Trerotola S O, Johnson M S, Harris V J, Shah H, Ambrosius W T, McKusky M A, Kraus M A
Department of Radiology, University Hospital, Indiana University Medical Center, Indianapolis 46202-5253, USA.
Radiology. 1997 May;203(2):489-95. doi: 10.1148/radiology.203.2.9114110.
To assess the outcome of interventional radiologic placement of tunneled hemodialysis catheters via the right internal jugular vein.
In 194 patients, the catheter was placed via the right internal jugular vein unless thrombosis was present. Real-time ultrasound-guided puncture and fluoroscopic guidance were used. Patients were followed up until catheter removal or death. Outcomes evaluated included infection, thrombosis, and catheter malfunction.
In 175 patients, 250 consecutive catheters were placed via the right internal jugular vein with 100% success. All catheters functioned immediately after placement. Procedural complications were limited to clinically unimportant air embolus (n = 2). No instances of pneumothorax, hemothorax, or substantial bleeding complications occurred. Follow-up was available in 173 (99%) patients. Mean and median "catheter duration" were 87 and 56 days, respectively. Catheter-related symptomatic venous thrombosis or stenosis was not observed. The rate of infection was 0.08 per 100 catheter days, and the rate of malfunction that necessitated removal was 0.22 per 100 catheter days. Definite or possible catheter thrombosis that necessitated removal occurred at a rate of 0.16 per 100 catheter days.
Interventional radiologic placement of tunneled hemodialysis catheters via the right internal jugular vein showed equal or better long-term results than those reported for surgical placement. Interventional radiologic placement should be the method of choice.
评估经右颈内静脉置入带隧道的血液透析导管的介入放射学操作结果。
194例患者中，除非存在血栓形成，否则均经右颈内静脉置入导管。采用实时超声引导穿刺和荧光透视引导。对患者进行随访直至导管拔除或死亡。评估的结果包括感染、血栓形成和导管功能障碍。
175例患者经右颈内静脉连续置入250根导管，成功率达100%。所有导管置入后立即发挥功能。操作并发症仅限于临床上无重要意义的空气栓塞（n = 2）。未发生气胸、血胸或严重出血并发症。173例（99%）患者获得随访。平均和中位“导管使用时间”分别为87天和56天。未观察到与导管相关的有症状静脉血栓形成或狭窄。感染发生率为每100导管日0.08例，因功能障碍而必须拔除的发生率为每100导管日0.22例。因明确或可能的导管血栓形成而必须拔除的发生率为每100导管日0.16例。
经右颈内静脉进行介入放射学置入带隧道的血液透析导管，其长期结果与手术置入报道的结果相当或更佳。介入放射学置入应作为首选方法。
