Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642, USA.
J Vasc Interv Radiol. 2009 Dec;20(12):1625-31. doi: 10.1016/j.jvir.2009.08.022.
To evaluate the feasibility of establishing a U-shaped inferior vena cava (IVC) catheter entirely from a transhepatic approach and to determine the catheter caliber that would provide adequate flow for hemodialysis.
Three pigs (weight, 45-50 kg) were used. A peripheral right hepatic vein was accessed transhepatically by using a 22-gauge needle, and a 0.018-inch wire was passed into the hepatic veins and IVC. An accessory right hepatic vein was accessed from the IVC. A snare was deployed in the accessory vein and used as a target for a second transhepatic 22-gauge needle pass. A wire was snared through the second transhepatic tract, around into the IVC, and through the first transhepatic tract. The 0.018-inch wire was upsized to a 0.035-inch platform. Measurements where made to tailor a U-shaped catheter from simple 10.2- and 12-F tubes by cutting them longitudinally (single long side hole) along the length of the IVC segment. The U-shaped hemodialysis catheter was placed over the wire and positioned so that the catheter opening lay in the IVC. With use of a dialysis machine, pressures and flow tolerance at set flow rates (100, 200, 300, 350, and 400 mL/min) were tested.
All pigs underwent and survived successful catheter placements. All 10.2- and 12-F catheters tolerated flow rates up to 350 and 400 mL/min, respectively.
Establishing a U-shaped hemodialysis catheter with an entirely transhepatic approach is technically feasible. The 10.2-F U-shaped dialysis catheters provided a flow rate (>350 mL/min) that is appropriate for hemodialysis in human clinical settings.
评估经肝途径完全建立 U 形下腔静脉（IVC）导管的可行性，并确定为血液透析提供足够流量的导管口径。
使用 3 头猪（体重 45-50kg）。经皮肝穿刺右肝静脉，用 22 号针将 0.018 英寸导丝插入肝静脉和 IVC。经 IVC 进入辅助右肝静脉。在辅助静脉中部署套圈，用作第二根经皮肝 22 号针道的靶标。导丝穿过第二根经皮肝穿刺道，套圈，穿过第一根经皮肝穿刺道。将 0.018 英寸导丝更换为 0.035 英寸的平台。通过沿 IVC 段的长度将简单的 10.2-和 12-F 管纵向切割（单个长侧孔）来制作 U 形导管。将 U 形血液透析导管套在导丝上，并将其定位，使导管开口位于 IVC 中。使用透析机，在设定流速（100、200、300、350 和 400mL/min）下测试压力和流量耐受度。
所有猪均成功进行并耐受了导管放置。所有 10.2-F 和 12-F 导管分别耐受高达 350 和 400mL/min 的流速。
经完全经肝途径建立 U 形血液透析导管在技术上是可行的。10.2-F U 形透析导管提供的流速（>350mL/min）适用于人体临床环境中的血液透析。
