Abstract: SA-PO1088
Percutaneous Transhepatic Venous Access for Hemodialysis: A 25-Year Experience
Session Information
- Vascular Access - II
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Souza, Rafael A. S., University of Sao Paulo, São Paulo, São Paulo, Brazil
- Torres, Fabio M., University of Sao Paulo, São Paulo, São Paulo, Brazil
- Reis, Fábio A., University of Sao Paulo, São Paulo, São Paulo, Brazil
- Santa Catharina, Guilherme P., University of Sao Paulo, São Paulo, São Paulo, Brazil
- Smolentzov, Igor, University of Sao Paulo, São Paulo, São Paulo, Brazil
- Silva, Bruno C., University of Sao Paulo, São Paulo, São Paulo, Brazil
- Abensur, Hugo, University of Sao Paulo, São Paulo, São Paulo, Brazil
Background
Vascular access is vital for hemodialysis (HD) patients, and some of them exhibit occlusions in the most common sites of catheter insertion. In such dramatic situations, percutaneous transhepatic (PT) placement of HD catheters can provide alternate vascular access for HD. Our objectives were to retrospectively evaluate survival, safety and complications associated with PT catheters in a HD center at a tertiary hospital in Brazil.
Methods
All PT catheters were placed in patients who had exhausted other vascular access sites, by an experienced interventional vascular team. The following outcomes were evaluated: catheter removal due to low flux, infection or catheter rupture. Additionally, death or kidney transplantation with functioning catheter were also noted. Data is expressed as median (25;75) percentiles, and crosstabulated in chi-square tests.
Results
During a 25-year period, 24 PT catheters were placed in 7 patients (one woman and six men). Median age at catheter insertion was 51 (33; 54) years and dialysis vintage of 197 (40; 522) months. Median PT catheter survival was 277 (24; 537) days. Catheter removal for low flux, infection and rupture was observed in 46%, 21% and 13% of patients, respectively. Removal for low-flux rate was 1.3/1000 patients-day and for infection, 0.59/1000 patients-day. Two patients died with functioning catheter and one underwent kidney transplantation. Two patients are currently dialyzing with PT catheters and no complications were observed. Reasons for TP catheter removal when comparing first vs non-first insertions were different (chi-square 9.24, p=0.01), as catheter rupture was more frequently observed in first insertion and low-flux in non-first insertions (table 1).
Conclusion
Using TP catheters in patients with multiple access failure is a feasible procedure, as overall infection and thrombosis rates are similar to other sites of catheter insertions. Patients should be advised about catheter-related care, especially in first insertion, in order to avoid catheter rupture.
Table 1. Outcomes according to catheter insertion
| Event | First Catheter | p | |
| Yes | No | ||
| Rupture | 0 | 3 | 0.021 |
| Low-flux | 10 | 1 | 0.041 |
| Infection | 3 | 2 | 1.0 |