Invasive and innovative nephrology

Background. A nephrologist in the millennium offers comprehensive care to renal failure patients. Interventional nephrology plays a major role in this new approach. Overton Brooks Veterans Affairs Medical Center (OBVAMC) is the first federal health care provider in the nation offering such services. Lack of interventional radiologists and a busy surgical service has catalyzed the existence of interventional nephrology at this center. We report our early experience in successfully providing complete care to veterans with renal failure, despite multiple logistical obstacles. Method. The OBVAMC is an acute care facility providing nephrology support to hospitalized veterans and also handles access-related issues for eligible chronic dialysis patients. All procedures performed from June 2000 to September 2003 were analyzed. The procedures were performed in the cardiac catheterization laboratory or in the surgical operating rooms. Results. A total of 366 procedures were performed, which included: 110 tunneled cuffed catheter (TCC) placements, 157 temporary dual lumen catheters, 36 TCC removals, 30 fistulograms, 24 thrombectomy-/angioplasty, 1 stent placement, 3 Tenckhoff catheter placements, 3 central venograms, and 2 accessory vein ligations. Bleeding from the exit site of a TCC in one patient was the only complication encountered. Conclusion. Interventional nephrology experience at OBVAMC has been very encouraging and has succeeded in providing optimal care to the veterans. Interventional nephrology programs can be developed in any tertiary care hospital.