Medical Clinic III, Department of Nephrology, University Hospital Frankfurt, Frankfurt, Germany.
Blood Purif. 2017;44(3):206-209. doi: 10.1159/000477755. Epub 2017 Jul 1.
In selected cases, cuffed tunneled catheters via the iliac vein are implanted as a last resort access for hemodialysis. To monitor the correct position, sonography of the inferior vena cava (IVC) is sufficient in most cases. Position control using an X-ray of the abdomen is not routinely recommended when femoral catheters are implanted. In this report, we describe the case of a 59-year-old patient on chronic hemodialysis due to granulomatosis with polyangiitis and complex shunt history with multiple shunt occlusions and revisions. The implantation of an iliac-cuffed tunneled catheter led to complications because the catheter was malpositioned into the left ascending lumbar vein (ALV). It is important to be aware of potential incorrect positioning of dialysis catheters into the ALV. Due to the anatomical relation to the IVC, this happens more frequently on the left side than on the right side. In case of doubt, the correct placement of large-bore catheters via iliac access route should be verified by means of appropriate imaging before hemodialysis is performed.
在某些情况下，会通过髂静脉植入带袖口的隧道导管，作为血液透析的最后一种选择。为了监测正确的位置，在大多数情况下，下腔静脉（IVC）的超声检查就足够了。当植入股导管时，不建议常规使用腹部 X 射线进行位置控制。在本报告中，我们描述了一例因肉芽肿性多血管炎而接受慢性血液透析的 59 岁患者，该患者具有复杂的分流史，存在多次分流阻塞和修复。带袖口的隧道导管的植入导致了并发症，因为导管错位进入了左侧升主动脉（ALV）。重要的是要意识到透析导管可能会不正确地定位到 ALV。由于与 IVC 的解剖关系，这种情况在左侧比右侧更常见。如果有疑问，在进行血液透析之前，应通过适当的影像学检查来验证通过髂血管通路植入大口径导管的正确位置。
