Unconventional Venous Access Techniques

ABSTRACT

For patients dependent on permanent venous catheters for survival, the progressive loss of venous access sites should prompt a systematic approach to alternative sites and techniques to maximize patient survival and minimize complications. Interventional radiologists should be familiar with the appropriate use of both conventional and unconventional types of venous access and their associated risks. This article discusses the use of venous access sites available as alternatives to occluded internal jugular veins, including the subclavian veins, the femoral veins, the inferior vena cava, and the hepatic veins. In addition, unconventional techniques for venous access are reviewed, including recannulization of occluded neck and chest veins, catheterization of small thyrocervical veins, and sharp recannulization of occluded central veins.

Venous access - unconventional - translumbar - hemodialysis

REFERENCES

• 1 Garofalo R S, Zaleski G X, Lorenz J M, Funaki B, Rosenblum J D, Leef J D. Exchange of poorly functioning tunneled permanent hemodialysis catheters.  AJR Am J Roentgenol. 1999;  173 155-158
• 2 Mokrzycki M H, Singhal A. Cost-effectiveness of three strategies of managing tunneled, cuffed hemodialysis catheters in clinically mild or asymptomatic bacteremias.  Nephrol Dial Transplant. 2002;  17 2196-2203
• 3 Robinson D, Suhocki P, Schwab S J. Treatment of infected tunneled venous access hemodialysis catheters with guidewire exchange.  Kidney Int. 1998;  53 1792-1794
• 4 Merport M, Murphy T P, Egglin T K, Dubel G J. Fibrin sheath stripping versus catheter exchange for the treatment of failed tunneled hemodialysis catheters: randomized clinical trial.  J Vasc Interv Radiol. 2000;  11 1115-1120
• 5 Trerotola S O, Kuhn-Fulton J, Johnson M S, Shah H, Ambrosius W T, Kneebone P H. Tunneled infusion catheters: increased incidence of symptomatic venous thrombosis after subclavian versus internal jugular venous access.  Radiology. 2000;  217 89-93
• 6 Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses.  Nephrol Dial Transplant. 1991;  6 722-724
• 7 Cimochowski G E, Worley E, Rutherford W E, Sartain J, Blondin J, Harter H. Superiority of the internal jugular over the subclavian access for temporary dialysis.  Nephron. 1990;  54 154-161
• 8 Merrer J, De Jonghe B, Golliot F et al.. Complications of femoral and subclavian venous catheterization in critically ill patients.  JAMA. 2001;  286 700-707
• 9 National Kidney Foundation Dialysis Outcomes Quality Initiative .Available at: http://www.kidney.org/professionals/kdoqi/guidelines Accessed June 2006
• 10 Funaki B, Zaleski G X, Leef J A, Lorenz J, Van Ha T, Rosenblum J D. Radiologic placement of tunneled hemodialysis catheters in occluded neck, chest, or small thyrocervical collateral veins in central venous occlusion.  Radiology. 2001;  218 471-476
• 11 Zaleski G X, Funaki B, Lorenz J M et al.. Experience with tunneled femoral hemodialysis catheters.  AJR Am J Roentgenol. 1999;  172 493-496
• 12 Lund G B, Trerotola S O, Scheel Jr P J. Percutaneous translumbar inferior vena cava cannulation for hemodialysis.  Am J Kidney Dis. 1995;  25 732-737
• 13 Smith T P, Ryan J M, Reddan D N. Transhepatic catheter access for hemodialysis.  Radiology. 2004;  232 246-251
• 14 Stavropoulos S W, Pan J J, Clark T W et al.. Percutaneous transhepatic venous access for hemodialysis.  J Vasc Interv Radiol. 2003;  14 1187-1190
• 15 Chavanon O, Maurizi-Balzan J, Chavanis N, Morel B, Blin D. Successful prolonged use of an intracardiac catheter for dialysis.  Nephrol Dial Transplant. 1999;  14 2015-2016
• 16 Chandler N M, Mistry B M, Garvin P J. Surgical bypass for subclavian vein occlusion in hemodialysis patients.  J Am Coll Surg. 2002;  194 416-421