Comparison of catheter patency between surgical inside-out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusion
Objective: Femoral tunneled cuffed catheters (TCCs) can provide long-term hemodialysis access for patients with exhausted upper extremity access sites due to thoracic central venous occlusion. However, the use of femoral vein catheters (FVCs) has reportedly been associated with the risk of infection...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-12-01
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| Series: | Journal of Vascular Surgery Cases and Innovative Techniques |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S246842872200209X |
| _version_ | 1797975819589517312 |
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| author | Nutsiri Kittitirapong, MD Benjaporn Jeraja, MD Piyanut Pootracool Chaowanun Pornwaragorn, MD Gorawee Tepsamrithporn Surasit Sitthilor, BNS Suthas Horsirimanont, MD |
| author_facet | Nutsiri Kittitirapong, MD Benjaporn Jeraja, MD Piyanut Pootracool Chaowanun Pornwaragorn, MD Gorawee Tepsamrithporn Surasit Sitthilor, BNS Suthas Horsirimanont, MD |
| author_sort | Nutsiri Kittitirapong, MD |
| collection | DOAJ |
| description | Objective: Femoral tunneled cuffed catheters (TCCs) can provide long-term hemodialysis access for patients with exhausted upper extremity access sites due to thoracic central venous occlusion. However, the use of femoral vein catheters (FVCs) has reportedly been associated with the risk of infection, malfunction, and discomfort. An inside-out technique will facilitate chest TCC placement by intentional retrograde extravascularization of the proximal occluded venous stump into the mediastinum. Next, the wire and small catheter are exteriorized to the skin at the base of the neck with a small skin incision. Then, the hemodialysis catheter is railed back down to the right atrium. With this technique, we placed the tip of the catheter into intrathoracic superior vena cava or brachiocephalic vein. In the present study, we compared the catheter patency of the inside-out technique vs a standard approach for FVC placement. Methods: The present randomized controlled trial was conducted from May to December 2020. We included 22 patients requiring long-term hemodialysis with failed recanalization of thoracic central venous occlusion. The patients were randomized into the surgical inside-out (S-inside-out) group and FVC group. Results: The S-inside-out and FVC groups included 10 and 12 patients, respectively. All 22 patients had undergone successful catheter placement. Catheter survival function was significantly higher for the S-inside-out group than for the FVC group (100% vs 50%, respectively; P = .017). In addition, the EQ-5D utility score was significantly better for the S-inside-out group (P = .008). Four cases of catheter infection occurred in the FVC group, but no catheter infection was found in the S-inside-out group. Procedural-related complications occurred in two patients; one case each of hemothorax and stroke in the S-inside-out group. Conclusions: Use of the S-inside-out technique facilitated upper chest TCC placement for hemodialysis patients with exhausted access sites. This technique provided better catheter survival function, a better quality of life, and a lower infection rate, which outweighed the procedure risk. |
| first_indexed | 2024-04-11T04:41:30Z |
| format | Article |
| id | doaj.art-9e6fed9d86a6432896a3326490d258fb |
| institution | Directory Open Access Journal |
| issn | 2468-4287 |
| language | English |
| last_indexed | 2024-04-11T04:41:30Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Vascular Surgery Cases and Innovative Techniques |
| spelling | doaj.art-9e6fed9d86a6432896a3326490d258fb2022-12-28T04:19:04ZengElsevierJournal of Vascular Surgery Cases and Innovative Techniques2468-42872022-12-0184885893Comparison of catheter patency between surgical inside-out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusionNutsiri Kittitirapong, MD0Benjaporn Jeraja, MD1Piyanut Pootracool2Chaowanun Pornwaragorn, MD3Gorawee Tepsamrithporn4Surasit Sitthilor, BNS5Suthas Horsirimanont, MD6Division of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, ThailandDepartment of Surgery, Chonburi Hospital, Chonburi, ThailandDivision of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, ThailandDivision of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, ThailandDivision of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, ThailandNursing Service Department, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, ThailandDivision of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand; Correspondence: Suthas Horsirimanont, MD, Division of Vascular Surgery, Department of Surgery, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, 270 Rama VI Rd, Bangkok 10400, ThailandObjective: Femoral tunneled cuffed catheters (TCCs) can provide long-term hemodialysis access for patients with exhausted upper extremity access sites due to thoracic central venous occlusion. However, the use of femoral vein catheters (FVCs) has reportedly been associated with the risk of infection, malfunction, and discomfort. An inside-out technique will facilitate chest TCC placement by intentional retrograde extravascularization of the proximal occluded venous stump into the mediastinum. Next, the wire and small catheter are exteriorized to the skin at the base of the neck with a small skin incision. Then, the hemodialysis catheter is railed back down to the right atrium. With this technique, we placed the tip of the catheter into intrathoracic superior vena cava or brachiocephalic vein. In the present study, we compared the catheter patency of the inside-out technique vs a standard approach for FVC placement. Methods: The present randomized controlled trial was conducted from May to December 2020. We included 22 patients requiring long-term hemodialysis with failed recanalization of thoracic central venous occlusion. The patients were randomized into the surgical inside-out (S-inside-out) group and FVC group. Results: The S-inside-out and FVC groups included 10 and 12 patients, respectively. All 22 patients had undergone successful catheter placement. Catheter survival function was significantly higher for the S-inside-out group than for the FVC group (100% vs 50%, respectively; P = .017). In addition, the EQ-5D utility score was significantly better for the S-inside-out group (P = .008). Four cases of catheter infection occurred in the FVC group, but no catheter infection was found in the S-inside-out group. Procedural-related complications occurred in two patients; one case each of hemothorax and stroke in the S-inside-out group. Conclusions: Use of the S-inside-out technique facilitated upper chest TCC placement for hemodialysis patients with exhausted access sites. This technique provided better catheter survival function, a better quality of life, and a lower infection rate, which outweighed the procedure risk.http://www.sciencedirect.com/science/article/pii/S246842872200209XCatheter patencyFemoral catheterHemodialysisInside-outTunneled cuffed catheter |
| spellingShingle | Nutsiri Kittitirapong, MD Benjaporn Jeraja, MD Piyanut Pootracool Chaowanun Pornwaragorn, MD Gorawee Tepsamrithporn Surasit Sitthilor, BNS Suthas Horsirimanont, MD Comparison of catheter patency between surgical inside-out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusion Journal of Vascular Surgery Cases and Innovative Techniques Catheter patency Femoral catheter Hemodialysis Inside-out Tunneled cuffed catheter |
| title | Comparison of catheter patency between surgical inside-out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusion |
| title_full | Comparison of catheter patency between surgical inside-out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusion |
| title_fullStr | Comparison of catheter patency between surgical inside-out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusion |
| title_full_unstemmed | Comparison of catheter patency between surgical inside-out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusion |
| title_short | Comparison of catheter patency between surgical inside-out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusion |
| title_sort | comparison of catheter patency between surgical inside out technique and conventional femoral approach for tunneled cuffed catheter placement in patients with thoracic central venous occlusion |
| topic | Catheter patency Femoral catheter Hemodialysis Inside-out Tunneled cuffed catheter |
| url | http://www.sciencedirect.com/science/article/pii/S246842872200209X |
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