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Abstract No. 89: Translumbar hemodialysis catheters in patients with limited central venous access—does size matter?
SCIENTIFIC SESSIONS: MONDAY
Scientific Session 7 Dialysis Interventions Monday, March 26, 2012 8:00 AM – 10:00 AM Room: 122 8:00 AM
Abstract No. 88
Femoral dialysis catheter access: results in 311 catheter insertions
Purpose: To determine the safety and functionality of femorally placed dual lumen dialysis catheters in a large patient population. Materials and Methods: From a prospectively collected data base, all patients receiving dialysis catheter access using the common femoral vein were collected from January 2008 through December 2010. Electronic and paper medical records were then retrospectively reviewed for demographic and clinical data related to the catheter placement and follow up. Images were reviewed from the archival system when necessary. Patients and families were contacted directly for missing follow up data. Results: 143 different patients (61 males, mean age 50 years) underwent placement of 311 dialysis catheters via the common femoral vein (right⫽217). The only or last catheter placed was still functioning or lost to follow up in 7 patients. The primary patency was 66.5 catheter days (range 0-404). 100 catheters were exchanged over a guidewire (range 1-9/catheter), largely for nontract infection (46%) or poor catheter function (47%). The mean secondary catheter patency was 105 catheter days (range 0-711). Catheters were removed largely due to infection (50%), presence of a functioning arteriovenous access (30%) or were still in place at the time of patient demise (14%). In total, the infection rate was 7.4 per 1000 catheter days. 77 patients had one or more sonographic studies of the ipsilateral lower extremity while the catheter was in place. 18% were positive for deep venous thrombosis (DVT) but only 2 catheters required removal solely for DVT. There were 12 (4%) placement complications, 6 related to bleeding, there were no deaths. Conclusion: Dialysis catheters can be safely placed via the femoral vein but have a rather brief patency interval even in the face of frequent interventions designed to prolong catheter lifetime.
8:08 AM
Abstract No. 89
Translumbar hemodialysis catheters in patients with limited central venous access— does size matter? G. Nadolski, S. Trerotola, M.C. Soulen, M. Itkin, J. Mondschein, W. Stavropoulos, C. Farrelly; Hospital of the University of Pennsylvania, Philadelphia, PA
8:16 AM
Abstract No. 90
Failure to mature hemodialysis access fistulas: a 3-step approach to successful salvage R.N. Razdan, M. Zorzanello, M. Arici, E. Reiner, H.R. Mojibian, J. Pollak, J.E. Aruny; Vascular and Interventional Radiology, Yale University School of Medicine, New Haven, CT Purpose: To show the safety and efficacy of endovascular interventions for native hemodialysis access fistulas that fail to mature. Materials and Methods: A retrospective analysis of 36 patients was performed in subjects with primary failure of upper extremity hemodialysis access fistulas. The majority of the patients were first evaluated within 3 months of fistula creation after clinical evaluation by attending nephrologists determined the fistula could not be cannulated. Each patient underwent a three step algorithm to maximize treatment efficacy: 1. Maximize fistula diameter to at least 3 mm, coil embolize any accessory vessels, and treat stensoses. 2. Finish coiling of accessory vessels and
MONDAY: Scientific Sessions
T.P. Smith, C.Y. Kim, G. Janas, M.J. Miller, P. Suhocki, D.R. Sopko; Department of Radiology, Duke University Medical Center, Durham, NC
Purpose: To describe a single institution’s experience with translumbar hemodialysis catheters (THCs) and compare outcomes and complications between patients with normal body mass index (BMI) and those who are overweight (BMI⬎25). Materials and Methods: An IRB approved, HIPAA compliant retrospective review of all THCs placed between January 2002 and July 2011 was performed. In all, 33 patients (mean age 51.4 yrs, 51.5% male, 18 normal BMI, 15 BMI⬎25) were included. All had central venous occlusion preventing catheter placement in an internal or external jugular vein. Technical outcome, complications, indications for exchange/removal, and BMI were recorded. Mean catheter dwell time, cumulative access site duration, catheter related thrombosis and infection rates were calculated. Results: A total of 92 THC procedures were included for analysis (39 initial placements, 53 exchanges) with a total of 7825 catheter days. All were split tip catheters. Technical success rate was 100%. A total of 2 minor (2.2%) and 3 major (3.3%) complications occurred. Two (1 minor, 1 major) occurred in patients with normal BMI while three (1 minor, 2 major) occurred in those with BMI⬎25 (p⫽NS). Indication for exchange/removal (N⫽78) included catheter related infection (N⫽39, 50.0%), malposition (N⫽15, 19.2%), catheter malfunction/occlusion (N⫽10, 12.8%), mature permanent vascular access (N⫽7, 9.0%), conversion to peritoneal dialysis (N⫽3, 3.9%), functioning transplant (N⫽2, 2.6%), malfunction and infection (N⫽1, 1.3%) and unknown (N⫽1, 1.3%). Three THCs remained in use at the time of review. Nine patients died, and two were lost to follow up. Mean catheter dwell time for all, normal BMI and BMI⬎25 was 86.9⫾74.9, 86.1⫾67.8 and 87.8⫾81.9 days respectively (p⫽NS). Mean cumulative access site duration for all, normal BMI and BMI⬎25 was 257.0⫾343.7, 216.7⫾243.4 and 309.8⫾448.5 days, respectively (p⫽NS). Catheter related central venous thrombosis rate was 0.01 per 100 catheter days (N⫽1). Catheter associated infection rate was 0.51 per 100 catheter days (N⫽40). Conclusion: THC placement is safe and offers an effective route for hemodialysis in patients with limited venous access options. BMI does not affect the efficacy or the complication rate of THCs.
Scientific Session 7 Dialysis Interventions Monday, March 26, 2012 8:00 AM – 10:00 AM Room: 122 8:00 AM
Abstract No. 88
Femoral dialysis catheter access: results in 311 catheter insertions
Purpose: To determine the safety and functionality of femorally placed dual lumen dialysis catheters in a large patient population. Materials and Methods: From a prospectively collected data base, all patients receiving dialysis catheter access using the common femoral vein were collected from January 2008 through December 2010. Electronic and paper medical records were then retrospectively reviewed for demographic and clinical data related to the catheter placement and follow up. Images were reviewed from the archival system when necessary. Patients and families were contacted directly for missing follow up data. Results: 143 different patients (61 males, mean age 50 years) underwent placement of 311 dialysis catheters via the common femoral vein (right⫽217). The only or last catheter placed was still functioning or lost to follow up in 7 patients. The primary patency was 66.5 catheter days (range 0-404). 100 catheters were exchanged over a guidewire (range 1-9/catheter), largely for nontract infection (46%) or poor catheter function (47%). The mean secondary catheter patency was 105 catheter days (range 0-711). Catheters were removed largely due to infection (50%), presence of a functioning arteriovenous access (30%) or were still in place at the time of patient demise (14%). In total, the infection rate was 7.4 per 1000 catheter days. 77 patients had one or more sonographic studies of the ipsilateral lower extremity while the catheter was in place. 18% were positive for deep venous thrombosis (DVT) but only 2 catheters required removal solely for DVT. There were 12 (4%) placement complications, 6 related to bleeding, there were no deaths. Conclusion: Dialysis catheters can be safely placed via the femoral vein but have a rather brief patency interval even in the face of frequent interventions designed to prolong catheter lifetime.
8:08 AM
Abstract No. 89
Translumbar hemodialysis catheters in patients with limited central venous access— does size matter? G. Nadolski, S. Trerotola, M.C. Soulen, M. Itkin, J. Mondschein, W. Stavropoulos, C. Farrelly; Hospital of the University of Pennsylvania, Philadelphia, PA
8:16 AM
Abstract No. 90
Failure to mature hemodialysis access fistulas: a 3-step approach to successful salvage R.N. Razdan, M. Zorzanello, M. Arici, E. Reiner, H.R. Mojibian, J. Pollak, J.E. Aruny; Vascular and Interventional Radiology, Yale University School of Medicine, New Haven, CT Purpose: To show the safety and efficacy of endovascular interventions for native hemodialysis access fistulas that fail to mature. Materials and Methods: A retrospective analysis of 36 patients was performed in subjects with primary failure of upper extremity hemodialysis access fistulas. The majority of the patients were first evaluated within 3 months of fistula creation after clinical evaluation by attending nephrologists determined the fistula could not be cannulated. Each patient underwent a three step algorithm to maximize treatment efficacy: 1. Maximize fistula diameter to at least 3 mm, coil embolize any accessory vessels, and treat stensoses. 2. Finish coiling of accessory vessels and
MONDAY: Scientific Sessions
T.P. Smith, C.Y. Kim, G. Janas, M.J. Miller, P. Suhocki, D.R. Sopko; Department of Radiology, Duke University Medical Center, Durham, NC
Purpose: To describe a single institution’s experience with translumbar hemodialysis catheters (THCs) and compare outcomes and complications between patients with normal body mass index (BMI) and those who are overweight (BMI⬎25). Materials and Methods: An IRB approved, HIPAA compliant retrospective review of all THCs placed between January 2002 and July 2011 was performed. In all, 33 patients (mean age 51.4 yrs, 51.5% male, 18 normal BMI, 15 BMI⬎25) were included. All had central venous occlusion preventing catheter placement in an internal or external jugular vein. Technical outcome, complications, indications for exchange/removal, and BMI were recorded. Mean catheter dwell time, cumulative access site duration, catheter related thrombosis and infection rates were calculated. Results: A total of 92 THC procedures were included for analysis (39 initial placements, 53 exchanges) with a total of 7825 catheter days. All were split tip catheters. Technical success rate was 100%. A total of 2 minor (2.2%) and 3 major (3.3%) complications occurred. Two (1 minor, 1 major) occurred in patients with normal BMI while three (1 minor, 2 major) occurred in those with BMI⬎25 (p⫽NS). Indication for exchange/removal (N⫽78) included catheter related infection (N⫽39, 50.0%), malposition (N⫽15, 19.2%), catheter malfunction/occlusion (N⫽10, 12.8%), mature permanent vascular access (N⫽7, 9.0%), conversion to peritoneal dialysis (N⫽3, 3.9%), functioning transplant (N⫽2, 2.6%), malfunction and infection (N⫽1, 1.3%) and unknown (N⫽1, 1.3%). Three THCs remained in use at the time of review. Nine patients died, and two were lost to follow up. Mean catheter dwell time for all, normal BMI and BMI⬎25 was 86.9⫾74.9, 86.1⫾67.8 and 87.8⫾81.9 days respectively (p⫽NS). Mean cumulative access site duration for all, normal BMI and BMI⬎25 was 257.0⫾343.7, 216.7⫾243.4 and 309.8⫾448.5 days, respectively (p⫽NS). Catheter related central venous thrombosis rate was 0.01 per 100 catheter days (N⫽1). Catheter associated infection rate was 0.51 per 100 catheter days (N⫽40). Conclusion: THC placement is safe and offers an effective route for hemodialysis in patients with limited venous access options. BMI does not affect the efficacy or the complication rate of THCs.