title: Dual-tract transhepatic U-shaped hemodialysis inferior vena cava catheter: a feasibility study in a swine model.
abstract: OBJECTIVE
  To evaluate the feasibility of establishing a U-shaped inferior vena cava (IVC) catheter entirely from a transhepatic approach and to determine the catheter caliber that would provide adequate flow for hemodialysis.
  
  
  METHODS
  Three pigs (weight, 45-50 kg) were used. A peripheral right hepatic vein was accessed transhepatically by using a 22-gauge needle, and a 0.018-inch wire was passed into the hepatic veins and IVC. An accessory right hepatic vein was accessed from the IVC. A snare was deployed in the accessory vein and used as a target for a second transhepatic 22-gauge needle pass. A wire was snared through the second transhepatic tract, around into the IVC, and through the first transhepatic tract. The 0.018-inch wire was upsized to a 0.035-inch platform. Measurements where made to tailor a U-shaped catheter from simple 10.2- and 12-F tubes by cutting them longitudinally (single long side hole) along the length of the IVC segment. The U-shaped hemodialysis catheter was placed over the wire and positioned so that the catheter opening lay in the IVC. With use of a dialysis machine, pressures and flow tolerance at set flow rates (100, 200, 300, 350, and 400 mL/min) were tested.
  
  
  RESULTS
  All pigs underwent and survived successful catheter placements. All 10.2- and 12-F catheters tolerated flow rates up to 350 and 400 mL/min, respectively.
  
  
  CONCLUSIONS
  Establishing a U-shaped hemodialysis catheter with an entirely transhepatic approach is technically feasible. The 10.2-F U-shaped dialysis catheters provided a flow rate (>350 mL/min) that is appropriate for hemodialysis in human clinical settings.
authors: Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642, USA. wspikes@yahoo.com
authors: Wael E A
authors: WE
authors: Saad
authors: Lawrence G
authors: LG
authors: Sahler
authors: Karin E
authors: KE
authors: Westesson
authors: Paul F
authors: PF
authors: Della Pietra
authors: Wael M
authors: WM
authors: Darwish
authors: Takashi
authors: T
authors: Kitanosono
authors: David L
authors: DL
authors: Waldman
mesh_terms: D000818:Animals; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000502:physiology*; D008297:Male; D008422:Materials Testing; D023421:Models, Animal; D015641:Radiography, Interventional; D006435:Renal Dialysis / Q000295:instrumentation*; D034421:Sus scrofa; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000502:physiology*