Managing the Failing Dialysis Permacath: Results from a 5-year Retrospective Analysis
Journal Title: Hellenic Journal of Radiology - Year 2017, Vol 2, Issue 3
Abstract
Purpose: To evaluate the results of a retrospective analysis on the management of failing permanent dialysis catheters. Material and Methods: Within 5 years (1/2011-12/2015), 1,158 permanent dialysis catheters were inserted to 853 patients (576 men, 67.5% -277 women, 32.5%) in our department. Of those, 648 patients had only one catheter placed while 205 patients had ≥2 catheters/interventions, reaching a total of 510 procedures (2.48 procedures/patient; 2-27). In 342 cases, catheters were placed to the jugular vein (J-group) and 168 catheters were placed in the femoral vein (F-group). In 413 cases only catheter exchange took place (CE-group), in another 89 cases balloon angioplasty was performed (PTA-group) and in 8 cases a bare metal stent was inserted (BMS-group). 272 central venous catheter (CVCs) had a split tip (SP-group) and a 238 straight tip (ST-group). Outcome measures included intervention-free period and independent predictors that might influence patency. Results: Mean follow up period was 475.64 days (1-1712 days). Mean intervention-free period was 268.35 days (1-1545 days). According to the Kaplan Meier survival analysis, there was statistically significant difference in favour of the J-group (Median Survival: 136 days vs. 69.5 days for F-group, p<0.0001). CE-group had significantly better results, when compared to PTA-group and BMS-group (Median Survival: CE-group 116 days, PTA-group 89 days, BMS-group 73 days, p<0.0001). CVCs with a straight tip had significantly better intervention-free period compared to split tip (ST-group 126 days vs. 80 days for SP-group, p<0.001) Conclusions: Jugular access had significantly better patency results compared to femoral. Additional interventions (angioplasty and stenting) in a bail-out setting provided worse results compared to plain catheter exchange. Straight tip CVCs had significantly better patency rates.
Authors and Affiliations
Panagiotis Kitrou, Konstantinos Katsanos, Stavros Spiliopoulos, Nicolaos Christeas, Theodoros Petsas, Dimitrios Karnabatidis
Keywords
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