Comparison of feasibility and effectiveness of catheter placement with or without DSA guidance: a propensity score-matched cohort study

Abstract

Background The use of digital subtraction angiography (DSA)-guided placement for tunneled dialysis catheter (TDC) placement is preferred in developed countries due to its higher success rate and accurate positioning. However, in developing countries with limited medical resources, the procedure is typically only performed under ultrasound guidance. The healthcare system is facing challenges due to the shortage of resources and financial pressures. This study aims to evaluate the feasibility and effectiveness of DSA-guided catheter placement compared to ultrasound-guided placement in developing countries. Methods This retrospective cohort study included all TDC insertions at a hospital between January 2020 and October 2022. Patient demographics, laboratory results, surgical details, and hemodialysis information were collected. Propensity score matching (PSM) was used to balance the demographics and clinical characteristics between the DSA-guided and ultrasound-guided groups. Adverse events, catheter function, catheter tip position, and costs were evaluated. Results After matching, there were no significant differences between the groups. Both groups achieved adequate catheter blood flow and ultrafiltration volumes without deviations from dialysis prescriptions. The DSA-guided group had fewer events leading to early termination of dialysis compared to the ultrasound-guided group. Catheter tip position in the right atrium was more consistent in the DSA-guided group. Cost analysis showed higher expenses with DSA-guided procedures. When the study was limited to patients with catheter tips located in the right atrium, there was no significant difference in adverse events between the two groups. Conclusion The performance of hemodialysis catheters inserted under DSA guidance is superior to those inserted under ultrasound guidance during postoperative blood dialysis. This may be related to the position of the tip of the catheter. We recommend using DSA when it cannot be ensured that the tip of the catheter is located in the right atrium.