Use of the femoral vein as insertion site for tunneled hemodialysis catheters.
OBJECTIVE
To determine the outcome of tunneled hemodialysis catheters inserted through the common femoral vein.


METHODS
From April 2000 to June 2003, 33 consecutive patients had 86 tunneled hemodialysis catheters inserted through the femoral vein. There were 14 male and 19 female patients with a mean age of 56 years. Seventeen patients had bilateral central venous and/or superior vena cava (SVC) occlusions, 12 patients had unilateral central venous occlusions and were to receive contralateral arteriovenous fistulas or arteriovenous polytetrafluoroethylene grafts, and 4 patients received femoral catheters for other reasons. The technical success, complications, and clinical outcomes of these procedures were retrospectively evaluated.


RESULTS
All procedures were technically successful. Fifty-seven catheters were inserted into the right femoral vein and 29 into the left femoral vein. This included 25 catheter exchanges in 13 patients. Two patients developed thigh hematomas. Follow-up data were available for 68 catheters; mean follow-up period was 51 days with a total of 3,484 catheter days. The catheter-related infection rate was 6.3 per 1,000 catheter days; 22 catheters were removed for infection. Eighteen catheters were removed because of poor blood flows (<200 mL/min). Thirteen catheters were removed because they had become retracted. Primary catheter patency was 44% at 1 month.


CONCLUSIONS
The femoral vein provides an alternative access site for insertion of tunneled hemodialysis catheters when conventional sites are not available. However, tunneled femoral hemodialysis catheters have low primary patency rates and significant complications. Catheter retraction is a unique and common problem.
Falk
Abigail
A
American Access Care, 200 Boston Avenue, Medford, Massachusetts 02155, USA. abigailfalk123@pol.net
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D016470:Bacteremia / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005268:Femoral Vein; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000628:therapy
D005343:Fibrinolytic Agents