Percutaneous transhepatic hemodialysis catheters in chronic hemodialysis patients: technique, functional outcome, and complications from a large population study

Abstract

Background: Chronic renal failure is one of the main health problems in Egypt. Arterio-venous fistulas, grafts, as well as conventional sites for placement of the dialysis catheters are liable to thrombosis; stenosis, and occlusions, so alternative routes are considered as life-saving ways in such cases. Transhepatic permcath is one of the new and up to date methods for inferior vena cava and right atrium catheterization. Few studies with rather limited nomber are available to evaluate transhepatic permcath. The aim of our study is to emphasize the technique, complications, and efficacy of application of percutaneous transhepatic hemodialysis catheters. Results: Two hundred-ninety six chronic renal dialysis patients were included in this prospective interventional study. They include 180 males and 116 females with mean age of 53.2 years ± 11.7 years ranging from 38 to 65 years. Percutaneous transhepatic hemodialysis catheters were inserted for all patients. Technical success of the procedure was achieved in all cases (100%). Post-procedure patency and function of the catheters were followed up with mean follow-up period 750 days. Mean of primary and secondary devices service intervals were 290 and 270 days respectively. Mean time catheter in situ was 280 days. Mean cumulative duration of catheter in situ was 557 days. Catheters migration, sepsis, thrombosis, and exit site infection rates were 0.14, 0.15, 0.18, and 0.32 per 100 catheter-days respectively. Three patients had hepatic subcapsular hematoma (1%). No mortality or other complications were related to the procedure. Conclusions: Combined ultrasound and fluoroscopic-guided transhepatic permanent dialysis catheter application for patients with exhausted classic venous access routes and non-functioning/thrombosed AV fistulas or grafts showed excellent technical success with good short and mid-term patency rates and low complications rates. Thus, this study encourages us to expand this promising technique for application of dialysis catheter in indicated cases.

Transhepatic double lumen hemodialysis catheter in exhausted vascular access: Feasibility, functionality, and outcome among hemodialysis patients

“…Stavropoulos et al 13 and Smith et al 14 attributed the high incidence of thrombosis in THC to the shorter trans-vascular distance traversed by the catheter to meet IVC probably influencing the flow in that segment. The observed catheter migration rate (0.12 per 100 catheter days) of THCs in this study is lower compared to previously published studies [13][14][15][16][17] As outlined seen in Table 3, another complication observed is the occurrence of infection. The infection rate for this study (0.046 per 100 catheter days) was lower compared to infection rates in previous studies.…”

“…The infection rate for this study (0.046 per 100 catheter days) was lower compared to infection rates in previous studies. [13][14][15][16][17] Catheter-related bloodstream infection also occurs in THC as it does in other types of catheters. 20 Migration is one of the complications identified in the previous studies.…”

“…22 The rate of migration in this study is not different from the rate observed in previous studies. [13][14][15][16][17] Ten of the catheters that had migrated to the hepatic vein were replaced but none of the patients experienced unexpected migrations or catheter-related fatalities.…”

“…Several studies have explored the use of transhepatic catheterization as access for hemodialysis and have concluded that transhepatic catheter placement is feasible and the risk for developing complications is reminiscent of conventional approaches. [13][14][15][16][17] This study aimed to assess the feasibility, functionality, and outcome of insertion of THCs among patients with ESVA undergoing hemodialysis. The present study presents a series of cases seen from 2009 to 2019 who had insertion THCs as an option for end-stage vascular access.…”

“…Several studies have explored the use of transhepatic catheterization as access for hemodialysis and have concluded that transhepatic catheter placement is feasible and the risk for developing complications is reminiscent of conventional approaches. 13 –17…”