Purpose: LifeSite (LS) is a new implantable subcutaneous vascular access device recently approved by the FDA is an attractive alternative to tunneled catheters due to improved blood flow, lack of recirculation, lower incidence of thrombosis, better patient acceptance and less complications.
Methods and Materials: At the VCU-MCV hospitals 20 patients had LifeSites placed, based on manufacturer's recommendations, under conscious sedation and local anesthesia, using the Seldinger technique for central vein access under ultrasound and fluoroscopic guidance. The total procedure took 40 to 120 minutes with fluoroscopic time ranging from 5 to 15 minutes.
Results: We observed 4,290 patient-days of LS use. Ten patients still had LS in place when the study was conducted. The 6- and 12-month 'device survival' was 70% and 44% respectively. Major complications occurred in 2 patients: a hematoma around the device in one, and rupture and embolization of one of the catheters in one (our first patient a morbidly obese male). At follow-up, 16 radiologic interventions were needed. The device was removed in six. Seven patients had device check due to decreased blood flow, one patient required catheter exchange, and two patients with exposed valves had revision and 'deepening' of the pockets.
Conclusion: Our preliminary experience suggests that the LS provides superior long-term dialysis access compared to tunneled catheters. In addition, the easy, pain-free access, the ability to shower and bathe, and to have more 'normal' activities are the main reasons for the high degree of satisfaction in our patients, relatives and health care personnel. The major drawback is the price ($3,000.00).
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