Managing the Failing Dialysis Permacath: Results from a 5-year Retrospective Analysis

Panagiotis M Kitrou, Panagiotis Papadimatos, Konstantinos Katsanos, Stavros Spiliopoulos, Nicolaos Christeas, Theodoros Petsas, Dimitrios Karnabatidis


Purpose: To evaluate the results of a retrospective analysis on the management of failing permanent dialysis catheters.

Material and Methods: Within 5 years (1/2011-12/2015), 1,158 permanent dialysis catheters were inserted to 853 patients (576 men, 67.5% -277 women, 32.5%) in our department. Of those, 648 patients had only one catheter placed while 205 patients had ≥2 catheters/interventions, reaching a total of 510 procedures (2.48 procedures/patient; 2-27). In 342 cases, catheters were placed to the jugular vein (J-group) and 168 catheters were placed in the femoral vein (F-group). In 413 cases only catheter exchange took place (CE-group), in another 89 cases balloon angioplasty was performed (PTA-group) and in 8 cases a bare metal stent was inserted (BMS-group). 272 central venous catheter (CVCs) had a split tip (SP-group) and a 238 straight tip (ST-group). Outcome measures included intervention-free period and independent predictors that might influence patency.

Results: Mean follow up period was 475.64 days (1-1712 days). Mean intervention-free period was 268.35 days (1-1545 days). According to the Kaplan Meier survival analysis, there was statistically significant difference in favour of the J-group (Median Survival: 136 days vs. 69.5 days for F-group, p<0.0001). CE-group had significantly better results, when compared to PTA-group and BMS-group (Median Survival: CE-group 116 days, PTA-group 89 days, BMS-group 73 days, p<0.0001). CVCs with a straight tip had significantly better intervention-free period compared to split tip (ST-group 126 days vs. 80 days for SP-group, p<0.001)

Conclusions: Jugular access had significantly better patency results compared to femoral. Additional interventions (angioplasty and stenting) in a bail-out setting provided worse results compared to plain catheter exchange. Straight tip CVCs had significantly better patency rates.


central venous catheter; central vein; dialysis; permacath; stent; angioplasty stenosis

Full Text:



Brown RS, Patibandla BK, Goldfarb-Rumyantzev AS. The survival benefit of “Fistula First, Catheter Last” in hemodialysis is primarily due to patient factors. J Am Soc Nephrol 2017; 28(2): 645-652.

Vassalotti JA, Jennings WC, Beathard GA, et al. Fistula first breakthrough initiative: targeting catheter last in fistula first. Semin Dial 2012; 25(3): 303-310.

Ash SR. Advances in tunneled central venous catheters for dialysis: design and performance. Semin Dial 2008; 21(6): 504-515.

Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49(1): 1-45.

Barrett N, Spencer S, McIvor J, et al. Subclavian stenosis: a major complication of subclavian dialysis catheters. Nephrol Dial Transplant 1988; 3(4): 423-425.

Naroienejad M, Saedi D, Rezvani A. Prevalence of central vein stenosis following catheterization in patients with end-stage renal disease. Saudi J Kidney Dis Transpl 2010; 21(5): 975-978.

Rusu MC. The valve of the superior vena cava-the supernumerary structure of the precaval segment of the crista terminalis. Folia Morphol (Warsz) 2007; 66(4): 303-306.

Petridis C, Nitschke M, Lehne W, et al. Tip design of hemodialysis catheters influences thrombotic events and replacement rate. Eur J Vasc Endovasc Surg 2017; 53(2): 262-267.

III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis 2001; 37(1 Suppl 1): S137-181.

Falk A, Maya ID, Yevzlin AS. A prospective, randomized study of an expanded polytetrafluoroethylene stent graft versus balloon angioplasty for in-stent restenosis in arteriovenous grafts and fistulae: Two-year results of the RESCUE study. J Vasc Interv Radiol. 2016; 27(10): 1465-1476.

Diskin CJ. Novel insights into the pathobiology of the vascular access - do they translate into improved care? Blood Purif 2010; 29(2): 216-229.

Rajan DK, Sidhu A, Noel-Lamy M, et al. Elastic recoil after balloon angioplasty in hemodialysis accesses: Does it actually occur and is it clinically relevant? Radiology 2016; 279(3): 961-967.

Kitrou PM, Spiliopoulos S, Papadimatos P, et al. Paclitaxel-coated balloons for the treatment of dysfunctional dialysis access. Results from a single-center, retrospective analysis. Cardiovasc Intervent Radiol 2017; 40(1): 50-54.

Kitrou P, Spiliopoulos S, Karnabatidis D, et al. Cutting balloons, covered stents and paclitaxel-coated balloons for the treatment of dysfunctional dialysis access. Expert Rev Med Devices 2016; 13(12): 1119-1126.

Kitrou PM, Spiliopoulos S, Katsanos K, et al. Paclitaxel-coated versus plain balloon angioplasty for dysfunctional arteriovenous fistulae: one-year results of a prospective randomized controlled trial. J Vasc Interv Radiol 2015; 26(3): 348-354.

Kitrou PM, Katsanos K, Spiliopoulos S, et al. Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472). Eur J Radiol. 2015; 84(3): 418-423.



  • There are currently no refbacks.