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 frequently these findings lead to a change in access approach. MATERIALS AND METHODS: One hundred consecutive hemodialysis catheter placements in 79 patients were retrospectively analyzed. Prior to catheter insertion, each patient underwent an US examination of the proposed access site by an interventional radiologist or interventional radiology fellow. The examinations were recorded on VHS tapes. The procedure notes, dictated radiology reports, and VHS tapes were reviewed for evidence of total occlusion, non-occlusive thrombus, presence of venous collaterals, stenosis, or variation in normal anatomy. The number of months that the patient required hemodialysis prior to catheter placement was also noted. RESULTS: Significant US findings were present in 28 patients (35%). Findings included total occlusion (n = 18), non-occlusive thrombus (n = 11), stenosis (n = 5), and anatomic variation (n = 1). These required a change in access approach in 21 patients. Unexpectedly, 54% of the patients with US findings had been undergoing dialysis for 12 months or less. CONCLUSION: These results underscore the importance of sonography in planning and performing vascular access procedures. A thorough US examination of the internal jugular veins is warranted prior to hemodialysis catheter placement, especially in patients with previous temporary or tunneled catheters. Three-quarters of patients with sonographic abnormalities required a change in access approach.