[Central venous stenosis in hemodialysis: comparative angiographic study of subclavian and internal jugular access].

From January 1986 to December 1990, we studied angiographically the subclavian-brachiocephalic vein of 100 patients dialysed on subclavian catheter for 50 (first group) and on internal jugular catheter for the 50 others (second group). These 2 groups are not statistically different for age: 61.6 +/- 11.3 years in the first and 61 +/- 11.1 in the second, for sex: respectively 48% and 56% of women, for time-length of catheter insertion: respectively 31 +/- 21.8 days and 31.7 +/- 16, and for number of dialysis sessions: respectively 13.5 +/- 9.1 and 13.6 +/- 7.1. The type of catheters, the frequency of removal for poor flow (16% in both groups) or for infections (6% in both groups) and the local nursing are similar in the 2 groups. Only the side of cannulation differs: the right side is used in 58% of cases in the first group and 78% in the second one. The angiographic study reveals a stenosis of the vein in 42% of the subclavian group and in 10% of the internal jugular group. The left side presents more risks of stenosis than the right, what can be explained by anatomical features. The strictures, whose severity is variable, are mainly located at and slightly above the junction of jugular and subclavian veins. This significative difference in favour of the internal jugular route asserts its superiority on subclavian route in respect of venous access of dialysed patients.