Emced KHALIL

Mid-term results of tunneled brachial venous hemodialysis catheter placement: Our single-center experience with 21 patients

of permanent hemodialysis catheter insertion via the brachial vein in unsuitable patients for catheter insertion from other vascular access sites. Methods: A total of 21 patients (6 males, 18 females; mean age: 54.4±11.3 years; range, 48 to 77 years) who underwent permanent hemodialysis catheter insertion via the brachial vein between February 2019 and February 2020 were retrospectively analyzed. All patients underwent brachial venous tunneled catheter insertion under the ultrasound guidance and under local anesthesia. Transthoracic echocardiography was performed before and six months after catheter insertion. The primary patency rate of the catheter at six months of follow-up, potential associated complications of a permanent hemodialysis catheter including catheter thrombosis and catheter infections, and all-cause mortality rates were recorded. Results: Catheter removal was required in eight patients (catheter thrombosis, n=5; catheter infection, n=2; and extensive hematoma, n=1). The catheters were patent in the remaining 13 (62%) patients at six months. Mortality occurred in one patient due to bacterial pneumonia. No life-threatening complications including hemothorax or pneumothorax and neurological injury was observed in any of the patients. Conclusion: Our study results show that brachial venous tunneled catheter placement for hemodialysis can be a safe and valid alternative to catheter insertion from the jugular or subclavian veins for vascular access in patients with end-stage renal disease.

Tünelli brakiyal venöz hemodiyaliz kateter yerleştirmesinin orta dönem sonuçları: 21 hasta ile tek merkezli deneyimimiz

Amaç: Bu çalışmada diğer vasküler erişim bölgelerinden kateter yerleştirme işlemine uygun olmayan hastalarda brakiyel venden kalıcı hemodiyaliz kateter yerleştirilmesinin güvenliliği ve etkinliği değerlendirildi. Çalışma planı: Şubat 2019-Şubat 2020 tarihleri arasında brakiyel venden kalıcı hemodiyaliz kateteri yerleştirilen toplam 21 hasta (6 erkek, 18 kadın; ort. yaş: 54.4±11.3 yıl; dağılım, 48-77 yıl) retrospektif olarak incelendi. Hastaların tümüne ultrason eşliğinde ve lokal anestezi ile brakiyel venöz tünelli kateter yerleştirme işlemi yapıldı. Kateter yerleştirilmesinden önce ve altı ay sonra transtorasik ekokardiyografi çekildi. Takibin altıncı ayında kateterin primer açıklık oranı, kateter trombozu ve kateter enfeksiyonları gibi kalıcı hemodiyaliz kateteri ile ilişkili muhtemel komplikasyonlar ve tüm nedenlere bağlı mortalite oranları kaydedildi. Bulgular: Sekiz hastada kateterin çıkarılması gerekti (n=5 kateter trombozu, n=2 kateter enfeksiyonu ve n=1 büyük hematom). Altıncı ayda geriye kalan 13 hastada (%62) kateterler açıktı. Bir hastada bakteriyel pnömoniye bağlı mortalite izlendi. Hastaların hiçbirinde hemotoraks veya pnömonotoraks gibi yaşamı tehdit eden komplikasyonlar ve nörolojik hasar görülmedi. Sonuç: Çalışma sonuçlarımız, hemodiyaliz için brakiyel venöz tünelli kateter yerleştirilmesinin, son dönem böbrek hastalığı olan hastalarda, juguler veya subklavyen venlerden yapılan kateter yerleştirilmesine güvenli ve geçerli bir alternatif olabileceğini göstermektedir.

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