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Use of unconventional dialysis access in patients with no viable alternative
Gabriel Herscu1, Karen Woo, Fred A Weaver
1Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Insights
Translumbar and transhepatic venous access provides a viable long-term option for hemodialysis in patients with exhausted conventional access. This study examined the safety and efficacy of these alternative routes for catheter-based vascular access.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Patients requiring hemodialysis often face challenges with conventional vascular access, including arteriovenous fistulas, grafts, and traditional catheters.
- Transhepatic and translumbar inferior vena cava catheters serve as alternative access routes when conventional options are exhausted.
Purpose of the Study:
- To evaluate the clinical experience with translumbar and transhepatic approaches for catheter-based hemodialysis access.
- To assess the viability of these methods in patients with no other access site options.
Main Methods:
- Retrospective review of patients undergoing transhepatic or translumbar inferior vena cava catheter placement for hemodialysis between June 2000 and May 2011.
- Data collection included prior access procedures, catheter duration and patency, complications, and mortality.
Main Results:
- Seven patients (4 transhepatic, 3 translumbar) were identified, with a mean age of 44 years.
- Patients had a mean of 14 prior dialysis access procedures.
- The mean service interval for the translumbar/transhepatic access was 380 days, indicating long-term usability.
Conclusions:
- Translumbar and transhepatic venous access are feasible and effective long-term alternatives for catheter-based hemodialysis.
- These routes offer a solution for patients with end-stage renal disease who have exhausted all conventional vascular access options.
Background:
Hemodialysis patients who have exhausted all of the conventionally used veins for vascular access, including arteriovenous fistula, arteriovenous graft, and traditional catheter access sites, present a challenge to the treating physician. Transhepatic and translumbar inferior vena cava catheters have been used in these patients who have no other access site option. The objective of the study was to examine our experience with translumbar and transhepatic approach for catheter-based hemodialysis access in patients who have exhausted all other options.
Methods:
A retrospective review was performed from June 2000 to May 2011 of all patients who underwent transhepatic or translumbar inferior vena cava catheter placement for the purpose of hemodialysis. Data abstracted included previous access procedures, duration of use and patency of dialysis catheters, catheter-related complications, and mortality.
Results:
Seven patients were identified. Four patients underwent transhepatic access and three underwent translumbar access. Five patients were female and two were male. The mean age was 44 years. The etiology of renal failure was diabetes in four patients, congenital hypoplastic kidneys in two patients, and acute glomerulonephritis in one patient. A mean of 14 (range: 11-18) dialysis access procedures were performed before catheter placement by transhepatic/translumbar interventions. The initial device service interval for all patients ranged from 15 to 658 days, with a mean of 295 days and a median of 245 days. Total access site service interval ranged from 15 to 790 days, with a mean of 380 days and a median of 245 days.
Conclusion:
Translumbar and transhepatic venous access is a viable long-term alternative route for catheter-based hemodialysis access in patients who have exhausted conventional options.
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