Nephrol Dial Transplant (1991) 6: 722-724 © 1991 European Dialysis and Transplant Association-European Renal Association

Nephrology Dialysis Transplantation

Original Article Post Catheterisation Vein Stenosis in Haemodialysis: Comparative Angiographic Study of 50 Subdavian and 50 Internal Jugular Accesses Departments of 'Nephrology-Haemodialysis and 2Radiology, General Hospital of Troyes, France

Abstract. From January 1986 to December 1990 we studied angiographically the subclavian-brachiocephalic vein of 100 patients dialysed by subdavian catheter for 50 (first group) and by internal jugular catheter for the 50 others (second group). These two groups were not statistically different as regards age (61-6 ± 11-3 years in the first and 61 ± 111 in the second), sex (48% and 56% were women), duration of catheter insertion (31 ± 21-8 and 31-7 ± 16 days), and the number of dialysis sessions (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 infections (6% in both groups), and the local nursing were similar in the two groups. The only difference was the side of cannulation: the right side in 58% of cases in group 1 and 78% in group 2. The angiographic study revealed a stenosis of the vein in 42% of the subdavian group and in 10% of the internal jugular group: a dramatic difference in favour of the internal jugular route, whose superiority over the subdavian route is asserted in respect of venous access of dialysed patients.

Introduction Temporary vascular access is necessary in haemodialysis when an arteriovenous fistula is not functional; it consists mainly in percutaneous cannulation of subdavian, internal jugular or femoral veins. These accesses are preferred to arteriovenous shunts because they are considered not to damage blood vessels. However, subdavian vein stenosis and/or thrombosis have been detected either by a painful swelling arm [1-10] or by systematic angiographic study [7-9, 11-15]. More recently, vein stenosis and/or thrombosis have also been reported, though less frequently, in case of internal jugular cannulation [16-21]. We therefore studied prospectively these two commonly used accesses for temporary dialysis, by evaluating angiographically the relative risks of stricture that may compromise future arteriovenous fistula.

Patients and Methods

From January 1986 to December 1990 all patients who received dialysis by subdavian or internal jugular catheter were studied by angiography of the subclavianbrachiocephalic vein. Excluded from the study were patients whose catheters had been in place less than a week or used for fewer than three dialysis sessions because of a minor risk of stenosis. Those who had ipsilateral repeated subdavian or internal jugular cathCorrespondence and offprint requests to: F. Schillinger, Department of Nephrology-Haemodialysis, General Hospital, 10003 Troyes, eters were also excluded. The catheter usually inserted France. was a 'Shaldon' (Avon Medical) which is 15 cm long, has Key words: Central vein stenosis; Venous angiography; Subdavian catheter; Internal jugular catheter; Chronic haemodialysis

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F. Schillinger1, D. Schillinger2, R. Montagnac1 and T. Milcent1

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Vein Stenosis in Haemodialysis: A Study

Results There were no complications from angiography in any of the 100 patients. As shown in Table 1, the two groups were remarkably similar with respect to age, sex,

duration of catheterisation, number of dialysis sessions, type and brand of catheters, number with inadequate flow and catheter infections. Only cannulation side differed. There were 42% with stenosis in the subclavian group and 10% in the internal jugular group (F

Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses.

From January 1986 to December 1990 we studied angiographically the subclavian-brachiocephalic vein of 100 patients dialysed by subclavian catheter for...
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