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Life of 38 years old saved by creating vascular access from nowhere for hemodialysis at Apollo Gleneagles Hospitals Kolkata
Kolkata, 25 June 2019: Shalini (name changed) underwent an unsuccessful kidney transplant (known follow-up case of chronic kidney disease, underwent previous renal transplant which failed after 5 yrs)in 2014 in a private hospital, post which she had to continue her dialysis on a regular basis. The frequent hemodialysis blocked her veins creating access problem for hemodialysis. This blockage also made her life miserable as she couldn’t lie down or lead a normal life. Unable to continue her dialysis elsewhere, she came to Dept. of Nephrology in Apollo Gleneagles Hospitals Kolkata in April, 2019 and was seen by Dr Sandeep Bhattacharyya who in turn referred her to Dept. of Vascular & Non-Vascular Intervention for any possible help.
Dr Manash Saha, Senior Consultant, Interventional Radiologist, Apollo Gleneagles Hospitals Kolkata on examining Shalini, realized that both her internal jugular veins (left and right) as well as both her subclavian and innominate veins (left and right) are completely blocked due to repeated dialysis and hence are not fit for further dialysis. Due to this blockage she had also effectively developed so called Superior Vena Cava Syndrome. This is when Dr Saha decided to perform venoplasty (opening up of these blocked veins) followed by permcath placement. The tricky procedure took about five and a half hours where Dr Saha inserted the permcath after opening the central venous stenosis finally via Right Subclavian venous route as all other routes had no access. The right basilic vein at arm was punctured and a 6-French sheath was placed through which the catheter and the guide wire were inserted, and finally Rt Subclavian and Innominate vein were opened up by serial balloon dilatation upto 10mm.
Dr Manash Saha further expressed, “Patients of chronic kidney disease who are on hemodialysis, frequently presents with access problem and multiple access veins thrombosis are of very common occurrence. Some of these patients have a tendency to develop thrombosis and fibrotic occlusions of the various venous channels as well, maybe due to several factors associated with them. These patients really pose great clinical challenges for continuation of the hemodialysis and require sometimes very difficult interventional procedures with innovative thinking for them. But in this case, it was almost complete loss of vascular access for hemodialysis where unusual multi-access approach had to be used for recanalization of one of the veins to create a hemodialysis path.”
Dr Sandip Kumar Bhattacharya said, “After the procedure Shalini has recovered and is now under regular dialysis. She will soon be ready for her second transplant.”
