Honorable Mention Tributary Venous Access (TVA); A New Approach to Vascular Access for Dialysis
Superior Vena Cava Catheters for Dialysis (SVCD) provide painless blood access for several months but catheter contact with venous intima always results in inflammation, which leads to fibrous sheathing (often reducing blood outflow rate) and central stenosis (often symptomatic). We have designed a novel blood access device called the Tributary Venous Access (TVA) in which a silicone catheter is placed through a tributary vein until the tip barely enters the target vein. Dacron cuffs and the tributary vein hold the catheter in position, so there is minimal contact of the catheter with the target vein intima. Tests in normal sheep compared blood outflow of a TVA placed through a jugular vein with the tip just entering the branchio-cephalic vein to that of a standard SVCD placed through the opposite jugular vein. The TVA provided the same blood outflow under gravity as the SVCD (180-240 ml/min), but caused much less venous pathology. The femoral vein in humans has 250-400 ml/min blood flow and pressure is always positive. A TVA placed through the saphenous vein with the tip just within in the femoral vein should supply sufficient blood flow for dialysis for a long time, without pathologic changes in the vein.
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