Managing the Failing Dialysis Permacath: Results from a 5-year Retrospective Analysis

Purpose: To evaluate the results of a retrospective analysis on the management of failing permanent dialysis catheters. Material and Methods: Within 5 years (1/2011-12/2015), 1,158 permanent dialysis catheters were inserted to 853 patients (576 men, 67.5% -277 women, 32.5%) in our department. Of those, 648 patients had only one catheter placed while 205 patients had ≥2 catheters/interventions, reaching a total of 510 procedures (2.48 procedures/patient; 2-27). In 342 cases, catheters were placed to the jugular vein (J-group) and 168 catheters were placed in the femoral vein (F-group). In 413 cases only cat heter exchange took place (CE-group), in another 89 cases balloon angioplasty was performed (PTA-group) and in 8 cases a bare metal stent was inserted (BMS-group). 272 central venous catheter (CVCs) had a split tip (SP-group) and a 238 straight tip (ST-group). Outcome measures included intervention-free period and independent predictors that might influence patency . Results: Mean follow up period was 475.64 days (1-1712 days). Mean intervention-free period was 268.35 days (1-1545 days). According to the Kaplan Meier survival analysis, there was statistically significant difference in favour of the J-group (Median Survival: 136 days vs. 69.5 days for F-group, p <0.0001). CE-group had significantly better results, when compared to PTA-group and BMS-group (Median Survival: CE-group 116 days, PTA-group 89 days, BMS-group 73 days, p <0.0001). CVCs with a straight tip had significantly better intervention-free period compared to split tip (ST-group 126 days vs. 80 days for SP-group, p <0.001) Conclusions: Jugular access had significantly better patency results compared to femoral. Additional interventions (angioplasty and stenting) in a bail-out setting provided worse results compared to plain catheter exchange. Straight tip CVCs had significantly better patency rates.