title: Life-saving vascular access in vascular capital exhaustion: single center experience in intra-atrial catheters for hemodialysis.
abstract: BACKGROUND
  Intra-atrial catheter (IAC) placement through an open surgical approach has emerged as a life-saving technique in hemodialysis (HD) patients with vascular access exhaustion.
  
  
  OBJECTIVE
  To assess the complications of IAC placement, as well as patient and vascular access survival after this procedure.
  
  
  METHODS
  The authors retrospectively analyzed all seven patients with vascular capital exhaustion, without immediate alternative renal replacement therapy (RRT), who underwent IAC placement between January 2004 and December 2015 at a single center.
  
  
  RESULTS
  Seven patients were submitted to twelve IAC placements. Bleeding (6/7) and infections (3/7) were the main complications in the early postoperative period. Two (2/7, 29%) patients died from early complications and 5/7 were discharged with a properly functioning IAC. The most frequent late complication was catheter accidental dislodgement in all remaining five patients, followed by catheter thrombosis and catheter-related infections in the same proportion (2/5). During follow-up, two of five patients died from vascular accesses complications. After IAC failure, one patient was transferred to peritoneal dialysis and a kidney transplant was performed in the other. Only one patient remains on HD after the third IAC, with a survival of 50 months. The mean patient survival after IAC placement was 19 ± 25 (0-60) months and the mean IAC patency was 8 ± 11 (0-34) months.
  
  
  CONCLUSIONS
  Placing an IAC to perform HD is associated to significant risks and high mortality. However, when alternative RRT are exhausted, or as a bridge to others modalities, this option should be considered.
authors.affiliation: Centro Hospitalar Lisboa Norte, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Pereira
authors.affiliation: Centro Hospitalar Lisboa Norte, Portugal.
authors.forename: Noélia
authors.initials: N
authors.lastname: Lopez
authors.affiliation: Centro Hospitalar Lisboa Norte, Portugal.
authors.forename: Iolanda
authors.initials: I
authors.lastname: Godinho
authors.affiliation: Centro Hospitalar Lisboa Norte, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Jorge
authors.affiliation: Centro Hospitalar Lisboa Norte, Portugal.
authors.forename: Estela
authors.initials: E
authors.lastname: Nogueira
authors.affiliation: Centro Hospitalar Lisboa Norte, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Neves
authors.affiliation: Centro Hospitalar Lisboa Norte, Portugal.
authors.forename: Alice
authors.initials: A
authors.lastname: Fortes
authors.affiliation: Centro Hospitalar Lisboa Norte, Portugal.
authors.forename: António G
authors.initials: AG
authors.lastname: Costa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries; D002404:Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies