title: Transhepatic hemodialysis catheters: functional outcome and comparison between early and late failure.
abstract: OBJECTIVE
  To describe the authors' experience with transhepatic placement of catheters, highlighting early and late complications, and to determine if this procedure is a viable option in patients in whom central venous occlusions present a significant challenge.
  
  
  METHODS
  The records of all the patients who underwent placement of transhepatic hemodialysis from January 2003 to October 2008 were retrospectively reviewed. Selected patients were dialysis-dependent, having undergone multiple access procedures and revisions. Kaplan-Meier analysis was used to estimate primary and secondary patency.
  
  
  RESULTS
  Twenty-two patients (mean age 42 years, range 22-70 years, 59% women) underwent a total of 127 transhepatic catheter placements at 24 transhepatic access sites; technical success was achieved in all cases. There were no hepatic injuries (bleeding or fistula formation). There were 105 exchanges in 14 patients, with a mean of 7.5 exchanges, a median of 5 exchanges (range 1-18 exchanges), and a catheter migration rate of 0.39 per 100 catheter-days. The sepsis rate was 0.22 per 100 catheter-days, and the catheter thrombosis rate was 0.18 per 100 catheter-days. The mean cumulative catheter duration in situ was 506.2 days, and the mean time catheter in situ was 87.7 days. The mean total access site interval was 1,046 catheter-days (range of 423-1,413 catheter-days).
  
  
  CONCLUSIONS
  Transhepatic hemodialysis catheter placement is associated with low rates of morbidity. In this series, transhepatic catheters provided the possibility of long-term functionality, despite associated high rates of catheter-related maintenance, provides a potentially viable access for patients with exhausted access options.
authors.affiliation: Dialysis Access Program, Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, 6550 Fannin Street, Houston, TX 77030, USA.
authors.forename: Houssam K
authors.initials: HK
authors.lastname: Younes
authors.forename: Candace D
authors.initials: CD
authors.lastname: Pettigrew
authors.forename: Javier E
authors.initials: JE
authors.lastname: Anaya-Ayala
authors.forename: George
authors.initials: G
authors.lastname: Soltes
authors.forename: Wael E
authors.initials: WE
authors.lastname: Saad
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.forename: Alan B
authors.initials: AB
authors.lastname: Lumsden
authors.forename: Eric K
authors.initials: EK
authors.lastname: Peden
mesh_terms: D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects*; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology*; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult