Iliac cuffed tunnelled catheters for chronic haemodialysis vascular access

Obtaining and maintaining vascular access is of pivotal importance in the care of chronic haemodialysis patients. According to the Dialysis Outcomes Quality Initiative (DOQI) guidelines, peripheral arteriovenous (AV) fistulas or grafts are the preferred type of access [1]. The use of central venous catheters for chronic haemodialysis is discouraged [1]. Compared with AV fistulas, central catheters carry a substantially increased risk of infection and bacteraemia [2]. However, in approximately a quarter of the patients, peripheral venous access has been exhausted or is not feasible in the first place [3,4]. In these cases, cuffed tunnelled right atrial catheters inserted into the jugular or subclavian veins permit adequate blood flow for dialysis. The femoral veins may be used in situations where the jugular or subclavian veins are not available. Femoral catheters are prone to exit-site infections and bacteraemia, and have an unacceptable risk of thrombosis and life-threatening embolism in ambulatory patients. In the current case report, we describe an alternative approach to haemodialysis vascular access. We successfully placed cuffed tunnelled catheters in the iliac veins of six patients, A–F, from our own chronic haemodialysis programme and an affiliated dialysis centre (Table 1). Each of the patients had a history of repeated creation and loss of peripheral vascular access except for one, in whom vascular surgeons ruled out peripheral access in the first place. All six patients had documented thrombosis of the jugular and/or subclavian veins (Table 1). Patient D had a history of chronic anticoagulation due to repeated catheter-related thrombosis (Figure 1). Description of procedure and clinical outcome