Insertion of tunneled hemodialysis catheter through the collateral vein adjacent to the thrombosed right jugular vein.

Kishor Kumar Rajasekaran, Abirami Krishnan, Santhosh Kumar P

Department of Nephrology, Kauvery Hospital, Salem

Background

The primary site for a tunneled hemodialysis catheter (THC) insertion is the right internal jugular vein (IJV) followed by the left IJV, subclavian vein, and femoral veins. We report a chronic hemodialysis patient who had completely occluded jugular veins in whom THC was inserted via collateral veins thereby securing access.

Case presentation

A 52 years aged male, diagnosed to have ESRD on maintainence HD last 5 years, with failed left brachio-cephalic fistula, presented to us with right temporary femoral dialysis catheter with history of failed right internal jugular catheter insertion elsewhere.

On screening USG Neck, he was found to have a right internal jugular vein diameter of 5 mm. Under fluoroscopic guidance, the metal guidewire was inserted which showed reflux of wire.(Fig 1) The guide wire was removed and angiography was done which showed complete occlusion of an internal jugular vein with an adjacent collateral draining into the brachiocephalic vein. (Fig 2). Floppy tip hydrophilic guide wire was passed and tunneled hemodialysis catheter was inserted with good flow in both lumen. (Fig 3-5).

Conclusion

Tunneled hemodialysis catheter insertion through collateral veins should be attempted as an option in the event of narrowed jugular veins under fluoroscopic guidance particularly in patients with difficult vascular access.

Dr. Kishor Kumar R - Top Nephrologist in Salem

Dr. Kishor Kumar R
Consultant – Nephrology

Dr. K.ABIRAMI Nephro

Dr. Abirami Krishnan
Nephrologist

Dr. P. Santhoshkumar

Dr. P. Santhosh Kumar
Consultant Radiologist

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