title: Management of patients with challenging vascular access needs.
abstract: The proportion of patients on dialysis with multiple access procedures, failed transplant(s), or no suitable sites for conventional arteriovenous (AV) fistula is increasing. We report on 4 patients at our institution requiring unusual measures to achieve vascular access for dialysis. All 4 patients had temporary femoral vein catheters for dialysis, but 3 had tunneled femoral catheters, with 1 patient using this modality of access for 28 months. One patient who had 13 vascular access procedures developed collateral circulation that was amenable to a new autogenous AV fistula. Two patients died of causes unrelated to vascular access, whereas 1 died from infection of an access device. In patients with challenging vascular access requirements, the use of simple procedures such as the insertion of a tunneled femoral catheter should be considered. A thorough assessment must be made before each new access procedure as collateral circulation may present new options.
authors.affiliation: Department of Surgery and Renal Services, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, United Kingdom. Jacob.akoh@phnt.swest.nhs.uk
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Akoh
authors.forename: Muhammad
authors.initials: M
authors.lastname: Riaz
mesh_terms: D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D002406:Catheterization, Peripheral / Q000379:methods; D002408:Catheters, Indwelling; D003928:Diabetic Nephropathies / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D005268:Femoral Vein; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013350:Subclavian Vein