Subcutaneous Implantation of the LifeSite®Hemodialysis Access System in the Femoral Vein

Abstract

Cannulation of the femoral vein is often necessary to provide immediate vascular access for hemodialysis patients in whom a functional permanent access is not available or in patients who have exhausted other access options. Femoral placement of dialysis catheters is typically short term - days, not months - and is associated with high rates of infection, occlusion, recirculation and intervention as well as a high risk of catheter dislodgment. A new, fully subcutaneous vascular access device - the LifeSite(R) Hemodialysis Access System (Vasca, Inc., Tewksbury, MA) - has demonstrated better safety and efficacy profiles than a standard tunneled dialysis catheter in clinical trails that evaluated placement within the thoracic veins. The case reported here extends the use of the Life-Site(R) System to femoral placement in a patient with multiple failed arteriovenous accesses and dialysis catheters subsequent to central venous stenosis. The LifeSite(R) System was successfully implanted in the patient's left femoral vein and has served the patient for 4 months with no infections or complications requiring intervention, delivering flow rates >400-450 ml/minute for high-flux, dual-needle hemodialysis. These initial results suggest that the LifeSite(R) Hemodialysis Access System represents a new, safe and effective vascular access option in patients with limited access choices due to failed access in the upper extremities, central venous stenosis, or other vascular inadequacies.