Catheters with jugular vein occlusion: alternative approaches
A fairly high proportion of end-stage renal disease (ESRD) patients undergoing regular hemodialysis have bilateral internal jugular vein obstruction and non-functioning arteriovenous fistula/graft.
For these patients, it is often necessary to use other routes, such as external jugular, subclavian, and femoral vein approaches, but these routes are thought to be less desirable, explain Egyptian nephrologists (Gouda ZE et al, Studying alternative approaches for placement of cuffed hemodialysis catheters in hemodialysis patients with bilateral internal jugular vein occlusion. J Vasc Access. 2018; 24:1129729818794414). The aim of the present study was therefore to investigate alternative approaches for placement of cuffed hemodialysis catheters in end-stage renal disease (ESRD) patients with bilateral internal jugular vein occlusion. The authors found a “variety of approaches”, which could help to conserve the anatomically limited number of percutaneous access sites in each patient.
The prospective cross-sectional follow-up study included 134 ESRD patients who were referred for insertion of a challenging hemodialysis catheter due to the existence of the bilateral vein occlusion.
The most common alternative approach is the trans-external iliac vein inferior vena cava approach (43.28%) followed by external jugular vein approach (14.93%), innominate vein approach (10.18%), internal jugular vein collaterals by interventional radiology (7.46%), femoral vein approach (7.46%), transhepatic approach (5.97%), subclavian vein approach (5.22%); least prevalent is the retrograde femoral vein approach (1.49%).
There are a variety of approaches for the insertion of cuffed hemodialysis catheters other than occluded internal jugular veins, conclude the authors. These alternative approaches are beneficial to the patients in that they may conserve the anatomically limited number of percutaneous access sites.