Shalini (name changed) underwent an unsuccessful kidney transplant (known follow-up case of chronic kidney disease, underwent previous renal transplant which failed after 5 years) 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 Department of Nephrology in Apollo Gleneagles Hospitals Kolkata in April 2019 and was seen by Dr Sandeep Bhattacharyya who in turn referred her to Deptartment of Vascular and Non-Vascular Intervention for any possible help.
Dr Manash Saha, senior consultant, Interventional Radiologist, Apollo Gleneagles
Hospitals Kolkata on examining Shalini, realised that both her internal jugular veins
(left and right) as well as both her subclavian and innominate veins (left and right) were completely blocked due to repeated dialysis and hence were 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
up to 10mm.
