Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 15 Apr 2021

Placing a Hemodialysis Catheter in Patients With Multiple Access Failure and Exhausted Usual Approachable Veins: Egyptian Single Center Experience

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MD,
MD,
MD, and
MD
Page Range: 47 – 53
DOI: 10.2309/JAVA-D-20-00029
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Highlights

  • Multiple central venous approaches, mainly brachiocephalic, as described in this study, may play a role as an alternative for placing either temporary or tunneled hemodialysis catheters in patients with multiple vascular access failure and exhausted approachable veins.

Abstract

Background: End-stage renal disease (ESRD) is a growing global health hazard. Most patients are maintained on dialysis rather than transplantation. Adequate vascular access for hemodialysis is crucial to achieve an optimal dialysis dose and to reduce morbidity and mortality. Patients with multiple access failure are in desperate need for lifesaving access, especially in the absence of alternatives (transplantation or peritoneal dialysis).

Objective: Patients with multiple vascular access failure and exhausted approachable veins are being referred to an interventional nephrology or radiology centers. The aim of this work is to evaluate a single center’s experience of sophisticated venous approaches to provide access for hemodialysis.

Methods: This study was performed at the Interventional Nephrology Center at Kasr Al-Ainy University Hospitals. Epidemiological data of patients, e.g., age, gender, as well as the number of previously cannulated central veins, were documented.

Results: Data of 188 patients with multiple dialysis venous access failure (117 females and 71 males, aged 17–56 years) were collected. Successful innominate (brachiocephalic) venous cannulation was achieved in 149 patients (79%). Eighteen patients had successful external iliac venous approach (9%). Successful transhepatic venous approach was placed as permanent access in 7 patients (4%). The rest of the patients (n = 14, 7%) were referred to other centers due to failure.

Conclusions: Sophisticated central venous approaches, mainly brachiocephalic, as described in this study, may play as alternatives for placing either temporary or tunneled hemodialysis catheters in patients with multiple vascular access failure and stenosed or thrombosed central veins.

Keywords: vascular access failure; brachiocephalic vein; exhausted veins; dialysis limited solutions
Copyright: Copyright © 2021 Association for Vascular Access. All rights reserved.
Figure 1.
Figure 1.

Ultrasound-guided internal jugular vein cannulation: (a) short-axis view and (b) long-axis view.14

Figure 2.
Figure 2.

Ultrasound image of subclavian vein.18

Figure 3.
Figure 3.

Femoral artery and vein.2021

Figure 4.
Figure 4.

Algorithm for stepwise approach.

Figure 5.
Figure 5.

Illustrative diagram of brachiocephalic approach.

Figure 6.
Figure 6.

Initial ultrasound examination of brachiocephalic vein.

Figure 7.
Figure 7.

Brachiocephalic puncture and temporary access.

Figure 8.
Figure 8.

Brachiocephalic venous ultrasound and fluoroscopy image.

Figure 9.
Figure 9.

Illustrative diagram of external iliac vein approach.

Figure 10.
Figure 10.

Double tunnel external iliac access with fluoroscopic image.

Figure 11.
Figure 11.

Illustrative diagram of transhepatic approach.

Figure 12.
Figure 12.

Transhepatic venous access when all other options failed.

Figure 13.
Figure 13.

Type of hemodialysis catheter inserted either temporary or tunneled.

Figure 14.
Figure 14.

The number of catheters inserted for each case before being enrolled in this study.

Figure 15.
Figure 15.

Shows possible cause for the need for long-term central venous dialysis access rather than arteriovenous fistula or graft.

Figure 16.
Figure 16.

Different successful approaches and referral percentage in relation to total number of patients.

Contributor Notes

Correspondence concerning this article should be addressed to moatazfatthy@gmail.com
Received: 01 Aug 2020
Accepted: 18 Dec 2020
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