title: Initial Clinical Experience: Symmetric-Tip Dialysis Catheter with Helical Flow Characteristics Improves Patient Outcomes.
abstract: OBJECTIVE
  To report preliminary clinical experience with a new symmetric-tip dialysis catheter compared with a conventional split-tip catheter.
  
  
  METHODS
  Over a 5-month period, patients requiring a tunneled catheter for hemodialysis or undergoing exchange of a dysfunctional dialysis catheter at a tertiary academic medical center were retrospectively analyzed. Patients underwent placement of a VectorFlow or Ash Split Cath catheter at the discretion of the inserting interventional radiologist. Patient demographics, catheter patency, mean blood flow rate, and arterial and venous pressures were compared according to catheter type. Catheter failure was analyzed based on clinical and anatomic variables by using a multivariate Cox proportional-hazards model.
  
  
  RESULTS
  A total of 33 VectorFlow and 46 Ash Split Cath catheters were placed. Patients in the VectorFlow group had significantly higher body mass index (P = .013) and Charlson Comorbidity Index (P = .049), as well as more non-internal jugular vein placements. At 120 days, 89% of VectorFlow catheters remained functional, compared with 45% of Ash Split Cath catheters (P = .046). The VectorFlow catheter was associated with 16% lower arterial pressures during dialysis (P = .009); mean blood flow rate was equivalent. On multivariate analysis, the risk of catheter failure was 13.3 times higher in the Ash Split Cath group compared with the VectorFlow group (P = .004). Left-sided catheters were also predictive of catheter failure (relative risk = 5.5; P = .02).
  
  
  CONCLUSIONS
  The VectorFlow catheter was associated with a significant increase in intervention-free catheter patency compared with the Ash Split Cath catheter, with equivalent flow at lower arterial pressures during dialysis.
authors.affiliation: Section of Interventional Radiology, Department of Radiology Penn Presbyterian Medical Center, University of Pennsylvania, 39th and Market Streets, Philadelphia, PA 19104. Electronic address: timothy.clark@uphs.upenn.edu.
authors.forename: Timothy W I
authors.initials: TW
authors.lastname: Clark
authors.affiliation: Section of Interventional Radiology, Department of Radiology Penn Presbyterian Medical Center, University of Pennsylvania, 39th and Market Streets, Philadelphia, PA 19104.
authors.forename: Jonas W
authors.initials: JW
authors.lastname: Redmond
authors.affiliation: Division of Vascular Surgery, Department of Surgery Penn Presbyterian Medical Center, University of Pennsylvania, 39th and Market Streets, Philadelphia, PA 19104.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Mantell
authors.affiliation: Section of Interventional Radiology, Department of Radiology Penn Presbyterian Medical Center, University of Pennsylvania, 39th and Market Streets, Philadelphia, PA 19104.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Nadolski
authors.affiliation: Section of Interventional Radiology, Department of Radiology Penn Presbyterian Medical Center, University of Pennsylvania, 39th and Market Streets, Philadelphia, PA 19104.
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.affiliation: Section of Interventional Radiology, Department of Radiology Penn Presbyterian Medical Center, University of Pennsylvania, 39th and Market Streets, Philadelphia, PA 19104.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Dowd
authors.affiliation: Section of Interventional Radiology, Department of Radiology Penn Presbyterian Medical Center, University of Pennsylvania, 39th and Market Streets, Philadelphia, PA 19104.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Dagli
authors.affiliation: Section of Interventional Radiology, Department of Radiology Penn Presbyterian Medical Center, University of Pennsylvania, 39th and Market Streets, Philadelphia, PA 19104.
authors.forename: Deepak
authors.initials: D
authors.lastname: Sudheendra
authors.affiliation: Section of Interventional Radiology, Department of Radiology Penn Presbyterian Medical Center, University of Pennsylvania, 39th and Market Streets, Philadelphia, PA 19104.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.affiliation: Division of Nephrology, Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania, 39th and Market Streets, Philadelphia, PA 19104.
authors.forename: Raphael D
authors.initials: RD
authors.lastname: Cohen
mesh_terms: D001783:Blood Flow Velocity; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome