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[Post-catheterization venous stenosis in hemodialysis: comparative angiographic study of 50 subclavian and 50
F Schillinger1, D Schillinger, R Montagnac
1Service de Néphrologie-Hémodialyse, CHG Troyes.
Insights
Internal jugular catheters significantly reduce vein stenosis compared to subclavian catheters in dialysis patients. This study highlights the internal jugular route as superior for long-term venous access in hemodialysis.
Area of Science:
- Vascular Surgery
- Nephrology
- Interventional Radiology
Background:
- Subclavian and internal jugular catheters are common venous access routes for hemodialysis.
- Complications such as stenosis can compromise long-term access.
- Evaluating the comparative incidence of venous stenosis is crucial for patient management.
Purpose of the Study:
- To compare the rates of subclavian-brachiocephalic vein stenosis between patients undergoing dialysis with subclavian catheters versus internal jugular catheters.
- To determine the superior venous access route for hemodialysis patients regarding stenosis development.
Main Methods:
- An angiographic study was conducted on 100 hemodialysis patients (50 subclavian, 50 internal jugular) from January 1986 to December 1990.
- Patient demographics, catheter dwell time, dialysis session frequency, catheter type, and reasons for removal were analyzed.
- Venous stenosis was assessed via angiography, comparing the two catheter groups.
Main Results:
- Venous stenosis was observed in 42% of patients with subclavian catheters compared to only 10% in those with internal jugular catheters.
- No statistically significant differences were found between groups regarding age, sex, catheter dwell time, or number of dialysis sessions.
- Catheter removal rates for poor flow (16%) and infections (6%) were similar in both groups.
Conclusions:
- The internal jugular catheter route demonstrates significantly lower rates of subclavian-brachiocephalic vein stenosis compared to the subclavian catheter route.
- The internal jugular route is asserted as the superior option for venous access in dialyzed patients due to reduced stenosis risk.
- Angiographic surveillance is essential for evaluating venous access complications in hemodialysis patients.
Abstract:
From January 1986 to December 1990, we studied angiographically the subclavian-brachiocephalic vein of 100 patients dialysed on subclavian catheter for 50 (first group) and on internal jugular catheter for the 50 others (second group). These 2 groups are not statistically different for age: 61.6 +/- 11.3 years in the first and 61 +/- 11.1 in the second, for sex: respectively 48% and 56% of women, for time-length of catheter insertion: respectively 31 +/- 21.8 days and 31.7 +/- 16, and for number of dialysis sessions: respectively 13.5 +/- 9.1 and 13.6 +/- 7.1. The type of catheters, the frequency of removal for poor flow (16% in both groups) or for infections (6% in both groups) and the local nursing are similar in the 2 groups. Only the side of cannulation differs: the right side is used in 58% of cases in the first group and 78% in the second one. The angiographic study reveals a stenosis of the vein in 42% of the subclavian group and in 10% of the internal jugular group: a dramatic difference in favour of the internal jugular route, whose superiority on subclavian route is asserted in respect of venous access of dialysed patients.