Unconventional venous access techniques

Non-conventional vascular accesses for the management of superior vena cava syndrome in patients with Intestinal Failure. Case series and systematic review

BACKGROUND

Type III Intestinal Failure (IF) is a devastating clinical condition.characterized by the inability of the gut to absorb necessary macronutrients, and/or water and electrolytes, requiring Parenteral Nutrition (PN) as chronic therapy. Long-term PN may lead to life-threatening complications; the loss of central venous access (LCVA) is the most frequent and challenging. To date, few studies in the literature have reported the relevance of Non-conventional Vascular Accesses (NCVA) in the management IF as part of the comprehensive multidisciplinary care.

METHODS

A retrospective analysis of a database collected from January 2006 to December 2019 was performed using SPSS v25.0 for statistical analysis, followed by a systematic review, using the PRISMA.methodology RESULTS: From January 2006 to December 2019, 184 NCVA were placed in 71 patients with LCVA as IF-related complication; 173 were placed in 61 patients by interventional radiology (IR) and 11 NCVA were placed in 10 patients by the surgical team during the intestinal transplant (ITx) operation. From the 173 IR procedures 166 (95.9%) were successful with 3 ± 2.7 procedures/patient; average catheter permanence rate was 738.68 ± 997 days; complications related to the procedures occurred in 18/173 (10.4%), including two deaths. On the other hand, among the 11 NCVA implanted by the surgical team, 7 (64%) were successful and were safely withdrawn 30 days after ITx when were no longer needed; 2 (18%) catheters malfunctioned during the first week and could not be further used, and 1 was accidently removed; average catheter permanence rate was 26 ± 4 days. There was one complication (9%) requiring laparotomy; there was no mortality associated the procedure in this group. A systematic review was conducted to evaluate the success and safety of NCVA as part of the treatment of HPN-related complications; from 337,542 papers, 14 studies were included. A total of 28 HPN-patients with LCVA received NCVA; 34 procedures were successfully performed, while procedure-related complications were reported in 11.7%, as well as one death.

CONCLUSIONS

The data analyzed show that NCVAs may be successfully placed by expert teams, allowing to sustain long-term PN, as well as increasing the Intestinal Transplantation applicability for candidates in the extreme need of vascular access.

The use of the internal mammary vein for central venous access

PURPOSE

To describe the use of the internal mammary vein as an alternative access for central venous catheters.

METHODS

We performed a retrospective review of patients who underwent placement of central venous catheters via the internal mammary vein. Patient demographics, indication for venous access, technical success, catheter type, dwell time and indication for exchange or removal were recorded.

RESULTS

Placement of central venous catheters via the internal mammary vein was attempted in 11 patients including 8 children (4 males, mean age 5.7 years) and 3 adults. The most common indication was parenteral nutrition in patients with intestinal failure (7/11). Initial needle access of the vein was successful in all patients. Catheter placement was successful in 9 and unsuccessful in 2 patients due to occlusion of the superior vena cava. There were no immediate complications. A total of 20 catheters of various sizes (3-14.5 French) and lengths (8-23 cm) were either placed (n = 12) or exchanged (n = 8). The most common indications for catheter exchange were poor function and malposition (7/8). Four catheters were removed for infection and 4 were accidentally removed. The mean dwell time was 141 days (range 0-963 days) per catheter for a total of 2829 catheter days. The total mean dwell time per patient, including primarily placed and exchanged catheters, was 314 days (range 5-963 days).

CONCLUSIONS

The internal mammary vein may provide a safe alternative route for patients who have lost their traditional access veins.

Early complications of translumbar cannulation of the inferior vena cava as a quick, last-chance method of gaining access for hemodialysis. Ten years of experience in one clinical center

Introduction

The gold standard of vascular access for chronic hemodialysis patients is the arteriovenous fistula (AVF). If an AVF cannot be created, the hemodialysis catheter can be inserted into the internal jugular, femoral or subclavian vein. After exhausting the abovementioned standard accesses, translumbar access to the inferior vena cava (IVC) is considered a quick, last-chance and rescue method.

Aim

Retrospective analysis of early complications (EC) of translumbar IVC catheterization using one type of catheter by one medical team.

Material and methods

From January 2010 to October 2019, a total of 34 translumbar IVC catheters were implanted in 27 patients.

Results

A major EC was found in 1 (2.9%) procedure. Minor EC occurred in 23.5 attempts. None of these complications required an intervention.

Conclusions

In patients with exhausted possibilities of obtaining standard vascular access for HD, translumbar IVC cannulation proved to be a safe and effective method.

Abdominal collateral veins as an unconventional access site for hemodialysis after primary access failure

INTRODUCTION

Vascular access dysfunction and the depletion of access pathways are complications associated with morbidity and mortality in dialysis patients. As described in the literature, catheter insertion through small collateral veins or recanalized cervical and thoracic veins is an attractive option.

CASE DESCRIPTION

This article reports a case in which a collateral vein in the abdominal region was used as an access for hemodialysis.

CONCLUSION

After multiple attempts with fistulas and catheters, the left abdominal wall collateral network proved to be a successful access site. Using unconventional veins can be an alternative in these patients.

Safety and efficacy of placing internal jugular dialysis catheter tip in the inferior vena cava

PURPOSE

To assess the efficacy and safety of placing the tip of the internal jugular (IJ) hemodialysis catheter in the inferior vena cava (IVC) in situations where it does not work well when placed in the right atrium.

METHODS

The medical records of chronic hemodialysis patients at an outpatient vascular intervention facility were retrospectively reviewed. Out of the 831 patients who had dialysis catheters exchanged over a 4-year period, 13 patients were identified who underwent catheter exchanges where the tip of the catheter was placed in the IVC via the IJ approach. These were all patients where the catheters had poor flows when placed in the right atrium earlier.

RESULTS

Adequate flow (>350 mL/min) was achieved in all 13 cases with the catheter placed in the IVC with no significant complications.

CONCLUSIONS

This study suggests that exchanging the catheter and placing the tip in the IVC is effective and safe in certain situations especially when the tip placement in the conventional position (i.e. the right atrium) does not work well.

Vascular Access for Placement of Tunneled Dialysis Catheters for Hemodialysis: A Systematic Approach and Clinical Practice Algorithm

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.

Abdominal collateral vein as an unconventional vascular access for hemodialysis in patient with central vein occlusion

A 65-year-old female patient with chronic kidney disease stage 5 and a history of spleen neoplasm with dissemination within peritoneum is presented. During 5 years of hemodialysis therapy, bilateral occlusion of brachiocephalic and iliac vein developed as a consequence of vein catheterization. An attempt to cannulate inferior vena cava was unsuccessful. A cannulation of dilated collateral abdominal veins with dialysis needles allowed to perform several hemodialysis sessions in the patient.

Endovascular therapy for palliative care of cancer patients

Interventional radiology procedures often play an integral role in the diagnosis and treatment of patients with cancer. In the latter stages of cancer treatment, palliative care therapies may be sought for improvement in the quality of remaining life for oncology patients. Increased awareness among interventionalists and referring oncologists regarding minimally invasive treatments for palliation is desirable to provide additional options for patients. In particular, endovascular therapies can provide control of symptoms and complications related to incurable malignancies.