Clinical case of transhepatic recanalization of the brachiocephalic vein with simultaneous implantation of a tunneled central venous catheter for hemodialysis

With long-term renal replacement therapy with hemodialysis, all possible vascular accesses may gradually be lost, including those associated with previous catheterizations. Furthermore, peritoneal dialysis is typically no longer effective in these patients. In such clinical cases, the only viable option is to attempt a tunneled central venous catheter (CVC) for hemodialysis as a life-saving procedure, based on life-saving indications. Such situations may be uncommon, but they do occur quite regularly. The use of transhepatic access as an additional method for central vein recanalization is justified, but only in the absence of other, less risky options. In cases of complete loss of classic vascular accesses following an unsuccessful attempt at transhepatic recanalization of the central veins, a tunneled CVC can be inserted into the right atrium through the created access.