Combined use of a Byrd dilator sheath and the tandem approach with the Tetra-Wire technique for stuck and infected haemodialysis catheter removal: what lead extractors should know, a case report

Background Removal of stuck tunnelled cuffed catheters (TCCs) is a rare but serious challenge in haemodialysis patients with exhausted vascular access. We report the first successful use of a polypropylene sheath combined with an adaptation of the tandem approach (a principal transvenous lead extraction technique employing a snare for controlled bidirectional traction from both superior and femoral approaches) for safe, effective removal of a stuck TCC. This case highlights that multidisciplinary expertise from lead extraction can be leveraged for catheter removal. Case Summary A 78-year-old woman with end-stage renal disease presented with erythema, swelling, and abscess at the left cervical tunnel site, two years after TCC placement. Imaging demonstrated complete occlusion of the left innominate vein. Manual extraction attempts failed due to severe fibrotic adhesions. Under general anaesthesia, two 0.035-inch guidewires were inserted into each catheter lumen and externalized via femoral access. A polypropylene dilator sheath was used for adhesiolysis; however, due to insufficient advancement with standard tandem pull-through wiring, the Tetra-Wire technique—employing four guidewires—was subsequently implemented to enhance coaxial stability and facilitate successful catheter extraction without complications. Discussion This case illustrates that our method, adapted from transvenous lead extraction, can be a viable alternative to conventional endoluminal dilatation. Unlike previously reported lead extraction–adapted methods, our approach generalizes to large-diameter TCCs while maintaining cost-effectiveness and coaxial alignment afforded by the tandem approach. These findings suggest that lead extraction techniques and expertise may be valuable in managing complex haemodialysis catheter extractions, potentially expanding the role of lead extractors in this setting.