PERCUTANEUS TRANSHEPATIC VENOUS ACCESS FOR HEMODIALYSIS: A SINGLE-CENTER EXPERIENCE

Introduction:

Central venous catheters (CVC) may be the only option for performing hemodialysis in many patients, either due to the need for urgent dialysis or because they are unable to have an arteriovenous fistula created. However, the exhaustion of traditional sites for its placement is a serious problem, requiring the selection of alternative sites for vascular access placement.

Methods:

We conducted a retrospective study at Pro-Rim Foundation (January 2017 - February 2024), in Joinville - SC, Brazil, on patients with transhepatic CVC, analyzing their clinical records for demographics, comorbidities, CVC details, dialysis adequacy, and outcomes. Transhepatic catheters were inserted using ultrasound and fluoroscopy in patients unable to establish conventional venous access or arteriovenous fistulas.

Results:

Twenty-four long-term transhepatic CVC (As seen below, pictures 1 and 2 ) were inserted in 12 patients at our center, of which 58.3% were male, with a mean age of 55.9 years. Diabetic kidney disease was the leading cause of end-stage renal disease (50. Fourteen were new catheter insertions and 10 were replacements. The procedures achieved a 100% technical success rate, with no complications within the first 24 hours. Over 3615 catheter-days, early complications included five catheter thromboses and one infection, while late complications involved six thromboses and two infections. The thrombosis rate was 0.30 per 100 catheter-days, and the infection rate was 0.08 per 100 catheter-days. The mean dialysis dose (assessed by eKt/V) observed with these transhepatic CVC was 1.29 (minimum 0.80; maximum 1.77). Seven patients died during follow-up, with only one death related to vascular access complications. The mean primary and secondary catheter’s patency times were 162.9 days (minimum 15; maximum 690 days) and 204.0 days (minimum 14; maximum 601 days), respectively.

Picture 1 - transhepatic catheter image - coronal plane 

Picture 2 - transhepatic catheter image - sagital plane 

Conclusions:

This study supports the viability of transhepatic CVC as an alternative access route in complex HD patients. Our high rate of catheter thrombosis was influenced by one patient with multiple episodes of catheter thrombosis. In conclusion, our results support the use of transhepatic CVC as a rescue access in patients with exhaustion of other traditional access locations. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.