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The increase in patients with chronic kidney disease with a hemodialysis requirement is growing. As is known, the success of an adequate treatment, among other things, is determined by a vascular access that provides adequate flows.
Those patients who cannot create arteriovenous fistulas, will switch to a tunneled catheter as an alternative. Unfortunately, as part of the potential complications, the requirement for migration to other implantation sites derived from infections, thrombosis or stenosis of the vessel, carries a risk of developing vascular exhaustion. This is where implantation in unusual sites is necessary to continue with hemodialysis treatment.
A potentially reproducible alternative with relatively low risks is transhepatic implantation, which under ultrasonographic and fluoroscopy guidance, can have a high success rate.
We present the following three cases, in which, due to vascular exhaustion, and the need to continue treatment through hemodialysis, we opted for the placement of a transhepatic tunneled catheter, which were successfully implanted.
In these three cases, two were implanted at the level of the middle hepatic vein and one through the right hepatic vein. The complications presented were 1 patient with bleeding that only required compression measures, and two cases with mild pain that was easily managed with conventional analgesics.
The three cases were discharged withing 48 hours without incidents. So far the three cases continue with functional access, the longest time is 2.2 years.
Therefore, we confirmed the transhepatic route as a rescue measure for the implantation of a tunneled catheter.