Universität zu Köln

Reindl-Schwaighofer, Roman, Matoussevitch, Vladimir, Winnicki, Wolfgang, Kalmykov, Egan ORCID: 0000-0001-6784-2243, Gilbert, James, Matzek, Wolfgang and Sengoelge, Guerkan (2020). A Novel Inside-out Access Approach for Hemodialysis Catheter Placement in Patients With Thoracic Central Venous Occlusion. Am. J. Kidney Dis., 75 (4). S. 480 - 488. PHILADELPHIA: W B SAUNDERS CO-ELSEVIER INC. ISSN 1523-6838

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Abstract

Rationale & Objective: Left-sided internal jugular and all subclavian central venous catheters (CVCs) cause thoracic central vein occlusions (TCVOs) more often than right-sided internal jugular catheters. To enable right-sided CVC placement in patients with TCVO, an inside-out access (IOA) approach was established at 3 vascular access centers in Europe involving use of a novel IOA device advanced from the right femoral vein. In the current analysis, we assessed the eligibility and success rate of this IOA approach in a cohort of patients with TCVO requiring a tunneled dialysis catheter. Study Design: Retrospective multicenter observational study. Setting & Participants: 36 patients with TCVO treated in Vienna, Austria; Oxford, England; or Cologne, Germany, who required hemodialysis access between July 2016 and June 2018. Exposure: Application of the IOA approach to gain vascular access. Outcome: The primary end point was the success rate of passing the TCVO to gain dialysis access using the IOA approach. Secondary end points were catheter patency at 3 months and procedure-related complications (early infections, bleeding, hematoma, and pericardial effusions). Analytical Approach: Descriptive statistics to characterize eligibility, success rate, and complications of the IOA approach. Results: 36 patients with TCVO and history of multiple CVCs and arteriovenous fistulas were referred to the participating centers for vascular access. 32 (89%) patients were eligible for the IOA approach. 39 treatments were performed, with 7 patients undergoing the IOA procedure a second time more than 3 months after initial CVC placement. Dialysis access was established successfully in 38 of 39 (97%) implementations of the IOA procedure. Median intervention time was 43 minutes. No complications occurred. Limitations: No comparison to other methods to place CVCs and the observational study design. Conclusions: The IOA approach is a promising method to enable rapid access to the right jugular vein in the setting of pre-existing TCVO. Additional experience is needed to understand the generalizability of these observations.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Reindl-Schwaighofer, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED Matoussevitch, Vladimir UNSPECIFIED UNSPECIFIED UNSPECIFIED Winnicki, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Kalmykov, Egan UNSPECIFIED orcid.org/0000-0001-6784-2243 UNSPECIFIED Gilbert, James UNSPECIFIED UNSPECIFIED UNSPECIFIED Matzek, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Sengoelge, Guerkan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-339474
DOI:	10.1053/j.ajkd.2019.08.024
Journal or Publication Title:	Am. J. Kidney Dis.
Volume:	75
Number:	4
Page Range:	S. 480 - 488
Date:	2020
Publisher:	W B SAUNDERS CO-ELSEVIER INC
Place of Publication:	PHILADELPHIA
ISSN:	1523-6838
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language VEIN CATHETERIZATION; SHARP RECANALIZATION; DIALYSIS; COMPLICATIONS; STENOSIS; IMPACT Multiple languages Urology & Nephrology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/33947