Translumbar hemodialysis long-term catheters: an alternative for vascular access failure

Abstract

Introduction: Vascular access (VA) in hemodialysis (HD) is essential to end-stage renal disease (ESRD) patients survival. Unfortunately, after some years in HD program, a significant number of patients may develop VA failure for many reasons. In this situation, arterial venous fistula (AVF) confection or catheters placement in traditional vascular sites (jugular, femoral or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheter (TLDC) may be a salvage option. Objectives: To describe placement technic, complications, and patency of 12 TLDC. Methods: A retrospective study was performed to analyze 12 TLDC placement in an angiography suite using fluoroscopic guidance at the University Hospital of the Rio Grande do Norte Federal University from January 2016 to October 2017. The data collected of the total procedures performed consisted of demographic characteristics, success rates, observed complications, patient survival, and catheter patency. Results: All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%. Conclusion: TLDC is an option for patients with VA failure, improving survival and acting as a bridge for renal transplantation.

Using a Catheter for Hemodialysis Placed in the Inferior Vena Cava for the First Time in N. Macedonia - Translumbar Approach

“…Mechanical obstruction is another problem of implantable catheters, and this was presented in a range of 0.08/100 to 0.19/100 catheter day.15,22 Catheter dislodgment is noted to be the leading cause of catheter failure for translumbar catheters, as excess adipose tissue is concentrated in the tunnel area. Also, obesity and the position of catheter insertion are the cause of mechanical complication [23]. A small dislocation of the catheter from the initial position was presented in our patient, which was attributed to obesity.…”

“…Despite the risk of complications, doctors are faced with a decision that has limited success in order to ensure the survival of patients. The literature reports only on small studies and case reports associated with the successful placement and complications of PTCH [9,15,23]. It is the option for doctors that in cases where no other VA alternatives are available, PTCH must be attempted as a routine alternative.…”

Xper computed tomography‐guided translumbar inferior vena cava catheterization for long‐term hemodialysis: A case report and literature review

“…Exhausted vascular access is one of the important reasons for the increased mortality in hemodialysis patients. 11 During long-term hemodialysis, many patients suffered from multiple fistula dysfunction and repeated indwelling central venous catheters, which finally might lead to all the conventional vascular accesses unavailable.…”

“…4,5 Although the patency and complications of TLDC case series are quite variable, the translumbar catheterization directly into IVC does provide a salvage option when traditional vascular sites (internal jugular, external jugular, femoral, or subclavian) are not feasible. [5][6][7][8][9][10][11] Here, we present a case of Xper computed tomography Xiying Bo and Yawei Liu contributed equally to this work.…”

Early complications of translumbar cannulation of the inferior vena cava as a quick, last-chance method of gaining access for hemodialysis. Ten years of experience in one clinical center.

“…All implantation procedures were successful. In the early period after surgery (< 30 days), one complication in the form of severe bleeding and one extubation failure were observed [ 13 ]. Nadolski et al analyzed the impact of body mass index (BMI), among other factors, on the risk of complications occurring during the insertion of a translumbar catheter into the IVC.…”