Percutaneous transhepatic venous access for hemodialysis: a single-center experience with a rescue access

Central venous catheters (CVC) are often the only option for hemodialysis, particularly when arteriovenous fistulas cannot be created or in urgent situations. However, the exhaustion of traditional access sites necessitates alternative approaches. This study aims to describe our center's experience with transhepatic venous access for hemodialysis, focusing on infection rates, catheter patency, and dialysis adequacy, to evaluate the feasibility of this option in patients with limited vascular access options.

We conducted a retrospective study at Pro-Rim Foundation (January 2017 - February 2024) on patients with transhepatic CVC. Clinical records were reviewed for demographics, comorbidities, CVC details, dialysis adequacy, and outcomes.

A total of 24 longterm transhepatic CVCs were placed in 12 patients (58.3% male, mean age 55.9 years). The technical success rate was 100%, with no complications within 24 hours. Over 3615 catheter-days, thrombosis occurred at a rate of 0.30 per 100 catheterdays, and infection occurred at 0.08 per 100 catheter-days. The mean dialysis dose (eKt/V) was 1.29. Seven patients died during follow-up, with only one death related to vascular access complications. The mean primary and secondary catheter patency times were 162.9 and 204.0 days, respectively.

Our study supports transhepatic hemodialysis catheters as a viable option for patients with no other access options, showing good long-term functionality, low infection rates, and reasonable dialysis adequacy. Thrombosis remains a significant challenge, necessitating better maintenance, monitoring, and further research to improve outcomes.