Our frequent use of hemodialysis catheters remains a paradoxical problem; few knowledgeable clinicians like them, but all of us use them. This dilemma and other pertinent topics related to hemodialysis catheters were recently discussed by a panel of expert clinicians, and their dialogue is presented in this supplemental issue of Endovascular Today. The participants in this discussion are highly regarded experts in vascular access for hemodialysis, including representatives from nephrology, vascular surgery, interventional radiology, and nursing.

Consensus was easy. The panelists agreed that the fundamental problem is our inability to create autogenous fistulas at the appropriate time in the predialysis patient. The current solution to this problem is, unfortunately, urgent or emergent placement of a hemodialysis catheter. The panelists debated causes and solutions, but all agreed that this is a multifactorial, systemic problem that will not soon be resolved.

The expert discussants also agreed that the current generation of hemodialysis catheters continues to be plagued by both early and late catheter failure. The etiologies of catheter failure were discussed, including poor insertion technique, suboptimal positioning of the catheter tip, and fibrin sheath formation. And, consequences of prolonged catheter use such as central venous stenosis stimulated a lively discussion among the panelists.

I hope that this roundtable discussion is interesting, educational, and provides new perspectives regarding the use of hemodialysis catheters in your patients.

[VIEW ROUNDTABLE PDF]

Disclaimer: Opinions expressed in this supplement are those of the physician roundtable panelists and not necessarily those of Bryn Mawr Communications, its editorial staff, the editorial advisory board, or Covidien. This supplement was supported with grant assistance and a discussion guide provided by Covidien. All artwork copyright © Covidien. Used with permission.