Different management methods for tunnel abscess in tunneled cuffed catheters with catheter-related bloodstream infections and central venous stenosis: two case reports.

Background: Tunneled cuffed catheters (TCCs) are critical vascular access tools for hemodialysis patients, but they are associated with complications such as tunnel infections (TIs) and catheter-related bloodstream infections (CRBSIs). Current guidelines recommend removing infected TCCs, but this can exacerbate central venous stenosis (CVS) and complicate subsequent catheter reinsertion. This case series proposes a staged management protocol for complex TCC tunnel abscess infections complicated by CVS.

Case Presentation: We present two cases of complex TCC tunnel abscess infections with concurrent CVS. In case 1, a 67-year-old female with ANCA-associated vasculitis had a TCC tunnel abscess and CRBSI. After TCC removal, CT angiography(CTA) revealed occlusion of the right internal jugular vein and right brachiocephalic vein, along with in-stent stenosis of the superior vena cava. Endovascular interventions, including balloon angioplasty, facilitated successful TCC reinsertion. In case 2, a 71-year-old female with diabetic nephropathy underwent a staged strategy: the infected TCC was removed and replaced with a non-cuffed catheter (NCC) in situ. After infection control, balloon angioplasty resolved CVS, and a new TCC was reinserted. Both patients achieved infection control and preserved functional vascular access.

Conclusions: Both patients achieved infection control and preserved functional vascular access. However, Case 1 required technically demanding multistep endovascular procedures with elevated procedural risks, while Case 2 simplified reinsertion through NCC bridging. A staged management protocol (infection control → NCC transition → endovascular salvage) effectively addresses complex TCC infections with concurrent CVS, mitigates post-removal vascular injury, and enhances reinsertion success. Larger cohort studies are warranted to validate the efficacy and long-term safety of this approach.