Post Catheterisation Vein Stenosis in Haemodialysis: Comparative Angiographic Study of 50 Subdavian and 50 Internal Jugular Accesses

Abstract

From January 1986 to December 1990 we studied angiographically the subclavian-brachiocephalic vein of 100 patients dialysed by subclavian catheter for 50 (first group) and by internal jugular catheter for the 50 others (second group). These two groups were not statistically different as regards age (61.6 +/- 11.3 years in the first and 61 +/- 11.1 in the second), sex (48% and 56% were women), duration of catheter insertion (31 +/- 21.8 and 31.7 +/- 16 days), and the number of dialysis sessions (13.5 +/- 9.1 and 13.6 +/- 7.1). The type of catheters, the frequency of removal for poor flow (16% in both groups) or infections (6% in both groups), and the local nursing were similar in the two groups. The only difference was the side of cannulation: the right side in 58% of cases in group 1 and 78% in group 2. The angiographic study revealed a stenosis of the vein in 42% of the subclavian group and in 10% of the internal jugular group: a dramatic difference in favour of the internal jugular route, whose superiority over the subclavian route is asserted in respect of venous access of dialysed patients.

Guidelines for the prevention of intravascular catheter-related infections

“…Category IA C. No recommendation can be made for a preferred site of insertion to minimize infection risk for a tunneled CVC [61][62][63]. Unresolved issue D. Place catheters used for hemodialysis and pheresis in a jugular or femoral vein rather than a subclavian vein to avoid venous stenosis if catheter access is needed [259][260][261][262][263]. Category IA IV.…”

Axillofemoral Fistula for Hemodialysis Access

“…The exhaustion of SVC outflow site is related to previous central vein cannulations, catheters implantation and central bridge fistulas creations with additional procedures for maintaining their passage during the time, with consequent venous fibrosis or occlusion [9][10][11][12][13] . Arteriovenous fistula (AVF) is the best permanent vascular access for hemodialysis.…”

Beware: The femoral haemodialysis catheter – a surgeon’s perspective

“…All stenoses observed were in the subgroup of patients with >30 catheter days. Comparatively, the reported stenosis rates with internal jugular and subclavian vein catheters are 10% [9] and 20 -50%, [9][10][11] respectively. In another study, 7 of 27 patients (26%) with tunnelled FHCs presented with ipsilateral lower-extremity swelling within 10 days of insertion.…”