D FERNANDES1, C SAJIV1, B PAWAR1, S THOMAS1, S NAYAR1, P GEORGE1, J OLAPALLIL1, M HAMILTON1
1Alice Springs Hospital, Alice Springs, Australia
The numbers of patients on hemodialysis (HD) is increasing exponentially in the Northern territory. Most of the patients are young and 50% of the patients in Central Australia start HD with a temporary access. The challenge for the practicing Nephrologists in remote Central Australia is to maintain a good vascular access. Nephrologists in this region have gained expertise in interventional skills (including endovascular skills) and have been able to contribute significantly to the maintenance of vascular access. There is a growing number of young patients who present with complex vascular requirements including temporary bridging semi-permanent catheter insertions.
Aim: We present a series of cases that required additional endovascular techniques for successful deployment of tunneled catheters.
Methods: Retrospective analysis of six patients in whom endovascular interventions were required at the time of line insertions
Results: 5 out of the 6 were females with an average age of 48.33 years (33-72). The average vintage on dialysis was 10.33 years (2-18). Most of them (5/7) had multiple fistulae constructed in both the arms and forearms along with multiple line insertions in the Internal Jugular and the Femoral veins.
Two patients required balloon assisted dilatation of the left brachiocephalic vein and one of them the left common iliac vein for successful insertion of tunneled catheters into the respective sites. The remaining cases required manipulation of guide wires into the target veins using guiding sheaths. No complications were observed during these procedures.
Conclusion: Endovascular techniques can be safely utilized to assist in the deployment of difficult tunneled catheter insertions.
Sajith has been practicing nephrology in Alice Springs for the past 4 years. The interventional service in Central Australia has slowly expanded from primarily fistula related procedures to complex catheter insertions. Sajith is one pf the nephrologists who has been actively pursuing interventional procedural work at Alice Springs.