Transhepatic catheter access for hemodialysis

PURPOSE: To retrospectively review the authors' experience regarding the safety and functionality of transhepatic hemodialysis catheters. MATERIALS AND METHODS: Sixteen patients (seven men and nine women aged 21-77 years; mean age, 51.6 years) underwent placement of 21 transhepatic hemodialysis catheters. Transhepatic catheters were placed in the absence of an available peripheral venous site (11 patients) or for preservation of a single remaining venous site to achieve permanent vascular access. Safety was assessed by means of complications encountered, and catheter functionality was assessed by means of total access site service interval. Catheter patency was described by using a Kaplan-Meier survival curve, and number of catheter days were compared according to patient sex by using a two-sample t test. RESULTS: Technical success was achieved in all patients. The mean total access site service interval was 138 catheter days (range, 0-599 days), and there was no significant difference according to patient sex (P = .869). Of the 16 catheters placed initially, five became dislodged and required an additional access procedure to be performed. These 21 catheters required 30 exchanges in 10 patients (48%) (range, 1-6 exchanges per patient). The most common reason for catheter exchange was device failure. There were six complications among 21 catheters placed (29%), including one death from massive intraperitoneal hemorrhage on the day after catheter placement. CONCLUSION: Transhepatic hemodialysis catheters offer a viable option to patients with limited options; however, there are maintenance issues and complications.