TRANSHEPATIC DIALYSIS CATHETER: THE LAST LIFELINE IN A PATIENT WITH VASCULAR ACCESS EXHAUSTION

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Abstract Title *

TRANSHEPATIC DIALYSIS CATHETER: THE LAST LIFELINE IN A PATIENT WITH VASCULAR ACCESS EXHAUSTION

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Co-author 1

Carlos Eduardo Ortiz Castañeda otizmedico@gmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico *

Co-author 2

Maria Fernanda Saavedra Velez fersaavedravz@gmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 3

Miriam Gabriela Nava Vargas mgnava93@gmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 4

Rodrigo Quintero Solis rodrigoquinterosolis@gmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 5

Jose Carlos Fernandez Huerta medicoudg@gmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 6

Blanca Alicia Ornelas Barajas blanca_aob@hotmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 7

Citlally Montserrat Villagomez Garcia montse031095@gmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 8

Alejandra Sanchez Hernandez saher.allen@gmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 9

Jesus Noe Bailon Contreras noebailoncontreras@gmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 10

Miguel Angel Franco Barrera fraba_95@hotmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 11

Edna Teresa Mendoza Villalobos ednamendozav@gmai.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 12

Juan Carlos Anaya Zamora jcaz1907@gmail.com Institute of Security and Social Services for State Workers Nephrology Guadalajara Mexico -

Co-author 13

Co-author 14

Co-author 15

Introduction

Vascular access exhaustion is a critical and often terminal complication in long-term hemodialysis (HD) patients. Once conventional venous sites are unusable, the interruption of renal replacement therapy (RRT) becomes life-threatening. Transhepatic catheterization represents an exceptional but potentially lifesaving option in these scenarios.

Methods

We report a 66-year-old man with diabetes mellitus, hypertension, and end-stage kidney disease (ESKD) on HD for six years, presenting with complete vascular access failure. Previous right and left jugular, subclavian, and femoral catheters were removed due to infections and thrombosis. After temporary peritoneal dialysis, abdominal hernia repair contraindicated its continuation. With urea 208 mg/dL, creatinine 14.9 mg/dL, and anuria, urgent RRT was mandatory. Imaging revealed occlusion of all major central veins. A tunneled transhepatic catheter was placed under ultrasound and fluoroscopic guidance into the left hepatic vein, using a 14 Fr, 33 cm Palindrome® catheter tunneled caudo-cephalically toward the right atrium.

Results

Immediate flow was achieved without resistance. Contrast confirmed correct positioning from the left hepatic vein to the inferior vena cava and right atrium. The patient tolerated the procedure well and underwent HD the same day without complications. At one-month follow-up, the catheter remained functional, with no signs of infection, migration, or mechanical dysfunction.

Conclusion

This case underscores the role of transhepatic access as a lifesaving intervention in patients with complete vascular exhaustion. When conventional routes are unavailable, this approach allows the continuation of dialysis and survival. Despite potential risks such as bleeding or thrombosis, transhepatic catheterization performed by experienced teams offers a feasible and durable option. Its early consideration in end-stage vascular failure may prevent treatment interruption and avert fatal outcomes.

Kewords