Vascular complications of continuous arteriovenous hemofiltration in trauma patients

Continuous arteriovenous hemofiltration (CAVH) has recently become useful in the treatment of acute renal failure following trauma. It allows continuous volume removal and avoids the acute hemodynamic changes often seen with hemodialysis. To determine the risks of CAVH catheters, the records of trauma patients undergoing CAVH from August 1989 through May 1992 were reviewed. Of 4685 trauma patients, 29 developed renal failure requiring dialysis, with 26 managed with CAVH. Vascular access was obtained via 126 percutaneous 8F femoral arterial and venous catheters (64 arterial, 62 venous) and four Scribner shunts. There was a total of 309 CAVH-D days, with an average of 11.9 days per patient. Complications included one femoral arteriovenous fistula, one pseudoaneurysm, and one deep venous thrombosis, resulting in a 3.1% (2 of 64) arterial complication rate and a 1.6% (1 of 62) venous complication rate. The incidence of arterial complications compares with that of angiography, but complications were major and required surgery. Alternative techniques such as continuous venovenous hemofiltration may prove beneficial.