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J Vasc Access 2021 May 3:11297298211011375. Epub 2021 May 3.

Indraprastha Apollo Hospital, India.

South and Southeast Asia is the most populated, heterogeneous part of the world. The Association of Vascular Access and InTerventionAl Renal physicians (AVATAR Foundation), India, gathered trends on epidemiology and Interventional Nephrology (IN) for this region. The countries were divided as upper-middle- and higher-income countries as Group-1 and lower and lower-middle-income countries as Group-2. Read More

J Pediatr Surg 2021 Mar 27. Epub 2021 Mar 27.

Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Children's of Alabama, 1600 7th Ave. S., Lowder Building Suite 300, Birmingham AL 35233, United States. Electronic address:

Background/purpose: Continuous renal replacement therapy (CRRT) is difficult in neonates for several reasons, including problems with catheter placement and maintenance. We sought to compare outcomes between standard hemodialysis catheters (HDC) and 6Fr-tunneled central venous catheters (TC-6Fr).

Methods: We evaluated neonates who received CRRT from December 2013 - January 2018. Read More

Front Surg 2021 9;8:629367. Epub 2021 Apr 9.

Department of Internal Medicine and Nephrology, Institute of Medical Sciences, University of Opole, Opole, Poland.

Central tunneled catheter (CTC)-related infections are a leading cause of a catheter loss, thus being the source of significant morbidity and mortality. The study aims at evaluating the impact of the implementation of the innovative redness, edema, discharge and tenderness, symptoms (REDS) scale (devised by the authors) for the description of the tunnel condition on the frequency of infection in long-term catheter users. The same cohort of the 40 patients was observed for 4 years altogether: 2 years before and 2 years after REDS application. Read More

Kidney Med 2021 Mar-Apr;3(2):248-256.e1. Epub 2021 Feb 10.

Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.

Background: It is unclear whether surgical placement of an arteriovenous (AV) fistula (AVF) confers substantial clinical benefits over an AV graft (AVG) in older adults with end-stage kidney disease (ESKD). We report vascular access outcomes of a pilot clinical trial.

Study Design: Pilot randomized parallel-group open-label trial. Read More

Ann Vasc Surg 2021 Apr 2. Epub 2021 Apr 2.

Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK; Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK.

Objectives: Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and replacement by a further TCVC. Theoretically, insertion of an early - cannulation graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr). Read More

Quant Imaging Med Surg 2021 Apr;11(4):1619-1627

Department of Radiology, KU School of Medicine-Wichita, University in Wichita, Wichita, KS, USA.

Vascular access procedures are crucial for the management of various critically ill pediatric and adult patients. Venous access is commonly performed in the form routine as well as tunneled peripherally inserted central catheters (PICC). These venous accesses are commonly used in emergency, surgical as well as ICU settings, for various infusions, total parenteral nutrition, long term intravenous antibiotics, frequent blood draws, etc. Read More

Ann Palliat Med 2021 Mar 18;10(3):3495-3499. Epub 2021 Mar 18.

Division of Nephrology, Department of Internal Medicine, West China Hospital of Sichuan University, Chengdu, China; Division of Intervention, West China Hospital of Sichuan University, Chengdu, China.

We present the case of a 53-year-old woman with a history of maintenance hemodialysis through arteriovenous fistula, CUFF catheter (cuffed tunneled catheter) and artificial vascular graft successively. Some signs of superior vena cava syndrome have presented including chronic edema in the face and left arm and varicose veins. Both CT (computed tomography) and angiography showed narrowing and occlusion in multiple veins, especially the right innominate vein, superior vena cava, inferior vena cava, left jugular vein, and bilateral common iliac veins. Read More

J Vasc Access 2021 Mar 16:11297298211002579. Epub 2021 Mar 16.

Vascular Access Team, A&E Department, ASST Provincia di Lodi, Lodi, Italy.

Background: The tunneling technique is currently widely used for placement of CVC. Recently, some clinicians have used this technique for peripherally inserted central catheters (PICC), or Midline catheters (MCs).

Objective: To describe a safe antegrade tunneling technique for PICCs and MCs insertion with a blunt tunneler. Read More

Ann Vasc Surg 2021 Mar 6. Epub 2021 Mar 6.

DFW Vascular Group, Dallas, TX; Department of Surgery, Methodist Dallas Medical Center, Dallas, TX; TCU School of Medicine, Fort Worth, TX. Electronic address:

Background: Superior vena cava (SVC) occlusion in dialysis patients is a serious complication that can cause SVC syndrome and vascular access dysfunction. While endovascular therapy has advanced to become the first line of treatment, open surgical treatment may still be needed occasionally. However, no long term outcome data has been previously reported. Read More

J Crit Care 2021 Jun 20;63:98-103. Epub 2021 Feb 20.

Division of Hospital Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, MI, United States of America; Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, United States of America; Patient Safety Enhancement Program, Ann Arbor VA Medical Center, Ann Arbor, MI, United States of America.

Purpose: Vascular access patterns in the intensive care unit (ICU) have shifted from non-tunneled central venous catheters (CVCs) towards peripherally inserted central catheters (PICCs). We evaluated perceptions of critical care practitioners regarding these devices and variation in evidence-based practice.

Materials: A 35-question survey on ICU vascular access was deployed in 13 Michigan hospitals. Read More

Ann Med Surg (Lond) 2020 Dec 21;60:76-80. Epub 2020 Oct 21.

Division of Nephrology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.

Background: There is currently a controversy for the optimal vascular access option in the elderly, regarding their multiple comorbidities and life expectancies. Our study aimed to compare the survival of tunneled cuff venous catheter (CVC) and arteriovenous access (AV access) in elderly patients.

Methods: A retrospective cohort study was performed by electronic medical record review. Read More

J Vasc Surg 2021 May 19;73(5):1787-1793. Epub 2020 Oct 19.

Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Ill. Electronic address:

Background: Autogenous arteriovenous fistula creation is the preferred route for vascular access for hemodialysis. Although preoperative venous mapping ultrasonography has been advocated as an operative planning adjunct and recently incorporated into the Society for Vascular Surgery clinical guidelines, controversy remains regarding its usefulness for predicting access success. The purpose of the present retrospective clinical study was to test the hypothesis that vein size measured on routine preoperative venous mapping is a poor predictor of primary fistula maturation. Read More

Int J Artif Organs 2021 May 4;44(5):302-309. Epub 2020 Oct 4.

Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.

Objectives: Examine the impacts of age, diabetes, gender, and access type on vascular access (VA) associated costs among Chinese hemodialysis (HD) patients.

Methods: We retrospectively included patients whose first permanent VA was created at the West China Hospital. Clinical characteristics, maturation, intervention, utilization, and exchange of every VA, as well as VA-related infection were collected. Read More

J Vasc Interv Radiol 2020 Oct 8;31(10):1654-1660.e1. Epub 2020 Jul 8.

Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.

Purpose: To report the device performance and safety for the Surfacer Inside-Out access catheter system in patients with thoracic central venous obstruction (TCVO) requiring central venous access (CVA).

Materials And Methods: Five sites prospectively enrolled 30 patients requiring a tunneled dialysis catheter between February 2017 and September 2018 in the SAVE (Surfacer System to Facilitate Access in Venous Obstructions) registry. Patient demographics, medical history, and type of TCVO were documented at enrollment. Read More

Turk J Med Sci 2021 02 26;51(1):95-101. Epub 2021 Feb 26.

Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey

Background/aim: This study aims to describe the technical success of the micropuncture technique, which is performed in placement of tunneled hemodialysis catheters in patients with central venous occlusion and limited access.

Materials And Methods: A total of 25 patients with central venous occlusion and in need of catheter placement for hemodialysis between 2012 and 2018 were included in this study and analyzed retrospectively. Technical success was defined as the placement of tunneled dialysis catheters with optimal position and function. Read More

Clin Nephrol 2020 Nov;94(5):237-244

Introduction: The implantation of acute or chronic vascular accesses for hemodialysis (HD) in end-stage kidney disease patients is a critical skill procedure for nephrologists, with an impact on short- and long-term outcomes of the modality and patient survival. Placement circumstances, however, may depend on the availability of technological support and will likely vary across the world.

Materials And Methods: We retrospectively reviewed our local experience with ultrasound-guided tunneled dialysis catheter (TDC) insertions but without access to fluoroscopic guidance. Read More

J Vasc Access 2020 Aug 30:1129729820954757. Epub 2020 Aug 30.

St. Joseph's University Medical Center, Paterson, NJ, USA.

In the pediatric population, vascular access is often challenging to secure and to maintain, especially for long-term intravenous (IV) treatment. The traditional approach for patients who require long-term IV antibiotics is placement of a peripherally inserted central catheter (PICC). The challenge in the pediatric population is the high risk of dislodgement after PICC placement, as these patients tend to pull their line out accidentally or purposefully. Read More

Hemodial Int 2020 10 27;24(4):487-494. Epub 2020 Aug 27.

Nephrology Department, Hospital Juan Ramón Jiménez, Huelva, Spain.

Introduction: Retrospective observational study to evaluate the technique of cannulation guided by ultrasound of the left internal jugular vein (LIJV) using a lateral oblique axis (LOAX) approach with variable angulation in the placement of tunneled central venous catheters (CVC) for hemodialysis.

Methods: Seventy-one patients with 77 LIJV vascular accesses aged 16 or older who needed CVC for hemodialysis were evaluated. The catheters were inserted, guided by LOAX ultrasound with variable angulation, depending on the angulation of the left brachiocephalic trunk. Read More

J Vasc Surg 2021 Feb 21;73(2):588-592. Epub 2020 Jul 21.

Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Mass. Electronic address:

Objective: Tunneled dialysis catheters (TDCs) are generally used as a temporary means to provide hemodialysis until permanent arteriovenous (AV) access is established. However, some patients may have long-term catheter-based hemodialysis because of the lack of alternatives for other dialysis access. Our objective was to evaluate characteristics of patients with, reasons for, and mortality associated with long-term TDC use. Read More

J Card Surg 2020 Sep 11;35(9):2370-2374. Epub 2020 Jul 11.

Department of Pediatric Cardiovascular and Thoracic Surgery, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.

Background: Left innominate vein occlusion is a known complication of pacemaker and central venous catheter placement. For dialysis-dependent patients with an arteriovenous fistula (AVF), this can prevent successful hemodialysis and may require surgical intervention.

Case Report: An 8-month-old male was diagnosed with hemolytic uremic syndrome and became dialysis-dependent at 11 months of age. Read More

Kidney Int Rep 2020 Jul 17;5(7):1000-1006. Epub 2020 Apr 17.

Medical Intensive Care Unit, UMR CNRS 6023, CHU Clermont-Ferrand, Clermont-Ferrand, France.

Introduction: The last decade has seen a steady increase worldwide in the prevalence of end-stage renal disease (ESRD). Hemodialysis is the major modality of renal replacement therapy (RRT) in 70% to 90% of patients, who require well-functioning vascular access for this procedure. The recommended access for hemodialysis is an arteriovenous fistula or a vascular graft. Read More

J Vasc Access 2021 Mar 30;22(2):243-253. Epub 2020 Jun 30.

Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar.

Background: Until the 1980s, central vascular access in the Neonatal Intensive Care Unit was predominantly delivered by umbilical catheters and only and if needed by surgical cutdowns or subclavian vein catheterization through blind percutaneous venipuncture. In the early 1980s, epicutaneo-caval catheters were successfully introduced.

Methods: In our Neonatal Intensive Care Unit, a dedicated team to insert epicutaneo-caval catheters was formally established in January 2017, including 12 neonatologists and 1 neonatal nurse practitioner. Read More

J Vasc Access 2020 Nov 15;21(6):1034-1041. Epub 2020 Jun 15.

Division of Interventional Radiology, Seattle Children's Hospital and University of Washington, Seattle, WA, USA.

Central venous access is an essential aspect of critical care for pediatric patients. In the critically ill pediatric population, image-guided procedures performed at the bedside expedite care and may reduce risks and logistical challenges associated with patient transport to a remote procedure suite such as interventional radiology. We describe our institutional technique for ultrasound-guided tunneled femoral venous access in neonates and infants and provide technical pearls from our experience, with an intended audience including specialists performing point-of-care ultrasound-guided procedures as well as interventional radiologist making their services available in the intensive care unit. Read More

Ren Fail 2020 Nov;42(1):200-206

Department of Internal Medicine, Faculty of Medicine, Al-Quds University, Abu Dis, Palestine.

Referral time for end-stage renal disease (ESRD) patients to nephrologists and initial vascular access method are considered significant factors that impact health outcomes at the time of hemodialysis (HD) initiation. Native arteriovenous fistula (AVF) is strongly recommended as initial access. However, little is known about the referral rate among ESRD receiving HD in Palestine and its correlation with AVF creation. Read More

J Vasc Access 2020 Jun 2:1129729820926081. Epub 2020 Jun 2.

Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Vascular access is necessary for hemodialysis, and in some cases where it is difficult to establish an arteriovenous fistula or arteriovenous graft, a permanent hemodialysis catheter may be used. However, serious catheter-related complications, such as central vein stenosis or thrombosis, can occur. We herein present a case of complete brachiocephalic vein obstruction in a patient with lupus nephritis receiving hemodialysis using a tunneled hemodialysis catheter. Read More

J Vasc Access 2020 Nov 5;21(6):959-962. Epub 2020 May 5.

Monash Children's Hospital, Melbourne, VIC, Australia.

Paediatric central venous access devices are associated with significant complications. Failure rates have been estimated to be as high as 25%, with securement failure a significant contributing factor. In this study, we evaluate the use of a subcutaneous securement device, securAcath, in minimising rates of central venous access device dislodgement and unintended early removal within a paediatric population. Read More

Int J Environ Res Public Health 2020 04 27;17(9). Epub 2020 Apr 27.

Department of Nephrology and Internal Medicine, Institute of Medical Sciences, University of Opole, 45-052 Opole, Poland.

Background: Optimal care of patients treated with a central tunneled catheter (CTC) as vascular access for hemodialysis requires a number of procedures. One of them is CTC removal, usually carried out using mostly the cut-down method (CDM) and the traction method (TM). The procedure seems to be simple and safe; however, occasionally, serious complications may occur. Read More

Medicine (Baltimore) 2020 Apr;99(15):e19805

Department of Nephrology, Chongqing Renji Hospital University of Chinese Academy of Sciences, Chongqing, China.

Rationale: The percutaneous catheterization of central veins is widely applied in patients with end-stage renal diseases as a permanent vascular access. To our knowledge, inadvertent placement of a hemodialysis catheter into the azygos vein through the left internal jugular vein is not described.

Patient Concerns: A 72-year-old female patient was admitted to the hospital for replacement of another new tunneled hemodialysis catheter due to poor flow in the left internal jugular vein tunneled catheter during hemodialysis. Read More

J Pediatr Surg 2020 Jun 9;55(6):1157-1161. Epub 2019 Dec 9.

Department of Pediatric Anesthesiology, University Hospital Bonn, Bonn, Germany.

Background: Tunneled Hickman/Broviac central venous catheter implantation is performed when patients require a central vein route for long-term therapy. The subclavian or internal jugular vein approach is often chosen for their implantation sites. However, access to the central vein can be difficult owing to thrombosis or stenosis when the same vein has already been accessed several times. Read More