Transhepatic insertion of vascular dialysis catheters in children: a safe, life-prolonging procedure.

INTRODUCTION: Central venous catheters (CVC) have been inserted percutaneously since 1989. This technique has been adapted for transhepatic insertion of large-bore catheters in children with occluded central veins.

MATERIALS AND METHODS: Three children aged 5, 11, and 12 years required hemodialysis or plasmaphoresis for treatment of life-threatening conditions. All central veins were occluded, thus transhepatic insertion of a large-bore catheter was necessary. All children underwent successful placement using a combination of ultrasound guidance and fluoroscopy. No complications occurred.

DISCUSSION: Transhepatic insertion of large-bore catheters can be performed safely in children. Catheter removal should be accompanied by track embolization to prevent exsanguinating hemorrhage.

CONCLUSION: Transhepatic insertion of dialysis catheters is a safe alternative in children with occluded central veins.