Transhepatic venous access for hemodialysis - a single-center experience

Introduction. A percutaneous transhepatic approach has been used to place tunneled catheters for hemodialysis in the inferior vena cava. This route through the suprahepatic vein could be used to place a tunnelled catheter for permanent hemodialysis without complications and with an excellent permeability rate. Case report. From 2011 to 2020 at the Military Medical Academy, we treated 4 patients with the transhepatic central venous catheter for hemodialysis. All of them had exhausted approaches during the period of hemodialysis. Arterio-venous fistulas thrombosed on the arms, subclavian vein thrombosis bilaterally or superior and inferior vena cava thrombosis, as well as bilateral iliac and femoral vein thrombosis were present as complications of longterm hemodialysis through femoral catheters. Peritoneal dialysis was not possible. One patient needed a scroll catheter since the hemodialysis did not have a good outcome, and one patient needed a thrombolysis of catheter due to its malfunction. The other two patients have been on hemodialysis without complications for 300 and 1,650 days, respectively. Conclusion. Transhepatic venous access under ultrasound and radioscopic guidance is a simple and safe method. It is an acceptable alternative for permanent hemodialysis catheters when other venous accesses are exhausted and when it is performed by a well-trained team.