Relato de caso: implante transparietohepático de cateter de longa permanência para diálise

Abstract

Transhepatic insertion of long-term dialysis catheter is an exception procedure used to obtain access in patients with central vein occlusion of lower and upper limbs. We report on a case of a young patient with history of dialysis for 15 years, who was submitted to an unsuccessful renal transplantation. This patient was in dialytic emergency and had confirmed occlusion of upper limb central veins and iliac veins. Transhepatic insertion of a long-term catheter was performed under general anesthesia. The catheter tip was placed at the level of the right atrium. Dialysis was satisfactorily performed on the same day.Keywords: Transhepatic insertion, hemodialysis, access. RESUMOO implante transhepático de cateteres de diálise de longa permanência é um procedimento de exceção, utilizado para obter um acesso em pacientes com oclusão de veias centrais de membros superiores e inferiores. O caso descrito relata um paciente jovem, com história de 15 anos de diálise, que foi submetido no passado a um transplante renal sem sucesso. Esse paciente encontrava-se em urgência dialítica e oclusão comprovada de veias centrais de membros superiores e de veias ilíacas. Foi realizado o implante do cateter de longa permanência pelo acesso transparietohepático sob anestesia geral. A ponta do cateter foi posicionada ao nível do átrio direito. A diálise foi realizada satisfatoriamente no mesmo dia.Palavras-chave: Implante transhepático, hemodiálise, acesso.

Acesso venoso trans-hepático percutâneo para hemodiálise: uma alternativa para pacientes portadores de insuficiência renal crônica

“…After exhausting all possibilities of venous access in the jugular, subclavian and femoral veins, preferentially in this order, the next access to be explored is the one agreed between the medical team and the patients and their relatives. The long-term percutaneous transhepatic catheter insertion has been described as an exception approach for hemodialysis in patients who do not have any other conventional access site available 1,3,5,10,11 . It is believed that the demand for alternative venous accesses will increase according to the increasing number of patients in need of hemodialysis.…”

“…The central venous access chosen for long-term catheters is the internal jugular vein due to its technical easiness, besides the fact that it presents lower rates of complications [4][5][6][7][8] . However, it is known that, due to multiple catheter exchanges and manipulations, these veins may occlude.…”

“…However, it is known that, due to multiple catheter exchanges and manipulations, these veins may occlude. When it is not possible to use the internal jugular vein, other accesses may be explored, such as the subclavian and femoral veins and the inferior vena cava via translumbar or transhepatic approaches 1,3,5,[9][10][11][12] .…”

“…The percutaneous transhepatic access was initially described for the administration of parenteral nutrition 9 , but in 1994 Po et al reported a case in which this same access was used for hemodialysis 14 . Since then, many descriptions of this technique with this objective have been found in the literature (case reports and small case series) as an option for patients with no other available deep venous access 1,3,5,10,11 . This is a feasible procedure which presents rates of complication and infection similar to those of usual venous approaches, besides demonstrating long-lasting patency.…”

Acesso vascular para hemodialise: o que ha de novo?

“…Here the puncture is made with a Chiba needle through the right tenth intercostal space in a postero-superior direction and the hepatic vein is located using fluoroscopy. A guide-wire is then used to direct the catheter along the suprahepatic vein to the right atrium 18,19 .…”