Abaza Masa, Almehmi Sloan E, Almehmi Ammar
Department of Biology, University of Alaska Anchorage, Anchorage, AK, USA.
Department of Biology, University of Alabama at Birmingham, Birmingham, AL, USA.
Clin Med Insights Case Rep. 2021 Dec 21;14:11795476211066354. doi: 10.1177/11795476211066354. eCollection 2021.
Vascular access is the Achilles tendon of hemodialysis and is considered the lifeline for patients with end stage renal disease. Arteriovenous fistulas and grafts are the preferred traditional access for performing dialysis therapy. However, some patients exhaust the traditional routes of dialysis vascular access for different reasons. In search for alternatives, other unusual vascular routes have been explored, such as transhepatic and translumbar approaches, as the last resort to preserve life in this unfortunate population. Here, we present the unusual case of a 66-year-old female who ran out of the traditional vascular access options and became catheter dependent via the right femoral vein. However, due to recurrent femoral catheter infections, extensive skin calciphylactic lesions and her body habitus, other routes were explored and the decision was to use the transhepatic approach. Traditionally, the right and middle hepatic veins are used to insert these catheters. However, the use of the left hepatic vein was not reported in the literature. Hence, in order to avoid the skin lesions seen in our patient, the dialysis catheter was inserted using the left hepatic vein. Overall, this case highlights the challenges of securing a reliable vascular access to perform dialysis therapy and brings attention to other vascular dialysis routes in certain clinical scenarios.
血管通路是血液透析的关键所在，被视为终末期肾病患者的生命线。动静脉内瘘和移植物是进行透析治疗的首选传统通路。然而，一些患者由于不同原因用尽了传统的透析血管通路途径。为寻找替代方法，人们探索了其他非常规的血管途径，如经肝和经腰途径，作为挽救这一不幸群体生命的最后手段。在此，我们介绍一例不同寻常的病例，一名66岁女性用尽了传统血管通路选择，通过右股静脉依赖导管进行透析。然而，由于反复出现股静脉导管感染、广泛的皮肤钙化防御性病变以及她的身体状况，人们探索了其他途径，并决定采用经肝途径。传统上，使用右肝静脉和中肝静脉插入这些导管。然而，文献中未报道使用左肝静脉的情况。因此，为避免在我们的患者中出现皮肤病变，透析导管通过左肝静脉插入。总体而言，该病例凸显了确保可靠血管通路以进行透析治疗的挑战，并在某些临床情况下引起了对其他血管透析途径的关注。
