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Published on: September 20, 2020
Transhepatic vascular access for diagnostic and interventional procedures: techniques, outcome, and complications
1Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA. mebeid@ped.umsmed.edu
Insights
The transhepatic approach offers a vital alternative for cardiac catheterization when femoral veins are unusable. This method provides access to cardiac areas, even when other routes are unsuitable.
Area of Science:
- Cardiology
- Interventional Radiology
Background:
- Femoral vein occlusion from prior cardiac catheterization limits venous access.
- Alternative routes like internal jugular or sub-clavian may be contraindicated or suboptimal.
- Superior vena cava interruption poses challenges for central venous access.
Purpose of the Study:
- To evaluate the transhepatic approach as an alternative route for cardiac catheterization and interventions.
- To discuss the indications, technical aspects, and potential complications of the transhepatic route.
- To highlight the utility of the transhepatic approach even with patent femoral veins.
Main Methods:
- Review of indications for transhepatic cardiac catheterization.
- Detailed description of the technical procedure for transhepatic access.
- Analysis of potential complications associated with the transhepatic route.
Main Results:
- The transhepatic approach provides a viable alternative when femoral access is compromised.
- It allows access to specific cardiac regions not easily reached by other methods.
- The procedure's feasibility and safety profile are discussed in relation to patient anatomy and planned interventions.
Conclusions:
- The transhepatic route is a crucial alternative for cardiac catheterization and interventions.
- It is indicated when femoral, jugular, or sub-clavian approaches are not feasible or optimal.
- Understanding its indications, techniques, and complications is essential for interventional cardiologists.
Abstract:
Early or multiple cardiac catheterizations may result in occlusion of the femoral veins prohibiting their use. The internal jugular or sub-clavian approach may be an appropriate alternative. However, these approaches may not be suitable in patients with surgical interruption of the superior vena cava. In other patients, they may not allow easy access to certain areas of the heart. The transhepatic approach is an important alternative route for performing cardiac catheterization and interventions. Depending on the planned procedure, it may be the preferred route to perform the cardiac catheterization even in the presence of patent femoral veins. The indications, technical details and potential complications of this approach are discussed.
