Ann Surg Treat Res.  2019 Nov;97(5):266-269. 10.4174/astr.2019.97.5.266.

Cut-down method for perm catheter insertion in patients with completely occluded internal jugular vein

  • 1Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.


The primary site for a hemodialysis catheter insertion is the right internal jugular vein (IJV) followed by the left IJV and subclavian vein. In cases when veins of the upper extremities are exhausted, femoral veins are an alternative insertion location. Femoral catheter insertions should only be used for short periods because of the increased risk of infection. There is a percutaneous technique to recanalize occluded central veins for hemodialysis catheter insertion. We experienced success with a cut-down method for permcath through a completely occluded IJV. We, therefore, find surgical recanalization to be better than percutaneous method in terms of cost and safety.


Cut-down; Internal jugular vein; Occlusion; Perm catheter

MeSH Terms

Femoral Vein
Jugular Veins*
Renal Dialysis
Subclavian Vein
Upper Extremity


  • Fig. 1 (A) Hemodialysis catheter tip malposition induced catheter malfunction. Both ascending arm venography showed stenosis of the left subclavian vein with collaterals. Right innominate vein stenosis also suspected in the venography. (B) Doppler ultrasonography revealed already occluded right IJV. Diameter of right IJV was checked as 1.5 mm. Lumen of the vein was completely collapsed without compressibility. (C) Diameter of left IJV was about 10 mm without stenosis. (D) Chest X-ray after catheter insertion showed no immediate complications. (E) Venography showed not definite stenosis from left IJV to the right atrium.

  • Fig. 2 (A) Garrett vascular dilator was inserted into right innominate vein through previously occluded right internal jugular vein. Ascending arm venography was overlaped on the C-arm image. This image confirmed the exact position of vascular dilator. (B) Plastic vein dilator was inserted into the vein. Blood aspiration test showed regurgitation without significant registant. (C) Tunneled cuffed dual lumen hemodialysis catheter was placed. (D) There was no immediate complication such as hemopneumothorax, catheter kinking, catheter malposition, etc. Immediate catheter function test with syringe aspiration showed no resistant. Left perm catheter removal was done.


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