Placing a Hemodialysis Catheter in Patients With Multiple Access Failure and Exhausted Usual Approachable Veins: Egyptian Single Center Experience

Abstract

Background: End-stage renal disease (ESRD) is a growing global health hazard. Most patients are maintained on dialysis rather than transplantation. Adequate vascular access for hemodialysis is crucial to achieve an optimal dialysis dose and to reduce morbidity and mortality. Patients with multiple access failure are in desperate need for lifesaving access, especially in the absence of alternatives (transplantation or peritoneal dialysis).Objective: Patients with multiple vascular access failure and exhausted approachable veins are being referred to an interventional nephrology or radiology centers. The aim of this work is to evaluate a single center’s experience of sophisticated venous approaches to provide access for hemodialysis.Methods: This study was performed at the Interventional Nephrology Center at Kasr Al-Ainy University Hospitals. Epidemiological data of patients, e.g., age, gender, as well as the number of previously cannulated central veins, were documented.Results: Data of 188 patients with multiple dialysis venous access failure (117 females and 71 males, aged 17–56 years) were collected. Successful innominate (brachiocephalic) venous cannulation was achieved in 149 patients (79%). Eighteen patients had successful external iliac venous approach (9%). Successful transhepatic venous approach was placed as permanent access in 7 patients (4%). The rest of the patients (n = 14, 7%) were referred to other centers due to failure.Conclusions: Sophisticated central venous approaches, mainly brachiocephalic, as described in this study, may play as alternatives for placing either temporary or tunneled hemodialysis catheters in patients with multiple vascular access failure and stenosed or thrombosed central veins.