Safety and functionality of transhepatic hemodialysis catheters in chronic hemodialysis patients

Abstract

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...

Percutaneous transhepatic hemodialysis catheters in chronic hemodialysis patients: technique, functional outcome, and complications from a large population study

“…In our study, the most common complication that led to catheter dysfunction is catheter thrombosis (0.18 per 100 catheter-days). This rate is matching with Younes et al [7] and lower than the rate of Stavropoulos et al [5], Smith et al [6] and Şanal et al [3]. Stavropoulos et al [5].…”

“…Transhepatic catheterization was first described by Po et al in 1994 [4] on an adult patient with end-stage lupus nephritis who had no alternative for vascular access and failed peritoneal dialysis; it was technically successful with no bleeding or thrombotic complications, and the patient underwent dialysis from that vascular access for a year [4]. This study was followed by other studies done on limited number of patients with limited data on the long-term effectiveness [3][4][5][6][7]. So we performed our study on 296 patients who had thrombosed conventional vascular accesses as well as non-functioning or thrombosed AV fistulas or grafts.…”

“…The conventional sites for placement of the dialysis catheters are internal jugular, subclavian, and femoral veins. In patients with ESRD, multiple interventions and long-term catheterizations at such conventional sites lead to thrombosis, stenosis, and occlusions of the veins, so alternative routes are considered as life-saving ways in such cases [3].…”

“…Transhepatic permcath is one of the new and up-todate methods for inferior vena cava (IVC) and right atrium catheterization. It was first described by Po et al in 1994 [4] in one case then was further scrutinized in three retrospective studies comprising 12,16,22, and 38 adult patients in the following years [3,[5][6][7]. So there is only limited experience in using this method with small number of patients involved in different studies.…”

Difficult vascular access in a patient on chronic hemodialysis

“…evaluated 38 patients with transhepatic tunneled hemodialysis catheters and evaluated the patency using Kaplan–Meier analysis and found it to be a safe and functional alternative route in patients who do not have an accessible central venous route. [ 4 ]…”