Garofalo R S, Zaleski G X, Lorenz J M, Funaki B, Rosenblum J D, Leef J A
Radiology Associates of the Fox Valley, Oshkosh, WI 54901, USA.
AJR Am J Roentgenol. 1999 Jul;173(1):155-8. doi: 10.2214/ajr.173.1.10397118.
The usefulness of exchanging poorly functioning tunneled permanent hemodialysis catheters in patients with end-stage renal disease was evaluated.
We retrospectively reviewed case histories of 51 consecutive patients who underwent 88 catheter exchanges because of poor flow rates. All hemodialysis catheters were initially placed by the radiology service using image guidance. Catheter exchanges were performed through the existing subcutaneous tract over two stiff hydrophilic guidewires and without additional interventions such as fibrin sheath stripping or venoplasty. Life table analysis was performed to evaluate catheter patency rates after initial placement (primary patency) and after multiple exchanges (secondary patency).
The technical success rate for hemodialysis catheter exchange was 100%. Primary catheter patency was 42% at 60 days and 16% at 120 days. Secondary patency was 92% at 60 days and 82% at 120 days. The cumulative infection rate was 1.1 per 1000 catheter days. No complications from the procedure occurred.
Catheter exchange is an effective means of prolonging catheter patency in patients with end-stage renal disease and limited central venous access.
评估终末期肾病患者更换功能不良的带隧道长期血液透析导管的有效性。
我们回顾性分析了51例因血流量不足而进行88次导管更换的连续患者的病历。所有血液透析导管最初均由放射科在影像引导下置入。通过现有的皮下通道，在两根硬亲水导丝引导下进行导管更换，无需进行纤维蛋白鞘剥脱或静脉成形术等额外干预。采用生命表分析法评估初次置管后（初级通畅率）和多次更换后（次级通畅率）的导管通畅率。
血液透析导管更换的技术成功率为100%。导管初级通畅率在60天时为42%，120天时为16%。次级通畅率在60天时为92%，120天时为82%。累积感染率为每1000导管日1.1次。该操作未发生并发症。
对于终末期肾病且中心静脉通路有限的患者，导管更换是延长导管通畅时间的有效方法。
