Surgical implantation of a tunnel dialysis catheter into the inferior vena cava. Case report

Abstract

A patient receiving treatment with maintenance hemodialysis underwent many unsuccessful attempts of arteriovenous fistula creation. Central venous catheters were implanted into the central veins of the chest; iliac veins remained the only stable type of vascular access in him. A further dysfunction required the implantation of a new catheter. The examination revealed that the right and left jugular veins were partially occluded, the brachycephalic vein was not passable, the right and left iliac veins were partially occluded, and the inferior vena cava was completely patent. Conversion of renal replacement therapy to peritoneal dialysis was impossible due to pancreatic necrosis and peritonitis in the past. Any attempts of endovascular recanalization of the brachiocephalic vein did not succeed. According to vital indications, a tunneled catheter was implanted into the inferior vena cava through retroperitoneal pararectal access in the right iliac region. Due to partial occlusion of the right common iliac vein, a catheter was implanted in the unification of the common iliac veins. The lumen of the vein was sealed around the catheter, the latter was additionally fixed to the rectus abdominis muscle aponeurosis, and the dacron cuff was attached to the external oblique abdominal muscle aponeurosis to ensure its optimal position. The catheter was placed on the anterior wall of the abdomen through the contraperture, and the blood flow was adequate. At the 6 months follow-up, the patient's condition was stable, the catheter was working properly.