Vascular Access for Placement of Tunneled Dialysis Catheters for Hemodialysis: A Systematic Approach and Clinical Practice Algorithm

Abstract

The role of interventional radiology in the overall management of patients on dialysis continues to expand. In patients with end-stage renal disease (ESRD), the use of tunneled dialysis catheters (TDCs) for hemodialysis has become an integral component of treatment plans. Unfortunately, long-term use of TDCs often leads to infections, acute occlusions, and chronic venous stenosis, depletion of the patient's conventional access routes, and prevention of their recanalization. In such situations, the progressive loss of venous access sites prompts a systematic approach to alternative sites to maximize patient survival and minimize complications. In this review, we discuss the advantages and disadvantages of each vascular access option. We illustrate the procedures with case histories and images from our own experience at a highly active dialysis and transplant center. We rank each vascular access option and classify them into tiers based on their relative degrees of effectiveness. The conventional approaches are the most preferred, followed by alternative approaches and finally the salvage approaches. It is our intent to have this review serve as a concise and informative reference for physicians managing patients who need vascular access for hemodialysis.

Do You Know Your Lines?

“…They are associated with higher rates of infection and mechanical complications, necessitating their early removal or exchange. 20 As a general rule, the preferred vein should not be on the dominant side. One should consider using distal veins first.…”

Placement of hemodialysis catheters with the help of the micropuncture technique in patients with central venous occlusion and limited access

“…The use of tunneled hemodialysis catheters especially in patients with end-stage renal disease and no access for surgical fistulas is increasing owing to its practical placement and management [1]. Central venous catheterization is one of the most common procedure performed in interventional radiology units with low complication rates, high technical success and long-term patency [2,3]. History of prior multiple catheter placements and long term indwelling catheters can result in central venous stenosis or occlusion and this can be concluded with limited vascular access for dialysis sessions [3].…”

Comparing the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter

“…Chronic kidney disease (CKD) is a progressive kidney dysfunction due to irreversible decreased renal function impairment. Dialysis and kidney transplantation are available options to prevent life-threatening uremia (1,2). The worldwide prevalence of chronic renal failure is 242 per million subjects and annually eight percent are added to this rate (3).…”