Percutaneous subclavian vein catheter hemodialysis--impact on vascular access surgery

The problem of the immediate need for access to the circulation for hemodialysis arises because of an acute renal failure (ARF), the failure of an established access route, or the acute presentation of end-stage renal disease. Prior to 1976 emergent hemodialysis at our center necessitated either surgical placement of an external shunt or intermittent femoral vein cannulization, Since 1976 indwelling percutaneous subclavian vein catheterization (SVC) has been used on a routine basis for emergency hemodialysis. We have evaluated retrospectively the clinical courses of 50 patients with ARF and 48 patients with chronic renal failure (CRF) who underwent SVC dialysis in comparison with the clinical courses of 50 patients with ARF and 35 patients with CRF who had external shunt dialysis. In the ARF group, SVC dialysis resulted in lower incidences of serious infection, hemorrhage, and access thrombosis and reduced the number of replacement access procedures needed. In the CRF group, SVC permitted creation of more autogenous fistulas, rarely failed because of infection or thrombosis, and could therefore be used for extended periods, allowing primary autogenous fistula placement and maturation. Future access sites were also saved. SVC dialysis has become our primary interval angioaccess procedure for acute hemodialysis.