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Computed Tomography (CT)-Navigated Translumbar Hemodialysis Catheters: A 10-Year Single-Center Experience
Tomas Jonszta1,2, Daniel Czerny1,2, Vaclav Prochazka1,2
1Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic.
Insights
Translumbar hemodialysis catheters (TLC) offer a safe and effective dialysis access option for patients with exhausted central venous sites. This study shows TLCs have comparable long-term patency and lower complication rates than traditional internal jugular vein catheters.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Dialysis patients often face challenges with traditional central venous access sites.
- The translumbar hemodialysis catheter (TLC) presents a viable alternative for establishing dialysis access when usual sites are unavailable.
Purpose of the Study:
- To evaluate the technical success, complication rates, and long-term patency of translumbar hemodialysis catheters (TLC).
- To compare TLC outcomes with those of internal jugular vein catheters (JVC) in patients requiring hemodialysis access.
Main Methods:
- A retrospective study comparing 39 TLC implantations with 196 internal jugular vein catheter (JVC) procedures.
- TLC implantation involved computed tomography (CT)-navigated translumbar inferior vena cava cannulation and fluoroscopy-guided catheter placement.
- Outcomes assessed included technical success, periprocedural complications, long-term patency, and infection/patency-related complication rates per 1000 catheter-days.
Main Results:
- Technical success rates were high for both groups (97.4% for TLC, 98.6% for JVC), with minor complication rates of 10.3% (TLC) and 4.2% (JVC).
- Primary-assisted patency at 1 and 3 years was comparable between TLC (88.7%, 72.0%) and JVC (81.6%, 67.0%) groups, with no statistically significant difference.
- The TLC group demonstrated significantly lower incidence rates of infection-related (0.15 vs 0.33 per 1000 catheter-days) and patency-related complications (0.11 vs 0.25 per 1000 catheter-days) compared to the JVC group.
Conclusions:
- CT-guided translumbar hemodialysis catheter (TLC) implantation is an effective method for creating dialysis access.
- TLCs provide satisfactory long-term patency and a low complication rate, making them a valuable option for patients with exhausted usual venous access sites.
Abstract:
BACKGROUND In dialysis patients with exhausted usual central venous access sites, the translumbar hemodialysis catheter (TLC) provides a viable option for dialysis access. The technical success of catheter insertion, associated complications, and long-term patency of TLC were evaluated in this study. MATERIAL AND METHODS This retrospective study included 37 patients with occluded central thoracic veins in whom 39 TLC implantation procedures were performed and 196 patients with internal jugular vein hemodialysis catheters (JVC). TLC implantation was performed as a hybrid procedure with computed tomography (CT)-navigated translumbar inferior vena cava cannulation and subsequent fluoroscopy-guided hemodialysis catheter placement. RESULTS The rates of technical success of the implantations and minor periprocedural complications were 97.4% and 10.3% in the TLC group and 98.6% and 4.2% in the JVC group, respectively. The median follow-up in the TLC and JVC groups was 673 days and 310 days, respectively. The primary-assisted patency at the 1-year and 3-year follow-up was 88.7% and 72.0% in the TLC group and 81.6% and 67.0% in the JVC group, respectively, with no statistically significant difference between the 2 groups. The incidence rate of infection-related and patency-related complications calculated for 1000 catheter-days was 0.15 and 0.11 in the TLC group and 0.33 and 0.25 in the JVC group, respectively. CONCLUSIONS The CT-guided implantation of the TLC is a useful option to create dialysis access with a low complication rate and satisfactory long-term patency in patients without usual venous access.
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