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Nephrol Dial Transplant (2003) 18: 1045-1051
© 2003 European Renal Association-European Dialysis and Transplant Association

Editorial Comment

Surgical alternatives to central venous catheters in chronic renal replacement therapy

Volker Mickley

Department for Vascular Surgery, Stadtklinik Baden-Baden, Germany

Keywords: arteriovenous access; central venous catheters; central venous obstruction; haemodialysis; peripheral arterial obstructive disease; review

The first 150 words of the full text of this article appear below.

Introduction

Disadvantages and risks of ‘permanent’ central venous catheters (CVC) in chronic renal replacement therapy (RRT) have repeatedly been emphasized in the literature [1–3]. Central venous access has been shown to be the most important independent risk factor for infection and death in patients on chronic RRT. The relative risk of bacteraemia is >7-fold higher in CVC patients when compared with fistula patients [4], and catheter-associated bacteraemia is burdened with a 20–40% rate of metastatic complications or death [5–7]. As a consequence, the relative risk of infection-related death is 1.4–2-fold higher but also the risk of death from cardiac causes and overall mortality are significantly enhanced in CVC patients, when compared with end-stage renal failure (ESRF) patients with arteriovenous fistula (AVF) [8,9]. Furthermore, a peripheral arteriovenous (av-) access has been shown to be more reliable than CVC . . . [Full Text of this Article]

Children

Elderly patients/limited life expectancy

Diabetes mellitus

Cardiac failure

Difficult access

Exhausted peripheral veins
Central venous obstructions
Steal syndrome
Recurrent access thromboses
Conclusion


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