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[Central venous stenosis in hemodialysis: comparative angiographic study of subclavian and internal jugular access]
F Schillinger1, D Schillinger, R Montagnac
1Services de Néphrologie-Hémodialyse, CH Troyes.
Insights
Internal jugular catheters show superior outcomes for dialysis patients compared to subclavian catheters, significantly reducing the risk of venous stenosis. This finding highlights the importance of catheter choice for long-term vascular access in hemodialysis.
Area of Science:
- Vascular Surgery
- Nephrology
- Medical Imaging
Background:
- Subclavian and internal jugular catheters are common for hemodialysis vascular access.
- Venous stenosis is a significant complication impacting long-term access.
- Previous studies have shown varying rates of complications between access sites.
Purpose of the Study:
- To compare the incidence of venous stenosis between subclavian and internal jugular catheter use in dialysis patients.
- To evaluate the long-term safety and efficacy of these central venous access methods.
Main Methods:
- Angiographic study of 100 dialysis patients (50 subclavian, 50 internal jugular) from 1986-1990.
- Groups were matched for age, sex, catheter dwell time, and dialysis session frequency.
- Data collected on catheter type, removal reasons (poor flow, infection), and cannulation side.
Main Results:
- Venous stenosis occurred in 42% of the subclavian catheter group versus 10% in the internal jugular group.
- Stenosis was more frequent on the left side, potentially due to anatomical factors.
- Strictures were primarily located at the jugular-subclavian vein junction.
Conclusions:
- The internal jugular route demonstrates a significantly lower risk of venous stenosis compared to the subclavian route.
- Internal jugular catheterization is a superior option for venous access in dialysis patients.
- Anatomical considerations may influence the risk of stenosis at different cannulation sites.
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. The left side presents more risks of stenosis than the right, what can be explained by anatomical features. The strictures, whose severity is variable, are mainly located at and slightly above the junction of jugular and subclavian veins. This significative difference in favour of the internal jugular route asserts its superiority on subclavian route in respect of venous access of dialysed patients.