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논문분류	춘계학술대회 초록집
제목	Transhepatic hemodialysis access insertion in a patient with exhausted vasculature
저자	Lovelynx Bayating
출판정보	2023; 2023(1):
키워드
초록	Objectives: This case report describes a case of successful percutaneous hepatic access insertion in a Filipino patient diagnosed with end-stage renal disease. To date, this is the first reported case of a percutaneous transhepatic access insertion in the Philippines. Methods: With exhausted traditional sites of vascular access, the transhepatic route was pursued. Under fluoroscopic guidance, the right hepatic vein was accessed (Figure 2) using a G21 introducer needle. The contrast was injected to visualize the inferior vena cava. A 0.018-inch guidewire was inserted into the needle. An Accustick introducer set was placed over the wire and after a series of maneuvers, the tip of a 0.038-inch guide wire was placed just above the renal veins. The hemodialysis catheter (Mahurkar Acute Dual Lumen Catheter Fr 13.5 x 24 cm) was placed over the wire under fluoroscopic guidance (Figure 2). Before the conclusion of the procedure, the lumens were flushed and had no resistance to flow upon aspiration of the arterial and venous limbs. Eventually, the catheter was secured to the skin using sutures. Results: The patient was strictly monitored for complications at the hemodialysis unit with no complications on HD access utility. After eight successful HD sessions, the patient was discharged improved. At the outpatient department, regular follow-up was done with no noted complications. Catheter time in situ was 64 days with a one-time replacement of catheter (chronic HD catheter split stream 36cm) on the 65th day due to catheter thrombosis. The patient has since then resumed dialysis with no reported complications on subsequent follow-ups. Conclusions: In patients with exhausted vasculature, wherein the creation of arteriovenous access is futile and since renal transplant is not readily available, transhepatic access may be considered a safe and functional alternative route.
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