Transhepatic venous catheters for hemodialysis

PurposeTo describe our experience with the technique of transhepatic venous access for hemodialysis and to evaluate its functionality and complications.Patients and methodsFrom March 2012 till October 2012, 23 patients with age ranging from 12 to 71 years old having end-stage renal disease (ESRD) were included in our study and were subjected to transhepatic venous catheter insertion. In 21 patients there were not any remaining patent peripheral venous accesses. In 2 patients there were only a last one venous access needed to be preserved. Thus, it was decided to make THVA. In all the 23 patients the indication was palliative due to inoperability which was because of inability to insert an arterio-venous graft or making another arterio-venous fistula. Complications were evaluated and calculated in terms of number of procedures, infection, dislodgement and outcome; in terms of disfunctionality of the catheter.Follow-up was performed by monitoring the catheter dialysis rate in each session, abdominal ultrasonography, fluoroscopy or CT. Mean survival time and median survival time from the start of treatment were calculated using Kaplan–Meier method.ResultsTwenty-three patients required a single transhepatic access procedure. Because of catheter dislodgment, two patients required a second access placement procedure, which resulted in a total of 25 separate transhepatic access sites in 23 patients. Technical success was achieved in 22 procedures. Functionality success was achieved in 20 patients. Functionality failure occurred in 3 patients.The trans-hepatic catheters stayed in place between 90 and 300 days. Complications occurred in 14 patients.ConclusionBased on our findings, transhepatic hemodialysis catheters have proven to achieve good long-term functionality. A high level of maintenance is required to preserve patency, although this approach provides remarkably durable access for patients who have otherwise exhausted access options.