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2015 ; 5
(ä): 31
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Vascular Access for Placement of Tunneled Dialysis Catheters for Hemodialysis: A
Systematic Approach and Clinical Practice Algorithm
#MMPMID26167389
Pereira K
; Osiason A
; Salsamendi J
J Clin Imaging Sci
2015[]; 5
(ä): 31
PMID26167389
show ga
The role of interventional radiology in the overall management of patients on
dialysis continues to expand. In patients with end-stage renal disease (ESRD),
the use of tunneled dialysis catheters (TDCs) for hemodialysis has become an
integral component of treatment plans. Unfortunately, long-term use of TDCs often
leads to infections, acute occlusions, and chronic venous stenosis, depletion of
the patient's conventional access routes, and prevention of their recanalization.
In such situations, the progressive loss of venous access sites prompts a
systematic approach to alternative sites to maximize patient survival and
minimize complications. In this review, we discuss the advantages and
disadvantages of each vascular access option. We illustrate the procedures with
case histories and images from our own experience at a highly active dialysis and
transplant center. We rank each vascular access option and classify them into
tiers based on their relative degrees of effectiveness. The conventional
approaches are the most preferred, followed by alternative approaches and finally
the salvage approaches. It is our intent to have this review serve as a concise
and informative reference for physicians managing patients who need vascular
access for hemodialysis.