title: Dialysis Catheter Placement in Patients With Exhausted Access.
abstract: Patients with end-stage renal disease undergo renal transplant, peritoneal dialysis, or intermittent hemodialysis for renal replacement therapy. For hemodialysis, native fistulas or grafts are preferred but hemodialysis catheters are often necessary. Per KDOQI, the right jugular vein is the preferred vessel of access for these catheters. However, in patients with long-standing end-stage renal disease vein thrombosis, stenosis and occlusion occurs. In these patients with end-stage vascular access, unconventional routes of placement of dialysis catheters are needed. These methods include placing them by means of sharp recanalization, via a translumbar route directly into the inferior vena cava, and via transhepatic and transrenal routes. These difficult, but potentially lifesaving methods of gaining vascular access are reviewed in this article.
authors.affiliation: Department of Radiology, Baylor College of Medicine, Houston, TX.
authors.forename: Syed
authors.initials: S
authors.lastname: Rahman
authors.affiliation: Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: JDKuban@mdanderson.org.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Kuban
mesh_terms: D015901:Angiography, Digital Subtraction; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D004867:Equipment Design; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D010690:Phlebography / Q000379:methods; D015641:Radiography, Interventional; D006435:Renal Dialysis; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Catheter; Hemodialysis; Permcath; Sharp recanalization