{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:06:54Z","timestamp":1784531214954,"version":"3.55.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"The China Medical Foundation","award":["2025CMFC7"],"award-info":[{"award-number":["2025CMFC7"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Vasc Access"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The 2019 KDOQI guidelines recommend fluoroscopy-guided placement of tunneled cuffed catheter tips within the right atrium. However, fluoroscopy may misidentify the cavoatrial junction. This study quantified the discrepancy between digital subtraction angiography and fluoroscopy in locating the cavoatrial junction and assessed its impact on intrathoracic central venous stenosis risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective cohort study analyzed 90 patients with right internal jugular tunneled cuffed catheters who underwent DSA at our hospital between June 2023 and May 2025; digital subtraction angiography and fluoroscopy were compared in locating the cavoatrial junction. Catheter tips were classified by DSA-defined location: superior vena cava upper segment (Group A), lower segment (Group B), or right atrium (Group C). Intrathoracic central venous stenosis risks were analyzed using logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The DSA-defined cavoatrial junction was consistently 21.64\u2009\u00b1\u20097.23\u2009mm caudal to fluoroscopic landmarks. The incidence of central venous stenosis was 34.4%. Intrathoracic central venous stenosis incidence was significantly higher in Group A versus C (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0167) and Group B versus C (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.0167). Catheter tip location within the superior vena cava was associated with 5.78-fold higher odds of intrathoracic central venous stenosis compared to placement within the right atrium (OR\u2009=\u20095.78, 95% CI: 1.75\u201319.06;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Fluoroscopy overestimates the cavoatrial junction position. Given that right atrium placement reduces intrathoracic central venous stenosis risk, advancing the catheter tip 10\u201330\u2009mm beyond fluoroscopically guided landmarks constitutes a key maneuver for achieving accurate positioning. Implementation of this optimization strategy is associated with a 5.78-fold reduction in odds of intrathoracic central venous stenosis, providing actionable optimization for hemodialysis access management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11297298251405368","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T11:47:13Z","timestamp":1770378433000},"page":"1699-1706","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fluoroscopy-guided catheter tip positioning optimization: 10\u201330\u2009mm beyond landmarks is associated with reduced intrathoracic central venous stenosis risk in hemodialysis patients"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0634-1434","authenticated-orcid":false,"given":"Fen","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liming","family":"Gan","sequence":"additional","affiliation":[{"name":"Department of Chronic Disease Management Center, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6154-8879","authenticated-orcid":false,"given":"Xiaomei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"e_1_3_3_2_2","first-page":"365","article-title":"Chinese expert consensus on vascular access for hemodialysis in China (2nd edition)","volume":"18","author":"Qizhuang J","year":"2019","unstructured":"Qizhuang J, Yuzhu W, Chaoyang Y, et al. Chinese expert consensus on vascular access for hemodialysis in China (2nd edition). Chin Blood Purif 2019; 18: 365\u2013381.","journal-title":"Chin Blood Purif"},{"key":"e_1_3_3_3_2","article-title":"KDOQI clinical practice guideline for vascular access: 2019 update [published correction appears in Am J Kidney Dis. 2021 Apr;77(4):551]","volume":"75","author":"Lok CE","year":"2020","unstructured":"Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update [published correction appears in Am J Kidney Dis. 2021 Apr;77(4):551]. 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