Gouda Zaghloul Elsafy, Emara Mahmoud Mohamed, Elbarbary Hany Said, Koura Mahmoud Abdel Aziz, Elarbagy Ahmed Rabie
Internal Medicine Department, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt.
J Vasc Access. 2019 May;20(3):250-259. doi: 10.1177/1129729818794414. Epub 2018 Aug 24.
Internal jugular vein occlusion often makes necessary the use of less desirable routes as external jugular, subclavian, and femoral vein approaches in addition to inferior vena cava approaches. This a prospective cross-sectional follow-up study of the alternative approaches for placement of cuffed hemodialysis catheters in end-stage renal disease patients with bilateral internal jugular vein occlusion from the interventional nephrology point of view.
The study was conducted on 134 end-stage renal disease patients who were referred for insertion of a challenging hemodialysis catheter due to bilateral internal jugular vein occlusion. Ultrasound Doppler guided catheter insertion was used as a routine practice in addition to fluoroscopy or post insertion X-ray to localize catheter tip position and exclude complications. Follow-up of patients was conducted until the end of the study or catheter removal.
The most highly prevalent alternative approach is the trans-external iliac vein inferior vena cava approach (43.28%) followed by external jugular vein approach (14.93%), innominate vein approach (10.18%), internal jugular vein collaterals by interventional radiology (7.46%), femoral vein approach (7.46%), transhepatic approach (5.97%), subclavian vein approach (5.22%), and finally the retrograde femoral vein approach (1.49%).
End-stage renal disease patients maintained on regular hemodialysis who have bilateral internal jugular vein obstruction and non-functioning arteriovenous fistula/graft is a daily scenario in nephrology practice. Our study showed that there is a variety of approaches for the insertion of cuffed hemodialysis catheters other than occluded internal jugular veins. Interventional nephrologists have a major role in solving the problem of poor hemodialysis vascular access. These alternative approaches can conserve the anatomically limited number of percutaneous access sites in each patient.
颈内静脉闭塞常常使得除了下腔静脉途径外，还需要采用不太理想的途径，如颈外静脉、锁骨下静脉和股静脉途径。这是一项从介入肾脏病学角度对双侧颈内静脉闭塞的终末期肾病患者进行带 cuff 血液透析导管置入替代途径的前瞻性横断面随访研究。
该研究针对 134 例因双侧颈内静脉闭塞而需要置入具有挑战性的血液透析导管的终末期肾病患者开展。除了使用荧光透视或置入后 X 光来定位导管尖端位置并排除并发症外，常规采用超声多普勒引导下的导管置入。对患者进行随访直至研究结束或导管拔除。
最常用的替代途径是经髂外静脉下腔静脉途径（43.28%），其次是颈外静脉途径（14.93%）、无名静脉途径（10.18%）、介入放射学引导下的颈内静脉侧支途径（7.46%）、股静脉途径（7.46%）、经肝途径（5.97%）、锁骨下静脉途径（5.22%），最后是逆行股静脉途径（1.49%）。
在肾脏病学实践中，维持规律血液透析的双侧颈内静脉阻塞且动静脉内瘘/移植物无功能的终末期肾病患者是常见情况。我们的研究表明，除了闭塞的颈内静脉外，还有多种带 cuff 血液透析导管的置入途径。介入肾脏病学家在解决血液透析血管通路不佳的问题中起着主要作用。这些替代途径可以保留每个患者解剖学上有限的经皮穿刺部位数量。
