Kirurško postavljanje dijaliznog katetera pristupom na donju šuplju venu

Dino Papeš, Vedran Premužić, Anko Antabak

Trajni centralni venski kateteri (CVK) najmanje su poželjan oblik pristupa za kroničnu hemodijalizu, no prihvatljivi su ako su svi drugi oblici kroničnog pristupa iscrpljeni. Kod bolesnika kod kojih su trombozirane velike vene ramenog obruča i zdjelice, postavljanje CVK i njegova kasnija zamjena zahtjevni su postupci. Prikazan je slučaj 32-godišnjeg bolesnika kod kojega je zbog tromboze obiju potključnih i ilijačnih vena trajni dijalizni CVK postavljen izravno u donju šuplju venu retroperitonealnim pristupom. Radi sigurnosti od slučajne ekstrakcije katetera i lakše buduće zamjene, kateter je postavljen kroz sintetski provodnik anastomoziran na donju šuplju venu. Operativni zahvat je protekao bez komplikacija, a nakon 18 mjeseci kateter je uredno prohodan i funkcionalan. Kod bolesnika s trombozom ramenih i potključnih središnjih vena trajni dijalizni CVK može se postaviti torakoskopski u gornju šuplju venu ili izravno u desni atrij ili donju šuplju venu. U prikazanom slučaju zbog deformiteta toraksa izabran je i uspješno osiguran pristup u donju šuplju venu.

Permanent central venous catheters (CVCs) are the least desirable form of access for chronic hemodialysis. However, they are acceptable when all other forms of long-term vascular access have been exhausted. In patients with thrombosis of the major veins of the shoulder girdle and pelvis, CVC placement and subsequent replacement are technically demanding procedures. We present the case of a 32-year-old patient in whom, due to thrombosis of both subclavian and iliac veins, a permanent dialysis CVC was placed directly into the inferior vena cava via a retroperitoneal approach. To reduce the risk of accidental catheter dislodgement and to facilitate future replacement, the catheter was inserted through a synthetic graft anastomosed to the inferior vena cava. The procedure was completed without complications, and after 18 months the catheter remains patent and fully functional. In patients with thrombosis of the central veins of the shoulder region and subclavian veins, permanent dialysis CVCs can be placed thoracoscopically into the superior vena cava or directly into the right atrium or inferior vena cava. In the present case, due to thoracic deformity, access to the inferior vena cava was selected and successfully achieved.