Displacement of the inferior vena cava as a factor limiting catheter performance in long-term hemodialysis patients

Area of Science:

• Nephrology
• Vascular Access Surgery

Background:

• Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder leading to kidney failure.
• Long-term hemodialysis necessitates reliable vascular access, often challenging in ADPKD patients.
• Arteriovenous fistula (AVF) options were exhausted in this patient with a history of access failure.

Observation:

• An acquired anatomical abnormality, specifically an enlarged right kidney displacing the inferior vena cava, obstructed standard femoral catheter placement.
• Phlebography confirmed the venous displacement, posing a significant challenge for adequate hemodialysis blood flow.
• Previous attempts with standard tunnelled femoral catheters were unsuccessful due to this anomaly.

Findings:

• Successful and efficient hemodialysis was achieved using a 53 cm long cuffed catheter placed in the left femoral vein.
• This customized approach overcame the anatomical obstruction caused by the enlarged polycystic kidney.
• Venography proved essential in diagnosing the anomaly and guiding the appropriate catheter selection and placement.

Implications:

• Venography is a mandatory pre-procedural investigation for patients with a history of vascular access failure, particularly those with suspected anatomical abnormalities.
• This case highlights the importance of individualized vascular access strategies in complex hemodialysis patients.
• Performing venography can prevent costly and ineffective interventions, optimizing patient care and resource utilization.