Dialysis Access Program, Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, 6550 Fannin Street, Houston, TX 77030, USA.
J Vasc Interv Radiol. 2011 Feb;22(2):183-91. doi: 10.1016/j.jvir.2010.10.011.
To describe the authors' experience with transhepatic placement of catheters, highlighting early and late complications, and to determine if this procedure is a viable option in patients in whom central venous occlusions present a significant challenge.
The records of all the patients who underwent placement of transhepatic hemodialysis from January 2003 to October 2008 were retrospectively reviewed. Selected patients were dialysis-dependent, having undergone multiple access procedures and revisions. Kaplan-Meier analysis was used to estimate primary and secondary patency.
Twenty-two patients (mean age 42 years, range 22-70 years, 59% women) underwent a total of 127 transhepatic catheter placements at 24 transhepatic access sites; technical success was achieved in all cases. There were no hepatic injuries (bleeding or fistula formation). There were 105 exchanges in 14 patients, with a mean of 7.5 exchanges, a median of 5 exchanges (range 1-18 exchanges), and a catheter migration rate of 0.39 per 100 catheter-days. The sepsis rate was 0.22 per 100 catheter-days, and the catheter thrombosis rate was 0.18 per 100 catheter-days. The mean cumulative catheter duration in situ was 506.2 days, and the mean time catheter in situ was 87.7 days. The mean total access site interval was 1,046 catheter-days (range of 423-1,413 catheter-days).
Transhepatic hemodialysis catheter placement is associated with low rates of morbidity. In this series, transhepatic catheters provided the possibility of long-term functionality, despite associated high rates of catheter-related maintenance, provides a potentially viable access for patients with exhausted access options.
描述作者在经肝穿刺置管方面的经验，重点介绍早期和晚期并发症，并确定在存在中心静脉阻塞的患者中，该操作是否为可行的选择。
回顾性分析 2003 年 1 月至 2008 年 10 月期间所有接受经肝血液透析置管术的患者记录。选择的患者为依赖透析的患者，已经进行了多次通路手术和修正。采用 Kaplan-Meier 分析估计主要和次要通畅率。
22 名患者（平均年龄 42 岁，范围 22-70 岁，59%为女性）在 24 个经肝穿刺部位共进行了 127 次经肝导管放置；所有病例均获得技术成功。无肝损伤（出血或瘘管形成）。14 名患者中有 105 次交换，平均 7.5 次交换，中位数为 5 次交换（范围 1-18 次交换），导管迁移率为 0.39/100 导管日。感染率为 0.22/100 导管日，导管血栓形成率为 0.18/100 导管日。导管在位平均累计时间为 506.2 天，导管在位平均时间为 87.7 天。总通路部位间隔的平均时间为 1046 导管日（范围 423-1413 导管日）。
经肝血液透析导管置管术并发症发生率低。在本系列中，尽管与导管相关的维护率较高，但经肝导管提供了长期功能的可能性，为用尽通路选择的患者提供了一种潜在可行的通路。
