Vats Hemender S, Bellingham Janet, Pinchot Jason W, Young Henry N, Chan Micah R, Yevzlin Alexander S
Section of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 52713, USA.
J Vasc Access. 2012 Jan-Mar;13(1):51-4. doi: 10.5301/JVA.2011.8444.
The right internal jugular (RIJ) vein is preferred for placement of long-term venous catheters (CVC) for hemodialysis (HD). Use of left IJ vein potentially depletes the access site for arteriovenous fistula (AVF) or arteriovenous graft (AVF) placement because of the high rates of central venous stenosis. The right external jugular (EJ) vein is a viable alternative to the LIJ. The purpose of this study is to compare blood flow outcomes in a series of percutaneously placed external jugular (EJ), LIJ and RIJ HD catheters.
Using a prospectively collected database, we identified 46 hemodialysis patients who received a tunneled catheter during a 4-year period. Blood flow outcomes of RIJ, LIJ, and EJ catheters that were date-matched over the study period were compared. Using ANOVA, the blood flow outcomes of the 3 tunneled catheter techniques at 30-d and 90-d were compared.
The 90-d blood flow outcomes of the 3 groups did not differ significantly. The 30-d blood flow was found to be 348.5± 56.62, 341± 22.42, and 365.7± 71.76 mL/min for RIJ, LIJ, and EJ respectively (P<.05). Using multiple regression analysis, no covariates (age, sex, race, diabetes) were found to be associated with blood flow outcomes at 30-d or 90-d. No identifiable factors were found to be associated with the difference in blood flow between 30-d and 90-d either.
EJ blood flow outcomes at 30-d and 90-d were comparable to both LIJ and RIJ historic data. Further prospective investigation is required to define the role of EJ CVC placement as another potential long-term access modality.
右颈内静脉（RIJ）是放置用于血液透析（HD）的长期静脉导管（CVC）的首选部位。由于中心静脉狭窄发生率高，使用左颈内静脉可能会减少动静脉内瘘（AVF）或动静脉移植物（AVG）的置入部位。右颈外静脉（EJ）是左颈内静脉的可行替代部位。本研究的目的是比较一系列经皮置入的颈外静脉（EJ）、左颈内静脉（LIJ）和右颈内静脉（RIJ）血液透析导管的血流结果。
使用前瞻性收集的数据库，我们确定了46例在4年期间接受隧道式导管置入的血液透析患者。比较研究期间日期匹配的右颈内静脉、左颈内静脉和颈外静脉导管的血流结果。使用方差分析，比较3种隧道式导管技术在30天和90天时的血流结果。
3组在90天时的血流结果无显著差异。右颈内静脉、左颈内静脉和颈外静脉在30天时的血流分别为348.5±56.62、341±22.42和365.7±71.76 mL/分钟（P<0.05）。使用多元回归分析，未发现协变量（年龄、性别、种族、糖尿病）与30天或90天时的血流结果相关。也未发现可识别的因素与30天和90天之间的血流差异相关。
颈外静脉在30天和90天时的血流结果与左颈内静脉和右颈内静脉的历史数据相当。需要进一步的前瞻性研究来确定颈外静脉CVC置入作为另一种潜在的长期血管通路方式所起的作用。
