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Right- Versus Left-Sided Approach for Transhepatic Tunneled Catheter Placement: Is There a Difference?
Omer F Nas1, Selman Candan2, Muhammed F Oztepe2
1Department of Radiology, Bursa Uludag University School of Medicine, 16059, Bursa, Turkey. omerfatihnas@gmail.com.
Insights
Right- and left-sided transhepatic tunneled catheterization show similar safety and efficacy. Physician preference can guide the choice of approach for chronic renal insufficiency patients.
Area of Science:
- Interventional Radiology
- Nephrology
- Vascular Access
Background:
- Transhepatic tunneled catheterization is crucial for patients with chronic renal insufficiency and failed central venous access.
- Evaluating the comparative outcomes of right- versus left-sided approaches is essential for optimizing patient care.
Purpose of the Study:
- To compare technical difficulties, complications, long-term efficacy, and risks of right-sided versus left-sided transhepatic tunneled catheterization.
- To identify factors influencing functional catheter duration.
Main Methods:
- Retrospective analysis of 83 transhepatic tunneled catheter placements (May 2012-November 2019).
- Comparison of complication rates between right- and left-sided approaches using statistical tests.
- Cox regression analyses to assess predictors of functional catheter days.
Main Results:
- Median functional catheter duration was 28 days (right) vs. 55.5 days (left).
- Complication rates were similar between both access sides.
- Gender was significant in univariate analysis, but not in multivariate analysis for functional catheter days.
Conclusions:
- Both right- and left-sided transhepatic tunneled catheterization approaches offer comparable safety and efficacy.
- The choice of access side can be based on physician preference.
Objective:
We aimed to compare the technical difficulties, complications, long-term efficacy, and risks between right- and left-sided approach transhepatic tunneled catheterization.
Methods:
We retrospectively evaluated transhepatic tunneled catheter placement cases in our institution between May 2012 and November 2019. Demographic and procedural parameters were recorded. Statistical tests were used to compare the complication rates of right- and left-sided approach. Furthermore, Cox regression analyses were used to investigate the relationship between functional catheter days and included parameters.
Results:
A total of 83 procedures were performed in 46 patients, with a female to male ratio of 1.88 and a mean age of 55.5 ± 18.2 years. Indication for catheter placement was chronic renal insufficiency and loss of central venous access through traditional routes in all cases. Median functional catheter durations were 28 days (1-382) and 55.5 days (1-780) for right-sided and left-sided access, respectively. Complication rates were similar for both sides. There was no difference between primary and revision procedures in terms of safety and efficacy outcomes. In univariate Cox regression analysis, gender was the only variable which was found to be statistically significant (HR = 2.014 (1.004-4.038)) for functional catheter days. In multivariate Cox regression model, gender and access side were included which failed to reach statistical significance.
Conclusions:
In our study, both right- and left-sided approaches provided similar safety and efficacy outcomes, suggesting that both techniques can be employed based on physician's preference.
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