Behera Vineet, Ahmad Shahbaj, Sinha Smriti, Reddy G Gireesh, Srikanth K, Ghosh Indranil, Chauhan Prabhat, Ramamoorthy Ananthakrishnan, Hande Vivek
Department of Nephrology, INHS Asvini, Mumbai, India.
Department of Medicine, Himalayan Institute of Medical Sciences, Dehradun, India.
Indian J Nephrol. 2025 Jan-Feb;35(1):46-52. doi: 10.25259/ijn_511_23. Epub 2024 Jul 8.
External jugular vein (EJV) is used to insert tunneled dialysis catheter (TDC) in patients with no AVF and exhausted right internal jugular veins (IJV). There is scarce data on TDC insertion in EJV by nephrologists with fluoroscopy guidance.
This was a prospective observational study that included hemodialysis patients with exhausted right IJV access who underwent EJV TDC insertion, and excluded occluded ipsilateral brachiocephalic vein or superior vena cava, EJV < 5 mm diameter, or patients with existing EJV TDC. All patients underwent evaluation of central veins. TDC insertions were performed by a nephrologist using ultrasound and fluoroscopic guidance. The primary outcome was the successful insertion of EJV TDC and catheter removal within 6 months due to major catheter dysfunction or complications.
EJV TDC was successfully inserted in 23/23 cases (100% success), of which 17 (73.9%) were in right side, and 21 (91.3%) were denovo insertions. Catheter dysfunction needing removal occurred in seven cases (30.4%) with subclavian vein thrombosis in five cases (21.7%) and infectious complications in two cases (8.6%). The censored catheter survival was 23/23 (100%) at 1 month, 22/23 (95.6%) at 3 months, and 13/20 (65%) at 6 months. Cases of EJV catheter removal had a significant association with drainage of EJV into subclavian vein as compared to other anatomical variants (p = 0.005).
EJV TDC insertion has a good technical success rate when performed under fluoroscopy. It is associated with an acceptable rate of catheter dysfunction, especially thrombosis, which is more common in EJV opening into subclavian veins.
对于没有自体动静脉内瘘（AVF）且右侧颈内静脉（IJV）已无法使用的患者，可通过颈外静脉（EJV）插入带隧道的透析导管（TDC）。关于在透视引导下由肾病科医生进行EJV内TDC插入的资料很少。
这是一项前瞻性观察性研究，纳入了右侧IJV已无法使用且接受EJV内TDC插入的血液透析患者，排除同侧头臂静脉或上腔静脉闭塞、EJV直径<5mm或已存在EJV内TDC的患者。所有患者均接受中心静脉评估。TDC插入由肾病科医生在超声和透视引导下进行。主要结局是成功插入EJV内TDC以及因严重导管功能障碍或并发症在6个月内拔除导管。
23例患者中有23例（成功率100%）成功插入EJV内TDC，其中17例（73.9%）在右侧，21例（91.3%）为初次插入。7例（30.4%）出现需要拔除导管的功能障碍，5例（21.7%）发生锁骨下静脉血栓形成，2例（8.6%）出现感染并发症。1个月时截尾导管生存率为23/23（100%），3个月时为22/23（95.6%），6个月时为13/20（65%）。与其他解剖变异相比，EJV导管拔除病例与EJV汇入锁骨下静脉显著相关（p = 0.005）。
在透视引导下进行EJV内TDC插入具有良好的技术成功率。其导管功能障碍发生率可接受，尤其是血栓形成，在EJV开口于锁骨下静脉的情况中更为常见。
