title: [A new bone anchored hemodialysis access].
abstract: When classic arteriovenous fistulas or grafts fail, dialysis patients have a vital requirement for a catheter to ensure vascular access. Permanent central venous catheters penetrate the cervical and thoracic soft tissues and the skin without rigid fixation. The infection rate for such devices is high, often requiring explantation. Bone anchored hearing aids are an established treatment in patients with conductive hearing loss. The implant is firmly fixed on the temporal bone and the abutment permanently penetrates the skin. Severe infections requiring explantation are very rare. We suppose that one of the main reasons for the low complication rate is the firm fixation of the implant to the temporal bone, which minimizes the movement of the skin relative to the underlying bone. Based on the experience with implantable hearing devices we developed a percutaneous bone anchored port fixed to the skull in the region of the temporal bone. Such a bone anchored port could be a beneficial alternative to conventional central venous catheters for patients undergoing hemodialysis. In the course of the development process we investigated the individual anatomy to locate the correct implantation site with sufficient bone thickness; we studied screw stability in bone; we developed the titanium implant that houses the port system as well as the surgical tools and procedure for save implantation; we tested flow rate, leak tightness and purification on mockups; we defined the Seldinger-insertion of the catheter into the internal jugular vein via a small neck incision. Our results show the technical feasibility of a temporal bone anchored port and form the basis of a now-approved clinical pilot study.
authors.affiliation: 1 Universitätsklinik für Hals-, Nasen- und Ohrenkrankheiten, Kopf- und Halschirurgie, Inselspital Bern.
authors.forename: Andreas
authors.initials: A
authors.lastname: Arnold
authors.forename: Anja
authors.initials: A
authors.lastname: Kruse
authors.forename: Simona
authors.initials: S
authors.lastname: Wiedmer
authors.forename: Matthias
authors.initials: M
authors.lastname: Widmer
authors.forename: Jérémie
authors.initials: J
authors.lastname: Guignard
authors.forename: Daniel
authors.initials: D
authors.lastname: Schütz
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Guenat
authors.forename: Matthias
authors.initials: M
authors.lastname: Bachtler
authors.forename: Marco
authors.initials: M
authors.lastname: Caversaccio
authors.forename: Dominik E
authors.initials: DE
authors.lastname: Uehlinger
authors.forename: Felix J
authors.initials: FJ
authors.lastname: Frey
authors.forename: Rudolf
authors.initials: R
authors.lastname: Häusler
authors.forename: Christof
authors.initials: C
authors.lastname: Stieger
mesh_terms: D001863:Bone Screws; D002408:Catheters, Indwelling; D004867:Equipment Design; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D006435:Renal Dialysis / Q000379:methods*; D053441:Suture Anchors; D062666:Vascular Access Devices