title: Use of unconventional dialysis access in patients with no viable alternative.
abstract: BACKGROUND
  Hemodialysis patients who have exhausted all of the conventionally used veins for vascular access, including arteriovenous fistula, arteriovenous graft, and traditional catheter access sites, present a challenge to the treating physician. Transhepatic and translumbar inferior vena cava catheters have been used in these patients who have no other access site option. The objective of the study was to examine our experience with translumbar and transhepatic approach for catheter-based hemodialysis access in patients who have exhausted all other options.
  
  
  METHODS
  A retrospective review was performed from June 2000 to May 2011 of all patients who underwent transhepatic or translumbar inferior vena cava catheter placement for the purpose of hemodialysis. Data abstracted included previous access procedures, duration of use and patency of dialysis catheters, catheter-related complications, and mortality.
  
  
  RESULTS
  Seven patients were identified. Four patients underwent transhepatic access and three underwent translumbar access. Five patients were female and two were male. The mean age was 44 years. The etiology of renal failure was diabetes in four patients, congenital hypoplastic kidneys in two patients, and acute glomerulonephritis in one patient. A mean of 14 (range: 11-18) dialysis access procedures were performed before catheter placement by transhepatic/translumbar interventions. The initial device service interval for all patients ranged from 15 to 658 days, with a mean of 295 days and a median of 245 days. Total access site service interval ranged from 15 to 790 days, with a mean of 380 days and a median of 245 days.
  
  
  CONCLUSIONS
  Translumbar and transhepatic venous access is a viable long-term alternative route for catheter-based hemodialysis access in patients who have exhausted conventional options.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Herscu
authors.forename: Karen
authors.initials: K
authors.lastname: Woo
authors.forename: Fred A
authors.initials: FA
authors.lastname: Weaver
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Rowe
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051437:Renal Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000209:etiology; D014682:Vena Cava, Inferior