Ultrasound imaging findings of femoral veins in patients with renal failure and its impact on vascular access.

BACKGROUND Patients requiring dialysis due to acute or chronic renal failure frequently require temporary vascular access. Femoral vein catheterization is the easiest method for obtaining temporary vascular access in haemodialysis patients. The aim of this study was to utilize ultrasound imaging to describe femoral vein structures and to examine anatomical variations in uraemic patients. METHODS We evaluated 114 (70 males, 44 females) renal failure patients. Femoral arteries were localized manually inferior to the femoral ligament, and ultrasonographic examination was performed from this location. Images of the vessels and demographic data of patients were recorded and analysed. Femoral veins were classified according to their diameter, patency and palpation status of the neighbouring femoral artery. RESULTS Three patients had a history of prior femoral catheterization. In one of these, who had a history of bilateral catheterization, we detected bilateral femoral vein thrombosis. Overall, non-palpable femoral arteries or unsuitable femoral veins were found unilaterally in 16 patients (14.0%) and bilaterally in six patients (5.2%). The depth of femoral arteries (r = 0.54, P<0.001) and femoral veins (r = 0.59, P<0.001) was correlated with body mass index (BMI). Femoral arteries and femoral veins were located significantly deeper in overweight (BMI >25) patients compared with normal weight patients (20.7+/-6.5 vs 14.6+/-5.1 mm, P<0.001 and 26.1+/-6.7 vs 18.9+/-5.5 mm, P<0.001). CONCLUSIONS Bilateral anatomical variations of femoral veins were relatively rare. However, ultrasound surveys should be performed in obese patients or when the femoral artery is not palpable.

[1]  W. Weitzel,et al.  Successful use of indwelling cuffed femoral vein catheters in ambulatory hemodialysis patients. , 1993, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[2]  A. Bodenham,et al.  Ultrasonography of the femoral vessels in the groin: implications for vascular access. , 2000, Anaesthesia.

[3]  Daniel Hind,et al.  Ultrasonic locating devices for central venous cannulation: meta-analysis , 2003, BMJ : British Medical Journal.

[4]  J. Farrell,et al.  Ultrasound-guided cannulation versus the landmark-guided technique for acute haemodialysis access. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[5]  P. Clavel,et al.  Indwelling silicone femoral catheters: experience of three haemodialysis centres. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[6]  M. Klinger,et al.  Femoral and iliac vein stenoses after prolonged femoral vein catheter insertion. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[7]  H. Kaneda,et al.  Repeated femoral vein puncturing for maintenance haemodialysis vascular access. , 2003, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[8]  R. M. Culpepper,et al.  Frequency of complications with prolonged femoral vein catheterization for hemodialysis access. , 1996, Nephron.

[9]  D. Tarng,et al.  Anatomical variation of the internal jugular vein and its impact on temporary haemodialysis vascular access: an ultrasonographic survey in uraemic patients. , 1998, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[10]  D. Cho,et al.  Ultrasound-guided cannulation of the femoral vein for acute haemodialysis access. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[11]  M. El-Shahawy,et al.  Awareness of internal jugular, subclavian, superior vena cava and femoral venous anomalies may reduce morbidity of acute venous catheter procedures. , 1995, Clinical nephrology.

[12]  M. Kramer,et al.  Comparison of subclavian vein with femoral vein catheterization for hemodialysis. , 1983, American journal of kidney diseases : the official journal of the National Kidney Foundation.