Tiltle：Difficulty removing dialysis cuff catheter after its adhesion to the right atrium.

Abstract：We describe the case of an elderly Japanese female who had experienced diabetic nephropathy since the year 20xx and had been undergoing dialysis treatment while receiving vascular access interventional therapy (VAIVT) for arteriovenous fistula (AVF) occlusion. The patient visited the clinic/hospital in 20xx+10 with the AVF occlusion; emergency VAIVT was performed but blood flow could not be resumed. The patient was not admitted and was treated as an outpatient, and thus a cuff catheter (Split stream catheter: SST28 cm, Medcomp) was inserted. An infection developed and was successfully treated with antibiotics. The dialysis treatment continued without issue. One year after the cuff catheter's insertion, the patient was admitted due difficulty breathing. Despite continued dialysis treatment with the catheter, the patient died 15 days post-admission. The removal of the catheter proved to be difficult. An autopsy was approved, and the area around the catheter was examined. The adhesion of the catheter to the right atrium was observed, but no infection was detected in the bloodstream. This case illustrates that dialysis with the use of a cuff catheter can be effective.

Souce：Ogawa T, Inamura M, Kawai Y, et al. Difficulty removing dialysis cuff catheter after its adhesion to the right atrium[J]. J Vasc Access, 2021 :1129729821993981. DOI: 10.1177/1129729821993981.

我们描述了一个日本老人女性的情况，该女性自20xx年以来就经历了糖尿病性肾病，并在接受透析治疗的同时接受了动静脉内瘘（AVF）阻塞的血管通路介入治疗（VAIVT）。患者在20xx + 10时因AVF闭塞而去了诊所/医院；进行了紧急VAIVT，但无法恢复血流。该患者未被接纳为门诊患者，因此插入了袖套导管（分流导管：SST28 cm，Medcomp）。后发生感染，并成功用抗生素治疗。透析治疗继续进行，没有问题。袖套导管插入一年后，患者因呼吸困难入院。尽管使用导管继续进行透析治疗，但患者在入院后15天死亡。明确出现拔除导管困难。批准了尸检，并检查了导管周围的区域。观察到导管粘附到右心房，但是在血流中未检测到感染。这种情况说明使用袖套导管进行透析可能是有效的。

启发：拔管困难的时候需考虑粘附的问题，若强行拔除可能出现其他不可预测的并发症。