Vo Hieu M, Syeda Raeeha, Ali Mohammad
Department of Interventional Radiology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA.
Department of Interventional Radiology, Mississippi Baptist Medical Center, Jackson, USA.
Cureus. 2024 Sep 13;16(9):e69365. doi: 10.7759/cureus.69365. eCollection 2024 Sep.
A transhepatic hemodialysis (HD) catheter serves as a final option for obtaining HD vascular access in patients whose conventional access sites, including internal jugular veins, external jugular veins, and femoral veins, are no longer viable. This could be due to intravascular thrombosis or central venous stenosis, among others. The ideal catheter tip position in transhepatic tunneled dialysis catheter is the right atrium for optimal blood flow necessary for dialysis. The report presents a case of a 46-year-old female, in whom the traditional vascular access sites for dialysis were not achievable and, thus, required the use of the hepatic access route. However, her case was further complicated due to the unique hepatic vascular anatomy, causing repeated retraction of the catheter tip from the right atrium to the inferior vena cava (IVC) and hepatic vein. This was circumvented by the atypical placement of the catheter tip down to the suprarenal IVC, deep enough to lodge the catheter in place with adequate flow for successful HD.
经肝血液透析（HD）导管是在包括颈内静脉、颈外静脉和股静脉在内的传统血管通路部位不再可行的患者中获得HD血管通路的最终选择。这可能是由于血管内血栓形成或中心静脉狭窄等原因。经肝隧道式透析导管的理想导管尖端位置是右心房，以实现透析所需的最佳血流。该报告介绍了一名46岁女性的病例，其传统的透析血管通路部位无法实现，因此需要使用肝血管通路。然而，由于独特的肝血管解剖结构，她的病例进一步复杂化，导致导管尖端反复从右心房回缩至下腔静脉（IVC）和肝静脉。通过将导管尖端非典型地放置到肾上腺水平以下的IVC，深度足以将导管固定到位并具有足够的血流以成功进行HD，从而避免了这种情况。
