57
J Gandhara Med Dent Sci
October - December 2026
:
:
LONG-TERM
OUTCOMES
OF
TRANSLUMBAR
HAEMODIALYSIS
CATHETERS
AS
SALVAGE
VASCULAR ACCESS IN
PATIENTS WITH EXHAUSTED CONVENTIONAL ACCESS OPTIONS
Shuah Ullah
1
, Ammar Hussain
2
,
Nabila Khan
2
,
Shariq Bin Yousuf
1
, Abdul Khalique
3
, Ziad Sophie
4
How to cite this article
Ullah S, Hussain A, Khan N, Yousuf
SB, Khalique A, Sophie Z. Long-Term
Outcomes of Translumbar
Haemodialysis Catheters as Salvage
Vascular Access in Patients with
Exhausted
Conventional Access
Options.
J Gandhara Med Dent Sci.
2026;13(4):57-62.
Date of Submission:
27-08-2026
Date Revised:
07-09-2026
Date Acceptance:
14-09-2026
2
Technologist, Department of Operation
Theatre Sciences, Sindh Institute of
Urology and Transplant, Karachi
3
Associate Professor, Department of
Urology, Sindh Institute of Urology and
Transplant, Karachi
4
Professor, Department of Vascular
Surgery Sindh Institute of Urology and
Transplant, Karachi
Correspondence
1
Shuah Ullah, Assistant Professor,
Department of Urology, Sindh Institute
of Urology and Transplant, Karachi
+92-333-3020602
drshuah@gmail.com
ABSTRACT
OBJECTIVES
This
study
evaluated
the
technical
success,
catheter
function,
patency,
complications,
and
predictors
of
failure
of
translumbar
haemodialysis
catheters
used
as
salvage
vascular
access
in
patients
with
exhausted
conventional access options.
METHODOLOGY
This record-based cohort study included 103 patients with end-stage kidney
disease
who
underwent
attempted
translumbar
catheter
placement
at
the
Sindh Institute of Urology and Transplantation, Karachi, from
March 2025 to
March 2026. We assessed consecutive eligible cases for procedural success,
dialysis
performance,
immediate
and
long-term
complications,
catheter
disposition, and access survival. We estimated patency using Kaplan–Meier
analysis.
Multivariable
binary
logistic
regression
identied
independent
predictors of catheter failure.
RESULTS
Technical success was achieved in 101/103 patients (98.1%), and 93 (90.3%)
completed
the
rst
dialysis
session
successfully.
Immediate
complications
occurred
in
10
(9.7%)
patients,
without
major
organ
injury
or
procedure-
related mortality. Primary patency was 85.3% at three months, 75.5% at six
months, and 57.6% at twelve months. Median assisted primary and secondary
patency
were
15.60
and
17.50
months,
respectively.
Catheter
dysfunction
occurred
in
29/101
(28.7%),
catheter-related
bloodstream
infection
in
23
(22.8%), and thrombosis or occlusion in 20 (19.8%). Bloodstream infection
and
initial
blood-ow
rate
below
300
mL/min
independently
predicted
catheter failure.
CONCLUSION
Translumbar
catheterisation
provided
high
technical
success
and
clinically
meaningful
patency
in
patients
with
severely
limited
vascular
access.
Rigorous
infection
prevention
and
early
correction
of
inadequate
catheter
ow
may
improve
durability
and
reduce
access
failure.
These
ndings
support translumbar access as a practical last-resort dialysis strategy.
KEYWORDS:
Translumbar
Catheter,
Haemodialysis,
Vascular
Access
Failure, Catheter Patency, Bloodstream Infection,End-Stage Kidney Disease
INTRODUCTION
Durable vascular access is fundamental to maintenance
haemodialysis.
An
arteriovenous
stula
or
graft
is
generally
preferred
for
long-term
therapy
because
it
oers
better
durability
and
lower
infection
risk
than
chronic
central
venous
catheterisation;
however,
tunneled
dialysis
catheters
remain
indispensable
when
urgent access is required or when arteriovenous options
are
not
feasible.
1,2
Contemporary
vascular-access
planning
therefore
emphasises
an
individualised
life
plan
that
considers
anatomy,
comorbidity,
life
expectancy, previous access history, and preservation of
future
options.
3,4,5
Repeated
catheterisation,
failed
fistulas and grafts, central venous thrombosis, and prior
endovascular procedures can progressively exhaust the
conventional
venous
routes.
Occlusion
of
the
internal
jugular,
brachiocephalic,
or
superior
vena
cava
pathways
may
eventually
prevent
safe
placement
of
a
standard
catheter
and
leave
the
patient
at
risk
of
inadequate
dialysis,
recurrent
hospitalisation,
and
loss
of life-sustaining access. At this stage, salvage options
include
translumbar
or
transhepatic
tunneled
catheterisation, arterial-arterial prosthetic access, right-
atrial
grafting,
and
other
unconventional
approaches.
6,7,8,9,10,11
Selection
depends
on
the
remaining
vascular
anatomy,
procedural
expertise,
expected
duration
of
dialysis,
and
the
risks
associated
with
each
route.
The
translumbar
technique
provides
percutaneous access to the inferior vena cava through a
posterior
lumbar
route,
followed
by
placement
of
a
tunneled haemodialysis catheter with the tip positioned
ORIGINAL ARTICLE
http://doi.org/10.37762/jgmds.13-4.988
58
J Gandhara Med Dent Sci
October - December 2026
in the inferior vena cava or near the cavoatrial junction.
Image guidance enables visualisation of the vena cava
and
surrounding
retroperitoneal
structures
and
can
reduce
the
risk
of
hemorrhage
or
injury
to
adjacent
organs. Published series from experienced centres have
reported
technical
success
rates
exceeding
95%,
supporting
translumbar
access
as
a
feasible
last-resort
option
when
conventional
central
veins
are
no
longer
usable.
8,9
Despite
high
technical
success,
translumbar
catheters
remain
vulnerable
to
the
complications
that
affect long-term dialysis catheters, including poor blood
flow,
thrombosis,
brin-sheath
formation,
kinking,
migration,
dislodgement,
and
catheter-related
bloodstream
infection.
Infection
is
particularly
important
because
it
can
cause
sepsis,
metastatic
infection, hospitalisation, catheter removal, and loss of
one
of
the
patient’s
nal
available
access
routes.
7,12
Consequently,
translumbar
catheterisation
cannot
be
judged
by
successful
insertion
alone;
functional
performance, patency, salvageability, infection burden,
and
catheter
disposition
are
equally
important
outcomes.
Most
published
evidence
consists
of
retrospective
series
and
technical
reports
from
high-
resource
interventional
centres,
and
long-term
data
from South Asian dialysis populations remain limited.
Differences in infection-control practice, access history,
patient comorbidity, and availability of catheter-salvage
procedures
may
inuence
outcomes
across
settings.
The present study therefore evaluated technical success,
first-dialysis
performance,
primary
and
secondary
patency,
complications,
nal
catheter
status,
and
predictors
of
failure
after
translumbar
haemodialysis
catheterisation
at
a
tertiary
renal-care
institution.
Identifying
modiable
predictors
of
failure
may
help
clinicians improve
surveillance and
preserve
access
in
patients with otherwise exhausted vascular options.
METHODOLOGY
This
retrospective
cohort
study
was
conducted
in
the
Department
of
Urology
at
the
Sindh
Institute
of
Urology and Transplantation (SIUT), Karachi, Pakistan,
from March 2025 to March 2026. The study evaluated
the technical success, functional performance, catheter
patency, complications and long-term clinical outcomes
of
translumbar
haemodialysis
catheters
inserted
in
patients
with
exhausted
conventional
vascular
access
options.
The
SIUT
Ethical
Review
Committee
approved the study under approval number SIUT-ERC-
2025/A-552,
issued
on
20
March
2025.
The
SIUT
Institutional
Review
Board
previously
reviewed
the
protocol under IRB No. 609, with a certicate dated 7
February
2025,
following
presentation
on
29
January
2025.
The
study
followed
institutional
ethical
requirements
and
the
principles
of
the
Declaration
of
Helsinki.
We
maintained
patient
condentiality
by
assigning anonymous
identication codes, and
we
did
not
enter
any
personally
identiable
information
into
the
study
database.
The
required
sample
size
was
calculated
using
the
single-population
proportion
formula: Sample size (n) = Z p (1 − p) / d. We
selected an anticipated technical success rate of 90% as
a
conservative
estimate,
based
on
previous
studies
reporting
technical
success
rates
exceeding
95%
for
image-guided
translumbar
haemodialysis
catheter
placement.
8
We
used
a
95%
condence
level
and
an
absolute
precision of 6%.
Sample size
(n)
=
(1.96)
0.90 (1 − 0.90) / (0.06), Sample size (n) = 3.8416
0.90
0.10
/
0.0036,
Sample
size
(n)
=
96.04
=96
patients.
The
minimum
required
sample
size
was
therefore
96
patients.
After
allowing
for
incomplete
records and potential
exclusions, the nal sample size
was increased to 103 patients. We enrolled all eligible
patients
who
underwent
attempted
translumbar
haemodialysis catheter insertion during the study period
using
consecutive
sampling.
The
study
included
patients
with
end-stage
kidney
disease
(ESKD)
who
had
exhausted
or
were
deemed
to
be
unsuitable
for
conventional
vascular
access
methods
and
were
on
maintenance haemodialysis. Indications were occlusion
of
the
superior
vena
cava
or
brachiocephalic
veins,
large
central
venous
thrombosis,
failure
of
multiple
arteriovenous stulas or grafts, inappropriate peripheral
veins
for
new
stulas
or
grafts,
and
unsuccessful
venous
recanalisations.
We
excluded
patients
with
insucient
clinical
and
procedural
information,
no
follow-up
information,
or
those
who
received
a
translumbar
catheter
for
reasons
other
than
long-term
haemodialysis access. Baseline data were obtained from
hospital
records
and
included
age, sex,
BMI,
diabetes
mellitus,
hypertension,
ischaemic
heart
disease,
previous
renal
transplantation,
duration
of
haemodialysis,
haemoglobin,
serum
albumin,
primary
cause
of
end-stage
kidney
disease,
previous
renal
catheterisation sites, and previous arteriovenous access
procedures
and
the
anatomical
or
clinical
indications
for the use of a translumbar catheter. The interventional
team used expertise and a uoroscopic or image-guided
approach to place the translumbar catheter, and aseptic
precautions
were
maintained.
After
assessing
the
inferior
vena
cava
and
surrounding
retroperitoneal
anatomy, the patient was positioned appropriately, local
anaesthesia
was administered with conscious sedation,
and the inferior vena cava (IVC) was accessed through
a posterior translumbar approach. Once the position of
the guidewire had been conrmed, the tract was dilated,
and
a
tunnelled
haemodialysis
catheter
was
advanced
and the tip placed either in the inferior vena cava or at
the cavoatrial junction as appropriate. The catheter was
found
in
the
correct
position
in
the
desired
venous
access;
aspiration
and
ushing
were
satisfactory,
and
haemodialysis was possible, which were achieved as a
Long-Term
Outcomes
of
Translumbar
Haemodialysis
Catheters
as
Salvage
59
J Gandhara Med Dent Sci
October - December 2026
technical
success.
Procedural
variables
included
procedure duration, number of puncture attempts, initial
catheter
blood-flow
rate,
success
of
the
rst
dialysis
session,
and
immediate
complications
such
as
access-
site
bleeding,
retroperitoneal
haematoma,
catheter
malposition, major organ injury, and procedure-related
mortality.
We
followed
patients
with
successful
catheter
placement
using
dialysis
records,
outpatient
visits, hospital admissions, and interventional radiology
chart review. Primary patency was dened as the time
between
catheter
insertion
and
the
rst
procedure
needed
to
maintain
catheter
function
or
to
remove
it.
Assisted primary patency was dened as the duration of
catheter
function
after
one
or
more
interventions
that
resulted
in
sustained
catheter
patency,
but
not
necessarily
permanent
catheter
removal
or
abandonment;
secondary
patency
was
dened
as
the
duration
of
catheter
function
following
catheter
insertion until the permanent removal or abandonment
of the catheter. Catheter dysfunction was dened as an
inadequate
blood-flow rate from the external circuit for
effective
haemodialysis
and/or
the
need
for
an
intervention
to
restore
function.
Long-term
complications
were
catheter-related
bloodstream
infection,
exit-site
infection,
tunnel
infection,
thrombosis
or
occlusion,
dislodgement,
migration,
kinking,
mechanical
damage
or
inferior
vena
cava
thrombosis.
We
dened
the
catheter-related
bloodstream infection rate as the number of infections
per 1,000 catheter-days at risk, calculated as the number
of
infections
reported
divided
by
the
number
of
catheter-days
at
risk.
We
also
collected
data
on
removal, indication for
removal, hospital admission due
to complications, and catheter mortality and function at
the
latest
follow-up.
A
two-sided
p-value
<0.05
was
considered
statistically
signicant.
We
used
SPSS
version 26.0 for data analysis.
RESULTS
We
analysed
103
attempted
translumbar
catheter
placements
for
baseline
and
immediate
procedural
outcomes; we evaluated long-term outcomes among the
101
technically
successful
placements.
The
mean
age
was
53.85
12.62
years,
58
(56.3%)
patients
were
male,
and
the
median
haemodialysis
duration
was
7.1
years
(Q1Q3
5.39.2).
Hypertension
(71.8%)
and
diabetes
mellitus
(47.6%)
were
common.
The
cohort
had
extensive
prior
access
exhaustion:
90.3%
had
previous
internal-jugular
catheterisation,
86.4%
had
undergone
arteriovenous
stula
formation,
67.0%
had
superior
vena
cava
or
brachiocephalic
vein
occlusion,
and
57.3%
had
at
least
two
failed
stulas
or
grafts.
Technical success was achieved in 101/103 procedures
(98.1%),
and
93/103
patients
(90.3%)
completed
the
first
dialysis
session
successfully.
Immediate
complications
occurred
in
10
patients
(9.7%):
ve
minor
access-site
bleeds,
three
small
retroperitoneal
haematomas,
and
two
malpositions
requiring
repositioning.
No
major
organ
injury
or
procedure-
related mortality occurred. During a median follow-up
of
7.0
months,
primary
patency
was
85.3%
at
three
months,
75.5%
at
six
months,
and
57.6%
at
twelve
months.
Median
primary
patency
was
not
reached;
estimated
mean
primary
patency
was
15.62
months.
Median
assisted-primary
and
secondary
patency
were
15.60
and
17.50
months,
respectively.
Catheter
dysfunction
occurred
in
29/101
patients
and
was
successfully
restored
in
18/29.
CRBSI
occurred
in
23/101 (22.8%), equivalent to 0.87 episodes per 1,000
catheter-days,
and
thrombosis/occlusion
occurred
in
20/101
(19.8%).
At
nal
follow-up,
58/101
catheters
(57.4%)
remained
functional.
In
adjusted
analysis,
CRBSI (AOR 10.95, 95% CI 3.3336.00; p<0.001) and
initial blood-ow rate <300 mL/min (AOR 4.14, 95%
CI
1.2313.97;
p=0.022)
independently
predicted
catheter failure.
Table 1: Baseline Characteristics, Previous Access History, and
Indications for Translumbar Catheterisation
Panel A: Demographic and Clinical Characteristics
Variable
Result
Age, years
53.85 12.62
Sex
Male
58 (56.3%)
Female
45
(43.7%)
BMI, kg/m
23.81 3.91
Diabetes mellitus
49 (47.6%)
Hypertension
74 (71.8%)
Ischaemic heart disease
21 (20.4%)
Previous renal transplantation
11 (10.7%)
Dialysis duration, years
7.1 (5.39.2)
Haemoglobin, g/dL
9.52 1.61
Serum albumin, g/dL
3.27 0.62
Primary cause
of end-stage
kidney disease
Diabetic kidney disease
39 (37.9%)
Hypertensive nephropathy
27 (26.2%)
Chronic glomerulonephritis
18 (17.5%)
Polycystic kidney disease
7 (6.8%)
Other or undetermined cause
12 (11.7%)
Panel
B: Previous Vascular Access History and Indications
Variable
n (%)
Previous internal jugular catheter
93 (90.3%)
Previous femoral catheter
65 (63.1%)
Previous subclavian catheter
29 (28.2%)
Previous arteriovenous stula
89 (86.4%)
Previous arteriovenous graft
27 (26.2%)
Two or more failed stulas/grafts
59 (57.3%)
Superior vena cava or brachiocephalic vein
occlusion
69 (67.0%)
Extensive central venous thrombosis
48 (46.6%)
Unsuitable peripheral vessels for new stula
44 (42.7%)
Failed previous recanalisation attempt
31 (30.1%)
Long-Term
Outcomes
of
Translumbar
Haemodialysis
Catheters
as
Salvage
60
J Gandhara Med Dent Sci
October - December 2026
Table 2: Procedural Characteristics and Immediate Outcomes
Variable
Result
Technical success
101 (98.1%)
Procedure duration, minutes
60.22 16.22
Puncture attempts
One attempt
75 (72.8%)
Two attempts
24 (23.3%)
Three attempts
4 (3.9%)
Initial blood-ow rate, mL/min
315.99 40.37
Successful rst dialysis session
93 (90.3%)
Immediate complication
10 (9.7%)
Minor access-site bleeding
05 (4.9%)
Small retroperitoneal haematoma
03 (2.9%)
Catheter malposition requiring
repositioning
02 (1.9%)
Major organ injury
0 (0.0%)
Procedure-related mortality
0 (0.0%)
Table 3: Catheter Patency and Functional Outcomes among
Technically Successful Placements
Outcome
Result
Follow-up duration, months
7.0 (3.014.0)
Three-month primary patency
85.3%
Six-month primary patency
75.5%
Twelve-month primary patency
57.6%
Median primary patency
Not reached
Mean primary patency, months
15.62 (95% CI: 13.49-17.75)
Median assisted primary patency,
months.
15.60 (95% CI: 11.64-19.56)
Median secondary patency, month
17.50 (95% CI: 14.19-20.81)
Catheter dysfunction
29/101 (28.7%)
Successful restoration of catheter
function
18/29 (62.1%)
Mean dialysis blood-ow rate
during follow-up, mL/min
300.50 51.95
Mean delivered Kt/V
1.27 0.18
Table 4: Long-term Catheter Complications, Disposition, and
Clinical Outcomes
Long-term Catheter-Related Complications
Complication
n (%age)
Catheter-related bloodstream infection
23 (22.8%)
Exit-site
infection
13
(12.9%)
Tunnel infection
07 (6.9%)
Catheter thrombosis or occlusion
20 (19.8%)
Catheter dislodgement
06 (5.9%)
Catheter migration
05 (5.0%)
Catheter kinking or mechanical damage
0
8 (7.9%)
Inferior vena cava thrombosis
03 (3.0%)
Catheter-related bloodstream infection
rate
0.87 per 1,000 catheter-
days
Catheter Disposition and Clinical Outcomes
Outcome
n (%age)
Permanent catheter removal
31 (30.7%)
Removal due to dysfunction or
thrombosis
12/31 (38.7%)
Removal due to infection
10/31 (32.3%)
Removal due to dislodgement or
mechanical damage
4/31 (12.9%)
Alternative vascular access established
3/31 (9.7%)
Renal transplantation
2/31 (6.5%)
Hospital admission due to catheter
complication
27 (26.7%)
All-cause mortality
18 (17.8%)
Catheter infection-related mortality
03 (3.0%)
Catheter functional at last follow-up
58 (57.4%)
Table 5: Multivariable Analysis of Factors Associated with
Catheter Failure
Predictor
Adjusted
odds ratio
95% condenc
e interval
p-value
Age ≥60 years
3.19
1.0010.26
0.051
Diabetes mellitus
1.25
0.413.80
0.699
Dialysis duration
≥7 years
1.42
0.484.16
0.526
Five or more
previous access
procedures
0.46
0.151.38
0.168
Serum albumin
<3.0 g/dL
1.47
0.454.80
0.528
Catheter-related
bloodstream
infection
10.95
3.3336.00
<0.001
Initial blood-ow
rate
<300mL/min
4.14
1.2313.97
0.022
DISCUSSION
This
study
showed
that
translumbar
haemodialysis
catheterisation
is
a
feasible
and
potentially
life-
sustaining
vascular-access
strategy
for
patients
with
exhausted
conventional
access
options.
Technical
success was achieved in 98.1% of procedures, 90.3% of
patients
completed
their
rst
dialysis
session
successfully,
and
no
procedure-related
mortality
or
major
organ
injury
occurred.
These
ndings
matter
because
the
participants
represented
a
particularly
dicult
population: 67.0%
had
superior
vena
cava
or
brachiocephalic vein occlusion, 57.3% had at
least two
failed arteriovenous accesses, and 46.6% had extensive
central
venous
thrombosis.
The
technical
success
observed
in
our
study
is
comparable
to
the
97.4%
reported
by
Jonszta
et
al.
in
their
10-year
experience
with
computed
tomography-guided
translumbar
catheter placement.
9
Similarly, Leś et al. reported only
one
major
early
complication
among
34
translumbar
procedures,
supporting
the
procedural
safety
of
this
approach
when
performed
by
an
experienced
team.
8
The
KDOQI
guideline
recommends
individualised
access
selection
according
to
the
patient’s
end-stage
kidney disease life plan.
10
At the same time, Inston et
al.
and
Sharma
et
al.
identied
translumbar
catheterisation
as
an
appropriate
salvage
option
when
conventional
venous
access
cannot
be
established.
10,5
Catheter
patency
and
functional
results
were
also
clinically
acceptable.
Primary
patency
was
85.3%
at
three months, 75.5% at six months and 57.6% at twelve
months, while
median
assisted
primary
and secondary
patency were 15.60 and 17.50 months, respectively. At
the
last
follow-up,
57.4%
of
the
catheters
were
still
working. Jonszta et al. reported 88.7% primary assisted
patency
at
1
year
and
72.0%
at
3
years
after
translumbar
catheter
placement
performed
under
the
guidance of computed tomography (CT).
9
Their higher
1-year
estimate
may
reect
dierences
in
catheter
Long-Term
Outcomes
of
Translumbar
Haemodialysis
Catheters
as
Salvage
61
J Gandhara Med Dent Sci
October - December 2026
denition
of
patency,
patient
selection,
catheter
maintenance,
and
intervention
frequency.
However,
both
studies
show
that
translumbar
access
effectively
sustains dialysis for a clinically relevant time. Raskin et
al.
also
found
that
translumbar
access
was
technically
successful and maintained vascular access patency for a
long
time
in
patients
with
end-stage
vascular
access
failure.
2
Sood et al. described translumbar access as one
of
the
most
useful
unconventional
routes
because
it
allows
catheter
exchange
over
a
guidewire
and
may
reduce migration
compared
with transhepatic
access.
12
Most importantly, a 2026 systematic review and meta-
analysis of 18 observational studies with 649 catheters
found
that
rates
of
irreversible
infection,
irreversible
dysfunction,
thrombosis,
and
catheter
displacement
were
signicantly
lower
with
translumbar
than
with
transhepatic catheters.
13
These results further reinforce
the importance of translumbar access for TEE when the
IVC is available, and patient anatomy is favorable. The
overall
success
rate
was
acceptable,
but
in
28.7%
of
successful
placements,
catheters
were
dysfunctional,
and
in
19.8%
of
placements,
thrombosis
or
catheter
occlusion
occurred.
In
62.1%
of
the
dysfunctional
catheters,
their
function was
restored,
highlighting
the
crucial
role
of
early
radiological
assessment
and
catheter-salvage
interventions.
Blood-flow
rate
(mean
during
follow-up)
was
around
300
mL/min
and
mean
delivered Kt/V was 1.27, which is generally acceptable
dialysis delivery. Adjusted odds of catheter failure were
more
than
four-fold
higher
with
an
initial
blood-flow
rate < 300 mL/min. If ow is poor initially, the catheter
tip may be malpositioned, kinked, or in contact with the
vessel wall, or the catheter may develop an early brin
sheath and/or thrombus. The technique
was developed
to enhance anatomical visualisation and reduce the risk
of
malposition,
vascular
injury,
and
injury
to
neighboring
retroperitoneally
located
structures.
14
Contemporary reviews also emphasise that appropriate
catheter
length
and
tip
placement
near
the
cavoatrial
region
are
essential
to
achieve
adequate
ow
and
reduce
recirculation
and
dysfunction.
12,13
Therefore,
a
catheter
with
an
initial
ow
rate
below
300
mL/min
should
not
be
considered
technically
adequate
and
should be promptly assessed by imaging and corrected.
The
most
signicant
late
complication
was
catheter-
related bloodstream infection (CRBSI), which occurred
at
0.87
per
1,000
catheter-days,
or
22.8%
of
patients.
The
overall
rate
of
0.40
per
1,000
catheter-days
was
higher than the rate reported by Almenara-Tejederas et
al. (0.40 per 1,000 catheter-days), but much lower than
the rate reported by Hajji et al. (3.7 per 1,000 catheter-
days).
7,15
In
a
similar
study,
Shahar
et
al.
found
that
bloodstream infection was an important complication in
haemodialysis
catheter
users
and
associated
it
with
longer
catheter
use
and
other
patient-related
risks.
16
Variations in catheter infection rates across studies may
reect
dierences
in
catheter-care
methods,
comorbidities, catheter duration, denitions of catheter-
associated
infection,
and
surveillance
regimes.
The
current
study
found
that
adjusted
odds
of
catheter
failure were nearly elevenfold higher with bloodstream
infection, indicating that infection poses a serious risk
to patient safety and catheter access. In haemodialysis
patients,
screening
and
targeted
decolonisation
in
selected high-risk groups may be benecial, as Vanegas
et
al.
showed
that
bacteraemia
is
signicantly
associated with S. aureus colonisation.
17
Fujimoto et al.
reported
that
sutureless
securement
was
signicantly
associated
with
reduced
CBI
risk
compared
with
conventional suturing, but they analysed non-tunnelled
catheters.
18
These ndings highlight the importance of
strict
hand
hygiene,
chlorhexidine
skin
antisepsis,
standardised hub disinfection, sterile dressing changes,
regular
exit-site
assessment,
and
prompt
treatment
based on culture.
LIMITATIONS
This
study
has
several
limitations.
Its
record-based,
single-centre
design
is
susceptible
to
selection
bias,
incomplete documentation, and variation in follow-up.
Median
follow-up
was
seven
months,
which
reduces
precision
of
longer-term
patency
estimates.
The
study
included no direct comparator group using transhepatic
access, surgical bypass, right-atrial grafting, or another
unconventional
route.
The
number
of
catheter-failure
events was limited relative to the number of predictors
included
in
the
regression
model,
resulting
in
wide
confidence intervals and possible residual confounding.
The
analysis
did
not
capture
infecting
organisms,
antimicrobial-resistance
proles,
catheter-lock
solutions,
detailed
salvage
interventions,
patient-
reported quality of life, or competing-risk methods for
transplantation
and
death.
Prospective
multicentre
comparisons
should
address
these
issues
with
standardised
patency
denitions
and
catheter-care
protocols.
CONCLUSIONS
Translumbar
haemodialysis
catheterisation
achieved
high technical success, acceptable dialysis performance,
and
clinically
meaningful
medium-
to
long-term
patency in patients with exhausted conventional access.
CRBSI
and
an
initial
blood-flow
rate
below
300
mL/min
were independent predictors
of failure. When
conventional routes are no longer feasible, translumbar
access
is
a
valuable
salvage
option
provided
that
placement
is
image
guided,
catheter
function
is
monitored
closely,
and
rigorous
infection-prevention
practices are maintained.
Long-Term
Outcomes
of
Translumbar
Haemodialysis
Catheters
as
Salvage
62
J Gandhara Med Dent Sci
October - December 2026
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CONFLICT OF INTEREST:
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FUNDING SOURCES:
None
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AUTHORS
CONTRIBUTION
The authors accept responsibility for all aspects of the work
and will ensure that any concerns regarding the accuracy or
integrity of any part are properly investigated and resolved.
Shuah
Ullah
-
Concept
&
Design;
Data
Acquisition;
Date
Analysis/Interpretation;
Drafting
Manuscript;
Critical
Revision; Final Approval
Ammar Hussain -
Concept & Design; Data Acquisition; Data
Analysis/Interpretation;
Drafting
Manuscript;
Critical
Revision; Final Approval
Nabila
Khan
-
Concept
&
Design;
Data
Acquisition;
Data
Analysis/Interpretation;
Drafting
Manuscript;
Critical
Revision; Final Approval
Shariq
Bin
Yousuf
-
Concept
&
Design;
Data
Acquisition;
Data
Analysis/Interpretation;
Drafting
Manuscript;
Critical
Revision; Final Approval
Abdul Khalique
-
Concept & Design; Data Acquisition; Data
Analysis/Interpretation;
Drafting
Manuscript;
Critical
Revision; Final Approval
Ziad
Sophie
-
Concept & Design; Data
Acquisition;
Drafting
Manuscript; Critical Revision; Supervision; Final Approval
Long-Term
Outcomes
of
Translumbar
Haemodialysis
Catheters
as
Salvage
