T he main central venous routes used in chronic hemodialysis patients with insufficient arteriovenous (AV) fistulas and graft failure are the jugular, subclavian, and femoral veins. Repeated interventions and chronic thrombosis, stenosis, and occlusions secondary to long-term catheterizations can make the use of these veins impossible over years (1,2). Alternative routes are lifesaving in these cases, and the principle routes are the translumbar inferior vena cava (IVC) and transhepatic veins (2-5).The use of the translumbar route is more widespread, its efficiency and safety are well known, and the experience in using this method has already been reported in the literature (5-8). Hepatic vein and IVC catheterization through the transhepatic route is a comparatively more up-to-date method than the one through the translumbar route, and there is only limited experience in using this method. Its success and complication rates were first described by Po et al. (9) in 1994 in one case, and this method was further scrutinized in three retrospective studies comprising 12, 16, and 22 adult patients in the following years (2-4).The aim of this retrospective study was to investigate the safety and functionality of transhepatic hemodialysis catheters in a series of 38 patients.
Methods
PatientsThe study was approved by the local ethics committee. Thirty-eight transhepatic tunneled hemodialysis catheter implanted patients (mean age 58±11 years; range, 23-80 years;
I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E
PURPOSEWe aimed to investigate the safety and functionality of tunneled transhepatic hemodialysis catheters in chronic hemodialysis patients.
METHODSThirty-eight patients (20 women aged 56±10 years and 18 men aged 61±11 years) with transhepatic tunneled hemodialysis catheters were evaluated. The date of the first transhepatic catheterization, indications, procedure details, functional time periods of catheters, reasons for the removal or revision of catheters, catheter-related complications, and current conditions of patients were retrospectively analyzed.
RESULTSA total of 69 catheters were properly placed in all patients (100% technical success) under imaging guidance during the 91-month follow-up period. The functionality of 35 catheters could not be evaluated: five catheters were removed because of noncomplication related reasons (surgical fistulas were opened in two cases [2/35, 5.7%], transplantation was performed in three cases [3/35, 8.6%]), 18 patients died while their catheters were functional (18/35, 51.4%), and 12 catheters were still functional at the time of the study (12/35, 34.3%). The functionality of catheters was evaluated the remaining 34 catheters that necessitated revision because of complications. Furthermore, only half of the catheters were functional on day 136 when evaluated using Kaplan-Meier analysis. The four main complications were thrombosis (16/34, 47%; complication rate of 0.37 days in 100 catheters), infection (8/34, 23.5%; 0.18 days in 100 catheters), m...
