Objective: To determine the patency rates and reasons for failure using different access routes for tunneled hemodialysis catheters. Methods: The records of patients who underwent insertion of 14 French tunnelled hemodialysis catheters were retrospectively analyzed. Catheter patency survival was demonstrated using Kaplan-Meier survival curve. Catheter failure and exchange reasons were evaluated. Results: One hundred and six patients underwent 474 catheter exchanges (mean/patient 4.47±1.62). Access was via right internal jugular vein (IJV) n=40, left IJV n=23, right femoral vein (FV) n=18, left FV n=11 and transhepatic vein n=14. The causes of catheter failure and exchange were: catheter-associated infection, catheter thrombosis, fibrin sheath and catheter tip malposition. Mean primary and cumulative catheter patency time (721 and 1276 days, respectively) was higher in the right IJV group compared with the others (p<0.001). The same parameters were lowest in the transhepatic group, being 118 and 466 days, for primary and cumulative patency, respectively (p<0.001). The incidence of catheter-related infections was higher in the left FV (0.42/100 patient-days) and catheter tip malposition was higher in the transhepatic (0.38/100 patient-days) and in the left IJV (0.32/100 patient-days). Conclusion:The use of right IJV should be the first option for hemodialysis access route. Based on our findings, if right IJV is unavailable the optimal access routes in order would be left IJV, right FV, left FV and finally transhepatic vein.

Arteriovenous fistula is a preferred approach to obtain vascular access in chronic hemodialysis patients. Arteriovenous fistula has some effects on cardiac and pulmonary systems. High output heart failure is a rare but an important complication of arteriovenous fistula. We report here a case of acute pulmonary edema after creating arteriovenous fistula in a hemodialysis patient with pneumonectomy.