Abstract: Objective To analyze the incidence and prognosis of symptomatic pulmonary embolism due to the operation of wire-guided exchange of tunneled cuffed dialysis catheters (TCC) with superior vena cava thrombosis. Methods We retrospectively analyzed 31 patients undergoing hemodialysis using TCC as the long-term vascular access and complicated with superior vena cava thrombosis in West China Hospital of Sichuan University from January 2015 to September 2016. These patients were treated with wire- guided exchange of TCC under the guidance of digital subtraction angiography (DSA) because of the TCC dysfunction.
Symptoms of acute pulmonary embolism, such as chest tightness, chest pain, dyspnea, hemoptysis, accelerated heart rate, hypotension and lower oxygen saturation were recorded during the operation and after the operation for 24 hours. Thoracic CT angiography (CTA) was performed for the symptomatic patients to determine whether pulmonary embolism happened. Results A total of 31 patients with the average age of 64.16 ±15.77 years old were enrolled in this study. Nine patients (29.03%) presented with pulmonary embolism related symptoms: 6 cases with different degrees of dyspnea, in which 2 patients felt chest tightness and one case had accelerated heart rate and transient lowering of oxygen saturation; 3 cases with accelerated heart rate. No patients had chest pain, hemoptysis and hypotension. Thoracic CTA examination revealed pulmonary embolism in one case (1/9). All patients were followed up by telephone, and no one died. Conclusions Wire-guided exchange of TCC under the guidance of DSA for the patients with TCC complicated with superior vena cava thrombosis is relatively safe. The incidence of symptomatic pulmonary embolism and severe adverse consequences is low.

Key words: tunneled cuffed catheter, catheter dysfunction, wire-guided exchange, superior vena cava thrombosis, pulmonary embolism