Studija slučaja
UNCONVENTIONAL HEMODIALYSIS ACCESS: PERCUTANEOUS TRANSHEPATIC VENOUS ACCESS AS A LIFESAVING OPTION - A SINGLE-CENTER EXPERIENCE AND LITERATURE REVIEW
BRANISLAV ČINGEL
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska
IVAN MARGETA
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska
KARLO KURTOV
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska
*
LADA ZIBAR
orcid.org/0000-0002-5454-2353
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska; Medicinski fakultet, Sveučilište Josipa Jurja Strossmayera u Osijeku, Osijek, Hrvatska
ŽELJKA JUREKOVIĆ
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska
SNJEŽANA ŠULC
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska
BOJANA ŠIMUNOV
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska; Medicinski fakultet, Sveučilište u Zagrebu, Zagreb, Hrvatska
BOJANA MAKSIMOVIĆ
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska; Medicinski fakultet, Sveučilište u Zagrebu, Zagreb, Hrvatska
KSENIJA VUČUR ŠIMIĆ
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska
IVA CANJUGA SEVER
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska
MARIO LAGANOVIĆ
; Zavod za nefrologiju, Klinička bolnica Merkur, Zagreb, Hrvatska; Medicinski fakultet, Sveučilište u Zagrebu, Zagreb, Hrvatska
* Dopisni autor.
Sažetak
Introduction: Hemodialysis catheters and arteriovenous fistulas are currently considered the gold standard of dialysis vascular access. Primary venous accesses are the internal jugular, subclavian, and femoral veins. Due to the nature of chronic kidney disease itself and its impact on the vascular system, frequent thrombotic occlusions of the vascular access occur, rendering it dysfunctional and sometimes leading to the lack of any possible conventional venous access for renal replacement therapy. Published data showed the noninferiority of nonconventional (transhepatic, translumbar) routes compared with the conventional ones regarding infectious complications. However, the long-term viability of these accesses remains questionable, while there is a high incidence of postprocedural access dysfunction.
Case reports: We present two cases from June 2023, of patients in need of nonconventional vascular access for hemodialysis as a vital indication, in which a catheter was placed via the transhepatic route into the inferior caval vein with the tip positioned in the right atrium. Conventional venous access routes were ruled out in both patients after a detailed radiologic workup showed inadequate flow and severe occlusions. The skin was punctured in the anterior axillary line and a Hickman-type (double luminal) catheter was inserted in the right hepatic vein with ultrasound guidance using the Seldinger technique. It was passed through the inferior caval vein with the tip positioned in the right atrium. After that, a tunnel was created on the anterior abdominal wall. The placed catheters provided sufficient flow for hemodialysis procedures in both patients. The first presented case provided the patient with adequate renal replacement therapy sessions until his death that ensued after postprocedural complications of cardiac surgery. In the second case, the access was a successful salvage bridging method after previous catheter dysfunction until the patient was conditioned for long-term automated peritoneal dialysis.
Conclusion: The two presented cases show successful transhepatic dialysis catheter insertion as a method of vascular access
in vital indications.
Ključne riječi
hemodialysis; renal replacement therapy; transhepatic venous access; tunneled dialysis catheter; vascular access
Hrčak ID:
331224
URI
Datum izdavanja:
16.5.2025.
Posjeta: 305 *