[Alternate hemodialysis catheterization access in patients with occluded peripheral venous access sites].

PURPOSE

The goal of this study was to evaluate translumbar and transhepatic placement of hemodialysis (HD) catheters for patients with occlusion of the veins that are commonly used for hemodialysis access.

METHOD

Over a 12-month period three translumbar and one transhepatic hemodialysis catheters were placed in 4 patients suffering from end-stage renal disease, who had thrombosis of the upper and lower extremity veins as well as the jugular veins. The percutaneous access was performed under fluoroscopic guidance. After successful passage of a guidewire into the right atrium and creation of a subcutaneous tunnel at the skin entry site, all patients received a 14 F double-lumen catheter that was placed with its tip in the right atrium.

RESULTS

Percutaneous translumbar and transhepatic placement of the HD catheters was successful in all patients. No intervention-associated complications were observed. Hemodialysis could be started 1 to 20 hours after initial catheter placement in all patients. During an observation period of 3 to 7 months, 3 patients underwent hemodialysis without any complications. In one patient, an occlusion of an translumbar HD catheter was observed after 5 months. This catheter could be temporarily recanalized using rTPA injection and was then exchanged after 6 months.

CONCLUSION

Transhepatic and translumbar placement of HD catheters is a safe and viable alternative for patients who have exhausted conventional venous access sites.