Case report, case study
UNCONVENTIONAL HEMODIALYSIS ACCESS: PERCUTANEOUS TRANSHEPATIC VENOUS ACCESS AS A LIFESAVING OPTION - A SINGLE-CENTER EXPERIENCE AND LITERATURE REVIEW
BRANISLAV ČINGEL
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia
IVAN MARGETA
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia
KARLO KURTOV
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia
*
LADA ZIBAR
orcid.org/0000-0002-5454-2353
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
ŽELJKA JUREKOVIĆ
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia
SNJEŽANA ŠULC
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia
BOJANA ŠIMUNOV
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia
BOJANA MAKSIMOVIĆ
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia
KSENIJA VUČUR ŠIMIĆ
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia
IVA CANJUGA SEVER
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia
MARIO LAGANOVIĆ
; Department of Nephrology, Clinical Hospital Merkur, Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia
* Corresponding author.
Abstract
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.
Keywords
hemodialysis; renal replacement therapy; transhepatic venous access; tunneled dialysis catheter; vascular access
Hrčak ID:
331224
URI
Publication date:
16.5.2025.
Visits: 305 *