title: 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.
authors.affiliation: Department of Radiology, Royal Liverpool University Hospital, L7 8XP Liverpool, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Powell
authors.forename: Tze Yuan
authors.initials: TY
authors.lastname: Chan
authors.forename: Rammohan
authors.initials: R
authors.lastname: Bhat
authors.forename: Kimberly
authors.initials: K
authors.lastname: Lam
authors.forename: Ranjeet S
authors.initials: RS
authors.lastname: Narlawar
authors.forename: Nicola
authors.initials: N
authors.lastname: Cullen
authors.forename: Peter
authors.initials: P
authors.lastname: Littler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods; D002408:Catheters, Indwelling; D003097:Collateral Circulation; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods*; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult