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Kidney Week

Abstract: PO1027

Reusing Occluded Veins: Inside-Out Central Venous Access for Hemodialysis, Our Institutional Experience

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Chishti, Emad A., University of Kentucky Medical Center, Lexington, Kentucky, United States
  • Alagusundaramoorthy, Sayee Sundar, University of Kentucky Medical Center, Lexington, Kentucky, United States
Background

Central venous occlusion is a challenge in end-stage renal disease (ESRD) patients dependent on hemodialysis. The inside-out central venous access (IOCVA) procedure is an established method of re-using occluded veins.

Methods

Retrospective single-center study examining characteristics of patients with ESRD who underwent IOCVA between 01/01/2017 – 05/01/2021. All procedures were performed with moderate conscious sedation by an interventional cardiologist or nephrologist.

Results

46 IOCVA procedures were performed in 39 ESRD patients. All procedures were performed to re-use the occluded right internal jugular vein (RIJ) for tunneled dialysis catheter placement. Mean patient age was 58 ± 14.6 years. 20 (51.3%) patients were male. Hypertension and diabetes were comorbid conditions in 29 (74.4%) and 20 (51.3%) patients, respectively. A total of 7 (17.9%) patients had prior kidney transplant. The average number of prior vascular accesses (defined as venous access or arteriovenous fistula/graft) in patients prior to IOCVA was 2.6 ± 1.7 (range 1-9). 9 (23.1%) had two prior accesses, and 30 (76.9%) had >3 prior accesses. 5 (12.8%) patients had >1 prior IOCVA procedure. 5 (12.8%) patients had complete superior vena cava occlusion. 17 (43.6%) patients had failed AVF/AVG and 2 (5.1%) had failed translumbar venous access. Technical success rate was 100% with no complications.

Conclusion

The RIJ vein is the most effective and durable site for long-term hemodialysis access. Occlusion, stenosis of this vein can lead to a downward spiral of access crisis with venous exhaustion resulting in trans-lumbar or trans-hepatic catheter placement for dialysis. These approaches are associated with high rates of dysfunction as well as infection, catheter migration and thrombosis. The transhepatic approach can also cause life-threatening intraperitoneal hemorrhage. The use of IOCVA alleviates the need to sacrifice subsequent veins and allows for the occluded RIJ to be re-accessed as many times as needed via the femoral vein. Our data provides further evidence in support of the safety and efficacy of IOCVA for long-term hemodialysis access in ESRD patients.