PMC10185021_01
Schematic diagram showing trans lumbar dialysis catheter
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CT scan guidance [Figure 1]. Coagulation parameters (partial thromboplastin time, prothrombin time, and platelet count) were checked and corrected before procedure as necessary.
Coronal CT scan plain abdomen showing polycystic appearance involving both kidneys and liver
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Translumbar route was preferred over the transhepatic route in view of innumerable cysts within the liver parenchyma secondary to polycystic liver disease [Figure 2]. Translumbar dialysis catheter (TLDC) in our case was placed in an angiography suite by using fluoroscopic and Dyna Chiba needle 21-G, a 15-cm-long needle, was advanced under fluoroscopic and DynaCT guidance through subcutaneous tissues and back muscles (erector spinae and psoas) toward the inferior vena cava (IVC) [Figure 2].
Dyna CT scan plain abdomen showing the tip of Chiba needle within the IVC
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Once the needle entered the IVC, a guidewire was passed through it [Figure 3 and 4], and COOK percutaneous access set was used to secure the access.
AP and lateral fluoroscopy image showing the tip of Chiba needle at the level of L3 vertebral body with wire within the IVC
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Once the needle entered the IVC, a guidewire was passed through it [Figure 3 and 4], and COOK percutaneous access set was used to secure the access. Dacron cuff was tunneled under the skin and sutured [Figure 4 and Figure 5].
AP radiograph showing trans lumbar tunneled dialysis catheter with tip of the catheter at cavo-atrial junction
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Dacron cuff was tunneled under the skin and sutured [Figure 4 and Figure 5].
Post-procedure CT scan showing the course of translumbar dialysis catheter entry into psoas muscle and later into IVC
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DynaCT was performed for confirming the course of translumbar catheter [Figure 6].