Interventional radiology placement of twin Tesio catheters for dialysis access: Review of 75 patients

PURPOSE: To evaluate the safety and efficacy of modern interventional radio logy techniques and imaging guidance for placement of jugular vein twin Tes io hemodialysis catheters, MATERIALS AND METHODS: Eighty-two sets (75 patients) of twin Tesio catheter s were percutaneously placed in the right (n = 70) and left (n = 12) intern al jugular veins with use of ultrasound (US) and fluoroscopic guidance. Imm ediate procedural and late complications were recorded. The efficacy of the Tesio system was also evaluated. RESULTS: With US and fluoroscopic guidance, the technical success for acces s and catheter placement was 100%. Measured dialysis blood flow rate of gre ater than 375 mL/min was obtained in 95% of the patients and recirculation averaged 4.6% +/- 5%. An inadvertent common carotid artery puncture occurre d in one (0.6%) patient and prolonged exit site bleeding occurred in anothe r five patients (3%). Each of these was successfully controlled with compre ssion. More chronically, catheter thrombosis and exit site infection occurr ed each at the rate of 0.16 episodes per 100 catheter days. All thrombosis and exit site infections responded to local thrombolysis and antibiotic the rapy, respectively. Bacteremia occurred in 20 patients and required cathete r removal in five patients. There was no clinical evidence of upper extremi ty or superior central vein thrombosis. CONCLUSION: Placement of internal jugular, twin Tesio catheters with use of imaging and interventional techniques provides a safe and efficacious mean s of either short or long-term hemodialysis.