Transhepatic insertion of vascular dialysis catheters in children: a safe, life-prolonging procedure.
BACKGROUND
Central venous catheters (CVC) have been inserted percutaneously since 1989. This technique has been adapted for transhepatic insertion of large-bore catheters in children with occluded central veins.


METHODS
Three children aged 5, 11, and 12 years required hemodialysis or plasmaphoresis for treatment of life-threatening conditions. All central veins were occluded, thus transhepatic insertion of a large-bore catheter was necessary. All children underwent successful placement using a combination of ultrasound guidance and fluoroscopy. No complications occurred.


CONCLUSIONS
Transhepatic insertion of large-bore catheters can be performed safely in children. Catheter removal should be accompanied by track embolization to prevent exsanguinating hemorrhage.


CONCLUSIONS
Transhepatic insertion of dialysis catheters is a safe alternative in children with occluded central veins.
Bergey
E A
EA
Department of Radiology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213 USA.
Kaye
R D
RD
Reyes
J
J
Towbin
R B
RB
D000641:Ammonia / Q000097:blood; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D010690:Phlebography; D010956:Plasmapheresis / Q000295:instrumentation*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000628:therapy; D006435:Renal Dialysis / Q000295:instrumentation*; D051437:Renal Insufficiency / Q000628:therapy; D012449:Safety; D014463:Ultrasonography
D000641:Ammonia