Researchers Report Success with Lumbar HD Catheters

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SAN FRANCISCO—Translumbar hemodialysis catheters (THCs) are safe and may offer an effective vascular access route for hemodialysis (HD) patients with limited venous access options, even in overweight patients, according to data presented at the 37th Annual Scientific Meeting of the Society of Interventional Radiology.

The new findings may be of particular interest to nephrologists because they pertain to a very challenging group of dialysis patients, said study investigator Cormac Farrelly, MD, Assistant Professor of Interventional Radiology at the University of Pennsylvania in Philadelphia. Intervention radiologists at the Hospital of the University of Pennsylvania previously published their experience with transhepatic dialysis catheters in 2003. The latest study suggests that a translumbar approach may have significant advantages over a transhepatic approach.

“The transhepatic approach tended to have high catheter thrombosis rates,” Dr. Farrelly said.

He and his colleagues retrospectively studied 33 patients who received THCs from January 2002 to July 2011. They had a mean age of 51.4 years and 51% were male. Of the 33 patients, 18 had a normal body mass index (BMI) and 15 had a BMI above 25 kg/m2 (overweight).

All subjects had central venous occlusion preventing catheter placement via an internal or external jugular vein. The researchers analyzed technical outcome, complication rates, and indications for exchange/removal. They also calculated the mean catheter dwell time, cumulative access site duration, catheter-related thrombosis rates, and infection rates.  Ninety-two THC procedures were included in the analysis (39 initial placements, 53 exchanges), with a total of 7,825 catheter days.

“To our knowledge this is the largest study to date looking at this type of catheter,” Dr. Farrelly said. “We had very low rates of complications and we only had one episode of bleeding. This was successfully managed with blood products and conservative therapy. There was no need for any extra procedure.”

The technical success rate was 100%. The investigators observed only two minor complications (2.2%) and three major complications (3.3%). One minor and one major complication occurred in patients with normal BMI and one minor and two major complications occurred in overweight patients. The most common indications for exchange/removal were catheter-related infection, catheter malfunction/occlusion, mature permanent vascular access, and conversion to peritoneal dialysis. As of March 2012, three THCs remained in use.

The mean catheter dwell time for all subjects was 86.9 days. It was 86.1 days for patients with normal BMI and 87.8 days for overweight patients. The mean cumulative access site duration was 257 days for the study population as a whole, 216.7 days for patients with a normal BMI and 309.8 days for overweight patients. The catheter-related central venous thrombosis rate was 0.01 per 100 catheter days and the catheter-associated infection rate was 0.51 per 100 catheter days.

“In our practice, experience has led us to prefer a translumbar over a transhepatic route for hemodialysis access placement. We have found no significant difference in how well these catheters function in patients with high and normal BMI's,” Dr. Farrelly explained.

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