title: Insertion of permanent hemodialysis catheters through the great saphenous vein.
abstract: BACKGROUND
  In patients with end stage renal disease when there is inability for the creation of a direct arterio-venous fistula or by using a graft, the insertion of a permanent hemodialysis catheter in a central vein ensures the conduction of hemodialysis. We present a technique of placing a permanent catheter in the inferior vena cava through the great saphenous vein without the use of a guide wire.
  
  
  METHODS
  Over the study period, 12 hemodialyzed patients, with a mean age of 73 years, were referred for placement of a dialysis catheter through the great saphenous veins. The procedure was performed under local anesthesia, ECG monitoring, and fluoroscopic control. The insertion of the tunneled hemodialysis catheters was accomplished with ease, through surgical exposure of the great saphenous vein, without the need for a guidewire.
  
  
  RESULTS
  The hemodialysis catheter's function was assessed intraoperatively. No intraoperative or immediate post operative complications were noted while during the study period 3 thromboses and an infection were detected (0,95 per 1000 catheter days). The primary catheter patency rates were 92%, 84%, 54% at 30, 90 and 180 days respectively, varying from 28 to 845 days (mean±SD = 294 ± 243,3).
  
  
  CONCLUSIONS
  The introduction of dialysis catheters in the inferior vena cava through the great saphenous vein is technically simple with rare complications and with higher patency rates compared to the traditional femoral approach.
authors.affiliation: Department of Surgery, General Hospital Agios Pavlos, Thessaloniki, Greece. ioannisskandalos@yahoo.gr
authors.forename: Loannis K
authors.initials: LK
authors.lastname: Skandalos
authors.forename: Asterios A
authors.initials: AA
authors.lastname: Samaras
authors.forename: Anestis I
authors.initials: AI
authors.lastname: Karakatsanis
authors.forename: Theodoros K
authors.initials: TK
authors.lastname: Ditsias
authors.forename: Antis A
authors.initials: AA
authors.lastname: Filippidis
authors.forename: Konstantinos S
authors.initials: KS
authors.lastname: Mavromatidis
authors.forename: Nikolaos K
authors.initials: NK
authors.lastname: Koutsouflianiotis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects; D004562:Electrocardiography; D005260:Female; D005471:Fluoroscopy; D006115:Greece; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods; D006435:Renal Dialysis; D012501:Saphenous Vein / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging