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

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.