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Experience with tunneled femoral hemodialysis catheters
G X Zaleski1, B Funaki, J M Lorenz
1Department of Radiology, The University of Chicago Hospitals, IL 60637, USA.
Insights
Tunneled femoral hemodialysis catheters offer a viable solution for patients lacking thoracic venous access. While these catheters experience higher infection rates and require more interventions, they provide successful long-term hemodialysis access.
Area of Science:
- Nephrology
- Vascular Access
- Interventional Radiology
Background:
- Central venous catheters are essential for hemodialysis.
- Thoracic venous access is preferred but not always available.
- Alternative access sites are crucial for patients with complex venous anatomy.
Purpose of the Study:
- To assess the efficacy and complication rates of tunneled femoral vein catheters.
- To determine the suitability of the femoral vein for permanent hemodialysis access in challenging cases.
Main Methods:
- 41 tunneled femoral vein catheters were placed in 21 patients over 3 years.
- Catheter tip placement varied: iliac bifurcation, mid-inferior vena cava (IVC), or IVC-right atrium junction.
- Interventions included catheter exchange for decreased flow and removal for infection or thrombosis.
Main Results:
- 100% technical success rate for catheter placement.
- 180-day primary and secondary patency rates were 55% and 61%, respectively.
- Infection rate was 2.4 per 1000 catheter days; one case of IVC thrombosis occurred.
Conclusions:
- Femoral vein catheters are a successful option for hemodialysis in patients with limited thoracic access.
- These catheters necessitate more frequent interventions and have a higher susceptibility to infection compared to thoracic counterparts.
- The common femoral vein can be a reliable site for permanent tunneled hemodialysis access when other options are exhausted.
Objective:
The purpose of this study was to evaluate the use and complication rate of tunneled femoral hemodialysis catheters placed in patients with no remaining thoracic venous access sites.
Materials And Methods:
Over a 3-year period, 41 tunneled femoral vein catheters (35 right, six left) were placed in 21 patients (15 women, six men; 21-89 years old; mean, 52 years). Catheters ranged in length from 40 to 60 cm. Tips were positioned immediately above the iliac bifurcation, at the mid inferior vena cava (IVC), or at the junction of the IVC and right atrium. Catheters were exchanged through the existing tract if the flow rate decreased to less than 200 ml/min. Catheters were removed if an episode of bacteremia did not resolve with antibiotics or if the insertion site became infected.
Results:
Technical success of placement was 100%. The 30-, 60-, and 180-day primary patency rates were 78%, 71%, and 55%, respectively. The 30-, 60-, and 180-day secondary patency rates were 95%, 83%, and 61%, respectively. Average time of function per intervention was 61 days. Infections requiring catheter removal occurred at a rate of 2.4 per 1000 catheter days. One episode of partial IVC thrombosis occurred after a catheter infection developed 78 days after initial catheter placement. No episodes of symptomatic pulmonary embolism occurred. Total length of follow-up was 2506 catheter days.
Conclusion:
Femoral vein catheters require more frequent interventions than do thoracic catheters and are more susceptible to infection. However, in patients with difficult central venous access, the common femoral vein may be successfully used for permanent tunneled hemodialysis access.