Skandalos Loannis K, Samaras Asterios A, Karakatsanis Anestis I, Ditsias Theodoros K, Filippidis Antis A, Mavromatidis Konstantinos S, Koutsouflianiotis Nikolaos K
Department of Surgery, General Hospital Agios Pavlos, Thessaloniki, Greece.
Int J Artif Organs. 2012 Jul;35(7):520-4. doi: 10.5301/ijao.5000100.
In patients with end stage renal disease when there is inability for the creation of a direct arterio-venous fistula or by using a graft, the insertion of a permanent hemodialysis catheter in a central vein ensures the conduction of hemodialysis. We present a technique of placing a permanent catheter in the inferior vena cava through the great saphenous vein without the use of a guide wire.
PATIENTS-METHODS: Over the study period, 12 hemodialyzed patients, with a mean age of 73 years, were referred for placement of a dialysis catheter through the great saphenous veins. The procedure was performed under local anesthesia, ECG monitoring, and fluoroscopic control. The insertion of the tunneled hemodialysis catheters was accomplished with ease, through surgical exposure of the great saphenous vein, without the need for a guidewire.
The hemodialysis catheter's function was assessed intraoperatively. No intraoperative or immediate post operative complications were noted while during the study period 3 thromboses and an infection were detected (0,95 per 1000 catheter days). The primary catheter patency rates were 92%, 84%, 54% at 30, 90 and 180 days respectively, varying from 28 to 845 days (mean±SD = 294 ± 243,3).
The introduction of dialysis catheters in the inferior vena cava through the great saphenous vein is technically simple with rare complications and with higher patency rates compared to the traditional femoral approach.
对于终末期肾病患者，当无法建立直接动静脉内瘘或使用移植物时，在中心静脉插入永久性血液透析导管可确保血液透析的进行。我们介绍一种不使用导丝经大隐静脉在下腔静脉放置永久性导管的技术。
患者-方法：在研究期间，12例接受血液透析的患者（平均年龄73岁）被转诊通过大隐静脉放置透析导管。该操作在局部麻醉、心电图监测和透视控制下进行。通过手术暴露大隐静脉，轻松完成隧道式血液透析导管的插入，无需导丝。
术中评估血液透析导管的功能。术中及术后即刻未发现并发症，而在研究期间检测到3例血栓形成和1例感染（每1000导管日0.95例）。导管的初始通畅率在30天、90天和180天时分别为92%、84%、54%，通畅时间从28天至845天不等（均值±标准差=294±243.3）。
经大隐静脉在下腔静脉插入透析导管技术上简单，并发症少，与传统股静脉入路相比通畅率更高。
