Importance of US findings in access planning during jugular vein hemodialysis catheter placements

PURPOSE: To evaluate the significance of internal jugular vein ultrasound ( US) findings in long-term hemodialysis patients and to assess how frequentl y these findings lead to a change in access approach. MATERIALS AND METHODS: One hundred consecutive hemodialysis catheter placem ents in 79 patients were retrospectively analyzed. Prior to catheter insert ion, each patient underwent an US examination of the proposed access site b y an interventional radiologist or interventional radiology fellow. The exa minations were recorded on VHS tapes, The procedure notes, dictated radiolo gy reports, and VHS tapes were reviewed for evidence of total occlusion, no n-occlusive thrombus, presence of venous collaterals, stenosis, or variatio n in normal anatomy, The number of months that the patient required hemodia lysis prior to catheter placement was also noted. RESULTS: Significant US findings were present in 28 patients (35%), Finding s included total occlusion (n = 18), non-occlusive thrombus (n = 11), steno sis (n = 5), and anatomic variation (n = 1), These required a change in acc ess approach in 21 patients. Unexpectedly, 54% of the patients with US find ings had been undergoing dialysis for 12 months or less. CONCLUSION: These results underscore the importance of sonography in planni ng and performing vascular access procedures. A thorough US examination of the internal jugular veins is warranted prior to hemodialysis catheter plac ement, especially in patients with previous temporary or tunneled catheters , Three-quarters of patients with sonographic abnormalities required a chan ge in access approach.