing a stuck catheter in the central vein. Case Report: A 45-year-old man complained of a stuck hemodialysis catheter in the left subclavian vein, which had been placed 8 months previously. An endovascular intervention has been tried using traction and snaring of the catheter tip, but it cannot be removed because the body part of the catheter is firmly attached to the central vein, so we decided to evacuate the catheter using the median sternotomy procedure. We found an adhesion between the left innominate vein's wall and the catheter's body about 4 cm from the catheter tip. The left innominate vein was incised longitudinally while detaching the catheter against the vein. We repair the left Innominate vein without using a graft. Conclusion: A stuck catheter to the central vein was an unexpected complication due to the removal of the hemodialysis catheter. There are several options for removing a stuck catheter, such as various endovascular interventions and open surgical techniques.
Rupture infected pseudoaneurysm on brachiocephalic AV-fistula: emergency and definitive management Reza Eka Putra; Prasetyo Edi
Journal of Indonesia Vascular Access Vol. 2 No. 2 (2022): (Available Online: December 2022)
Publisher : Indonesian Vascular Access Association (IVAA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jinava.v2i2.28

Abstract

Background: Vascular access bleeding is a rare event that can be fatal in hemodialysis patients. It requires emergency and surgical management to reduce the risk of ischemic events in the patient’s forearm and reduce mortality risk. Objective: To describe the clinical presentation, emergency and surgical intervention, and outcome of rupture-infected anastomotic pseudo aneurysm of the brachiocephalic arteriovenous fistula that underwent a definitive surgical procedure. Case Description: A 55-year-old man presented with bleeding on the AV-fistula surgery site, accompanied with pain and swelling on his forearm that occurred 3 hours before admission to the hospital. The Patient had a history of brachiocephalic AV-fistula surgery 3 weeks earlier. On physical examination, It was found that the surgical site wound looked wet and swollen, with lots of necrotic tissue and pus and lost stitches. In Emergency Departments, the patient was administered intravenous normal saline fluids, bleeding inhibitors and pressure bandages to reduce ongoing bleeding. Then the patient had planned for immediate vascular reconstruction surgery. The brachial artery is repaired using great saphenous vein patch plasty. Results: The patient’s postoperative 30-days follow-up went well, and there was no sign of complication, such as pain, infection, paresthesia, bleeding at the surgical site or ischemia in the distal forearm. Conclusion: Vascular access bleeding can be fatal to hemodialysis patients. Optimal treatment for the patient's life and hemodialysis access is a top priority. A good assessment of the condition of AVF and the choice of subsequent therapy greatly affect the patient's prognosis.
Co-Authors Andreas Andri Lensoen Reza Eka Putra Reza Eka Putra