Inferior Vena Cava Placement of a Transhepatic Tunneled Dialysis Catheter in a Patient with Atypical Hepatic Venous Anatomy: A Case Report.

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.