**4. Radiological control after the implantation of jugular catheters**

It has been suggested that every patient with a central venous catheter implanted on his or her superior hemithorax, must have PA chest radiography before actually using the catheter to confirm a correct placement. In occasions it is necessary to take the patient to hemodialysis therapy immediately after implanting the catheter and the radiological control can delay this process. In the year 2008 we published our experience with 245 jugular catheters implanted in the past years, all of them had PA chest radiography performed after the implantation. Only 4 cases (1,6%) had a significant complication (10). Based on this and if the implantation of the catheter was easy, we avoid soliciting the radiography and immediately proceed to the hemodialysis practice. (Figure 18).

Unusual Vascular Access for Hemodialysis Therapies 327

Fig. 19. Catheter in left persistent superior vena cava, confirm by Radiological studies.

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Restrepo Valencia C A, Buritica Barragan C M. Axillary catheter for hemodialysis, an

Andel H, Rab M, Felfernig M, Andel D, Koller R, Kamolz L-P, Zimpfer M. The axillary vein central venous catheter in severely burned patients. Burns 25: 753-756, 1999. Taylor BL, Yellowlees I. Central venous cannulation using the infraclavicular axillary vein.

Restrepo Valencia C A, Buritica Barragan C M. Placement of vascular access catheters for

Agrawal S, Alaly J R, Misra M. Intracardiac access for hemodialysis: A case series.

Restrepo Valencia C A, Buritica Barragan C M, Arango A. Catheter in the superior vena cava

Restrepo V C A, Chacon A C, Arcos Sanz C E. Es útil la profilaxis antibiótica para prevenir

Restrepo C A, Chacon J A, Villota D M. Safety related to the implantation of jugular

haemodialysis in the innominate vein: a little-used approach. Nefrologia 2009; 29:

for hemodialysis as a last resort in superior hemithorax. Nefrologia 2010; 30: 463-

infecciones relacionada con la inserción de catéteres transitorios para hemodiálisis?.

catheters for hemodyalisis and usefulness of PA chest X rays postprocedure. Acta

from the Dialysis Outcome and Practice Patterns Study (DOPPS): performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice

**5. References** 


Fig. 18. PA chest radiograph post insertion of central catheter is unnecessary.

Interestingly in 4 patients with insertion of catheters in left jugular vein we observed abnormal catheter course, corresponding to persistent left superior vena cava, anatomical abnormality confirmed by radiological or echocardiographic studies. (11) (Figure 19).

Fig. 19. Catheter in left persistent superior vena cava, confirm by Radiological studies.

### **5. References**

326 Chronic Kidney Disease

Fig. 18. PA chest radiograph post insertion of central catheter is unnecessary.

Interestingly in 4 patients with insertion of catheters in left jugular vein we observed abnormal catheter course, corresponding to persistent left superior vena cava, anatomical

abnormality confirmed by radiological or echocardiographic studies. (11) (Figure 19).


**The Role of Nephron-Sparing Surgery (NSS)**

Amélie Parisel, Frederic Baekelandt, Hein Van Poppel and Steven Joniau

For many years, radical nephrectomy (RN) has been the gold standard treatment for renal tumours. However, at present the available evidence supports elective nephron-sparing surgery (NSS) as the standard surgical treatment for renal cortical tumours ≤4 cm (clinical stage T1a). Furthermore, an increasing body of evidence demonstrates that even a minor loss of renal function can increase cardiovascular morbidity and consequently reduce life expectancy (Go et al., 2004). Thus, surgeons have the responsibility to preserve as much

International guidelines at present recommend NSS for small renal tumours up to 4 cm. However, the role of NSS for larger renal tumours (stage T1b: 4.1 – 7 cm, stage T2: >7 cm) remains controversial. During the last couple of years, data has emerged which demonstrates that NSS can be safely performed with acceptable complication rates compared to RN (Van Poppel et al., 2010). The advantage of NSS lies in avoiding the development of end-stage renal disease and the need for haemodialysis, while maintaining quality of life (Lesage et al., 2007). The size of the tumour is no longer considered to be a limiting factor for NSS and some now

NSS aims to preserve renal function without lacking its primary goal: eradicate the tumour. One of the challenges of NSS is to achieve negative surgical margins (NSM). It means that there are no cancer cells seen at the outer edge of the resection piece. This is marked with

In general, the incidence of PSM in T1b tumours is between 0 % (Patel et al., 2009) and 16.7% (Lee et al., 2010). Lee showed that the difference in recurrence rate for patients with PSM

Coffin et al (Coffin et al., 2011) found that an imperative indication for NSS had an impact on PSM rates (p=0.03). However, he also noticed that the median tumour size was

advocate NSS whenever possible and feasible (Becker et al., 2009).

**2.1.1 Positive Surgical Margins (PSM): Incidence, clinical relevance** 

**1. Introduction** 

renal parenchyma as possible.

**2. Open partial nephrectomy** 

compared to NSM was not significant.

**2.1 Oncologic control** 

ink.

**for Renal Tumours >4 cm** 

*University Hospitals Leuven* 

*Belgium* 

Cruz J, Restrepo C A. Accidental implantation of hemodialysis catheter in persistent left superior vena cava. Acta Med Colomb 2007; 32: 227-230. **20**
