Abstract
The aim of this article is to present procedures and algorithms for the insertion of a long-term dialysis catheter in patients who have stenoses or thrombosis in the region of the right internal jugular vein, which is the first-line approach for dialysis treatment. Before insertion of an alternative venous access it is necessary to perform a complex radiological mapping of the venous system using ultrasound and contrast-enhanced CT venography.
The basic alternative approaches include the use of the external jugular vein, femoral veins, and collateral veins of the upper half of the body. Technically difficult approaches involve translumbar cannulation of the inferior vena cava and percutaneous cannulation of the hepatic or renal veins.
New hybrid methods include inside-out central venous puncture with the Surfacer system, HeRO graft implantation, or open surgical catheter implantation into the superior vena cava or the right atrium. When a difficulty with the implantation of venous access for dialysis can be anticipated, patients should be referred to the centers, where a team of interventional radiologists, vascular surgeons, and nephrologists with experience in non-conventional vascular access is available.