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Transhepatic Catheter Access for Hemodialysis¹

¹ From the Department of Radiology, Division of Interventional Radiology (T.P.S., J.M.R.), and Department of Medicine, Division of Nephrology (D.N.R.), Duke University Medical Center, Room 1502, Durham, NC 27710. From the 2003 RSNA scientific assembly. Received May 1, 2003; revision requested July 1; final revision received October 12; accepted November 18. Address correspondence to T.P.S. (e-mail: smith146@mc.duke.edu).

View larger version (147K): [in a new window]   Figure 1a. Images in a 54-year-old man with hypertension-induced renal failure who underwent transhepatic dialysis catheter placement because of no remaining peripheral access sites. (a) Frontal view of the abdomen. A 22-gauge needle (solid arrow) engaged an appropriate hepatic vein on the second pass, and a guide wire (arrowheads) is seen coursing into the right atrium. A small amount of contrast material is seen in the common bile duct (open arrow) as the biliary system was engaged on the first needle pass. (b) Frontal view of the abdomen. Dual-lumen dialysis catheter has been placed with the tip in the right atrium (arrow).

View larger version (165K): [in a new window]   Figure 1b. Images in a 54-year-old man with hypertension-induced renal failure who underwent transhepatic dialysis catheter placement because of no remaining peripheral access sites. (a) Frontal view of the abdomen. A 22-gauge needle (solid arrow) engaged an appropriate hepatic vein on the second pass, and a guide wire (arrowheads) is seen coursing into the right atrium. A small amount of contrast material is seen in the common bile duct (open arrow) as the biliary system was engaged on the first needle pass. (b) Frontal view of the abdomen. Dual-lumen dialysis catheter has been placed with the tip in the right atrium (arrow).

View larger version (17K): [in a new window]   Figure 2. Graph shows transhepatic access patency distribution function (solid line) with 95% CIs (dotted lines). Patency time is in days; notably, more than 50% of catheters functioned for longer than 120 days.

View larger version (174K): [in a new window]   Figure 3a. Images in a 66-year-old woman with hypertension-induced renal failure who underwent transhepatic dialysis catheter placement because of no remaining peripheral access sites. (a) Transverse CT scan obtained approximately 7 hours after catheter placement demonstrates massive intraperitoneal hemorrhage (arrows). A portion of the transhepatic catheter is visualized (arrowhead). (b) Frontal view of the early phase of a selective hepatic arteriogram. The transhepatic catheter is seen as a subtraction artifact (arrowheads). Early extravasation (arrow) is visualized along the catheter from branches of the right hepatic artery. (c) Frontal view of a later phase of a selective hepatic arteriogram. The dialysis catheter (arrowheads) is again seen as a subtraction artifact. Contrast material extravasation (arrows) along the course of the catheter, which indicates bleeding, is better visualized on this image. (d) Frontal view of a selective hepatic arteriogram obtained after embolization of the right hepatic artery with coils (arrow). No contrast material extravasation is visualized along the catheter course (arrowheads). Despite intensive medical therapy, the patient died the following day.

View larger version (161K): [in a new window]   Figure 3b. Images in a 66-year-old woman with hypertension-induced renal failure who underwent transhepatic dialysis catheter placement because of no remaining peripheral access sites. (a) Transverse CT scan obtained approximately 7 hours after catheter placement demonstrates massive intraperitoneal hemorrhage (arrows). A portion of the transhepatic catheter is visualized (arrowhead). (b) Frontal view of the early phase of a selective hepatic arteriogram. The transhepatic catheter is seen as a subtraction artifact (arrowheads). Early extravasation (arrow) is visualized along the catheter from branches of the right hepatic artery. (c) Frontal view of a later phase of a selective hepatic arteriogram. The dialysis catheter (arrowheads) is again seen as a subtraction artifact. Contrast material extravasation (arrows) along the course of the catheter, which indicates bleeding, is better visualized on this image. (d) Frontal view of a selective hepatic arteriogram obtained after embolization of the right hepatic artery with coils (arrow). No contrast material extravasation is visualized along the catheter course (arrowheads). Despite intensive medical therapy, the patient died the following day.

View larger version (161K): [in a new window]   Figure 3c. Images in a 66-year-old woman with hypertension-induced renal failure who underwent transhepatic dialysis catheter placement because of no remaining peripheral access sites. (a) Transverse CT scan obtained approximately 7 hours after catheter placement demonstrates massive intraperitoneal hemorrhage (arrows). A portion of the transhepatic catheter is visualized (arrowhead). (b) Frontal view of the early phase of a selective hepatic arteriogram. The transhepatic catheter is seen as a subtraction artifact (arrowheads). Early extravasation (arrow) is visualized along the catheter from branches of the right hepatic artery. (c) Frontal view of a later phase of a selective hepatic arteriogram. The dialysis catheter (arrowheads) is again seen as a subtraction artifact. Contrast material extravasation (arrows) along the course of the catheter, which indicates bleeding, is better visualized on this image. (d) Frontal view of a selective hepatic arteriogram obtained after embolization of the right hepatic artery with coils (arrow). No contrast material extravasation is visualized along the catheter course (arrowheads). Despite intensive medical therapy, the patient died the following day.

View larger version (144K): [in a new window]   Figure 3d. Images in a 66-year-old woman with hypertension-induced renal failure who underwent transhepatic dialysis catheter placement because of no remaining peripheral access sites. (a) Transverse CT scan obtained approximately 7 hours after catheter placement demonstrates massive intraperitoneal hemorrhage (arrows). A portion of the transhepatic catheter is visualized (arrowhead). (b) Frontal view of the early phase of a selective hepatic arteriogram. The transhepatic catheter is seen as a subtraction artifact (arrowheads). Early extravasation (arrow) is visualized along the catheter from branches of the right hepatic artery. (c) Frontal view of a later phase of a selective hepatic arteriogram. The dialysis catheter (arrowheads) is again seen as a subtraction artifact. Contrast material extravasation (arrows) along the course of the catheter, which indicates bleeding, is better visualized on this image. (d) Frontal view of a selective hepatic arteriogram obtained after embolization of the right hepatic artery with coils (arrow). No contrast material extravasation is visualized along the catheter course (arrowheads). Despite intensive medical therapy, the patient died the following day.