NDT Advance Access originally published online on February 7, 2006
Nephrology Dialysis Transplantation 2006 21(7):2031-2033; doi:10.1093/ndt/gfl020
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Transhepatic venous access as an alternative for Tesio catheter in the case of a patient on haemodialysis with antiphospholipid syndrome
Email: grosadiez{at}yahoo.com; guillermo.rosadiez{at}hospitalitaliano.org.arSir,
We report on a case of a patient with antiphospholipid syndrome with exhaustion of vascular accesses for haemodialysis. The transhepatic route through the suprahepatic vein was used to place a tunnelled catheter for permanent haemodialysis without complications and with an excellent permeability rate.
A 54-year-old woman with end stage renal failure of unknown origin, on haemodialysis since April 1991 and who had had numerous permanent vascular accesses which were lost due to thrombosis, required the placement of double-lumen, transitory catheters on several occasions. The patient began peritoneal dialysis, but it was interrupted two years later, due to multiple peritonitis episodes which caused the loss of the peritoneal membrane. She, therefore, had to restart haemodialysis. Clinical and laboratory tests performed on the patient led to the diagnosis of antiphospholipid syndrome [1]. The angiographic test showed thrombosis in both subclavian veins and compromised both femoral and iliac veins (Figure 1).
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A Tesio haemodialysis catheter (27 cm in length) was inserted at the suprahepatic vein level, leaving its distal end in the right atrium and making a subcutaneous tunnelling in the middle axillary region (Figure 2). The procedure was well tolerated by the patient and complications were not observed. Anticoagulation was started after 24 h with enoxiparine dose of 30 mg/day, labelled according to the anti-Xa specific activity. From the beginning, this approach achieved an effective blood flow of 300 ml/min. There are as yet no complications with this access.
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Eleven years after the beginning the renal replacement therapy, it was necessary to look for a new alternative venous access such as the suprahepatic vein. The selection of this route over the translumbar was based on our previous experience with the approach of the suprahepatic vein.
The transhepatic venous access as a catheter placement site has been known for many years, not only for dialysis but also for chronic parenteral nutrition [2,3].
It is a safe and simple route for venous access with complications and infections, comparable with other places of venous access. Although others suggest that the direct translumbar access is a better alternative [4], to date our patient maintains an excellent primary permeability, with an effective functioning for haemodialysis 980 days after the placement of the catheter. The excellent permeability rate can probably be explained by the combination of a suitable anticoagulation, our experience with this unconventional route and the type of catheter used [5].
The transhepatic venous access under ultrasound and radioscopic guidance is a simple and safe method. It is an acceptable alternative for permanent haemodialysis catheters when other venous accesses are exhausted, and when it is performed by a well-trained team.
Conflict of interest statement. None declared.
Deparments of1 Nefrologia FME2 Diagnóstico por Imágenes3 Cirugía Cardiovascular Hospital Italiano de Buenos Aires Buenos Aires Argentina
References
- Wilson WA, Gharavi AE, Koike T et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome. Arthritis Rheum 1999; 42: 1309[CrossRef][Web of Science][Medline]
- Stavropoulus S, Pan J, Clark T et al. Percutaneous transhepatic venous access for haemodialysis. J Vasc Interv Radiol 2003; 14: 1187–1190[Medline]
- De Csepel J, Stanley P, Padua E et al. Maintaining long term central venous access by repetitive hepatic vein cannulation. J Pediatr Surg 1994; 29: 56–57[CrossRef][Web of Science][Medline]
- Smith TP, Ryan JM, Reddan DN. Transhepatic catheter access for haemodialysis. Radiology 2004; 232: 246–251
[Abstract/Free Full Text] - Wivell W, Bettmann M, Baxter B et al. Outcomes and perfomance of the Tesio twin catheter system placed for haemodialysis access. Radiology 2001; 221: 697–703
[Abstract/Free Full Text]
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