A Retrospective Comparative Study of Tunneled Haemodialysis Catheters Inserted Through Occluded or Collateral Veins Versus Conventional Methods

Abstract

Tunneled hemodialysis catheters become essential in dialysis access when there is no possibility of using a functioning arteriovenous fistula. Collateral or occluded veins visible on ultrasound are used for puncture and passage of catheters into the central venous system. Chronically occluded veins are crossed with guidewires to allow dilatation and subsequent passage of hemodialysis catheters. We performed a retrospective analysis of patient demographics, comorbidities, procedural complications, functional survival, performance, and history of previous vascular access. The study group was compared with two control groups in which dialysis catheters were inserted either by radiologists in the interventional suite or by clinicians on the wards. Nineteen patients from the study group were compared with same number of patients in both control groups. The mean age of the study group was higher compared with the control groups. There was no significant difference in mean functional survival, infection rates, dialysis pump speeds in the first 2 weeks, and procedural complications between the study group and the controls. The study group had a significantly higher number of previous vascular access interventions, longer dialysis careers, and more comorbidities. Tunneled dialysis catheter placement by way of collateral or occluded veins appears safe and effective. These techniques give the operator further options when faced with patients possessing challenging vascular access. Indeed, there may be a case for preferential use of these veins to keep patent central veins in reserve.

Complex central venous catheter for dialysis: interventional radiology experience in insertion and management of their complications

“…For this purpose, it seems useful to choose as access site in the first step, one of those sites with known stenosis or occlusions, to preserve any other venous accesses intact; many authors suggest that longevity and complications of CVC inserted into occluded or collateral veins compared to conventional methods show no difference in terms of complications, dialysis flow rate, catheter bacteraemia or access longevity. 2,20 It is to underline that our goal is to recanalize with a PTA the stenotic central venous vessels in which CVCs are already positioned, allowing both the positioning of a possible new CVC and its good functioning, as well as maintaining the patency of the vessel regardless of the CVC replacement or its removal; in the latter case, the aim would also be to preventively guarantee patency in order to allow any future use of this route for new CVC positioning (Figures 5 and 6).…”

“…For this purpose, it seems useful to choose as access site in the first step, one of those sites with known stenosis or occlusions, to preserve any other venous accesses intact; many authors suggest that longevity and complications of CVC inserted into occluded or collateral veins compared to conventional methods show no difference in terms of complications, dialysis flow rate, catheter bacteraemia or access longevity. 2,20…”

Complex Central Venous Catheter Insertion for Hemodialysis

“…Equally, a familiarity with these procedures should be sought before attempting, as they are not without risk. However, in 2009, we published data regarding longevity and complications of CVCs inserted through occluded or collateral veins versus conventional methods, with no difference in complication rates, dialysis flow rates, catheter-related bacteremia, or longevity of access (4).…”