Long-Term Outcomes of Translumbar Haemodialysis Catheters as Salvage Vascular Access in Patients with Exhausted Conventional Access Options
DOI:
https://doi.org/10.37762/jgmds.13-4.988Keywords:
Translumbar Catheter, haemodialysis, Vascular Access Failure, Catheter Patency, Bloodstream Infection, End-Stage Kidney DiseaseAbstract
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 identified independent predictors of catheter failure.
RESULTS
Technical success was achieved in 101/103 patients (98.1%), and 93 (90.3%) completed the first 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-flow 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 flow may improve durability and reduce access failure. These findings support translumbar access as a practical last-resort dialysis strategy.
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El Khudari H, Ozen M, Kowalczyk B, Bassuner J, Almehmi A. Hemodialysis catheters: update on types, outcomes, designs and complications. Semin Intervent Radiol. 2022;39(1):90-102. doi:10.1055/s-0042-1742346. PMID: 35210738 DOI: https://doi.org/10.1055/s-0042-1742346
Raskin D, Kirksey L, Bergen M, Gadani S, Levitin A, Quatromoni JG, et al. Translumbar and transhepatic tunneled dialysis catheter placements in the end stage renal disease population. Int J Cardiovasc Imaging. 2025;41(2):339-346. doi:10.1007/s10554-024-03313-6. PMID: 39731631 DOI: https://doi.org/10.1007/s10554-024-03313-6
Herscu G, Woo K, Weaver FA, Rowe VL. Use of unconventional dialysis access in patients with no viable alternative. Ann Vasc Surg. 2013;27(3):332-336. doi:10.1016/j.avsg.2012.04.019. PMID: 22998789 DOI: https://doi.org/10.1016/j.avsg.2012.04.019
Shehab M, Griton I, Kosykh S, Bachar AR, Haddad M, Rozenberg I. Alternative dialysis access strategies: a case report of a patient with transrenal hemodialysis catheter due to exhausted traditional routes and review of literature. J Vasc Access. 2025;26(2):687-692. doi:10.1177/11297298231220534. PMID: 38205592 DOI: https://doi.org/10.1177/11297298231220534
Sharma M, Tong WL, Thompson D, Vachharajani TJ. Placing an appropriate tunneled dialysis catheter in an appropriate patient including the nonconventional sites. Cardiovasc Diagn Ther. 2023;13(1):281-290. doi:10.21037/cdt-22-426. PMID: 36864971 DOI: https://doi.org/10.21037/cdt-22-426
Pride LB, Assaf EJ, West-Livingston LN, Cui CL, Chun TT, Long CA. Alternatives for exhausted dialysis access. Semin Vasc Surg. 2024;37(4):400-406. doi:10.1053/j.semvascsurg.2024.10.003. PMID: 39675848 DOI: https://doi.org/10.1053/j.semvascsurg.2024.10.003
Almenara-Tejederas M, Rodríguez-Pérez MA, Moyano-Franco MJ, de Cueto-López M, Rodríguez-Baño J, Salgueira-Lazo M. Tunneled catheter-related bacteremia in hemodialysis patients: incidence, risk factors and outcomes. A 14-year observational study. J Nephrol. 2023;36(1):203-212. doi:10.1007/s40620-022-01408-8. PMID: 35976569 DOI: https://doi.org/10.1007/s40620-022-01408-8
Leś J, Spaleniak S, Lubas A, Niemczyk S, Kade G. Early complications of translumbar cannulation of the inferior vena cava as a quick, last-chance method of gaining access for hemodialysis: ten years of experience in one clinical center. Wideochir Inne Tech Maloinwazyjne. 2021;16(1):282-288. doi:10.5114/wiitm.2020.99944. PMID: 33786145 DOI: https://doi.org/10.5114/wiitm.2020.99944
Jonszta T, Czerny D, Prochazka V, Vrtkova A, Chovanec V, Krajina A. Computed tomography (CT)-navigated translumbar hemodialysis catheters: a 10-year single-center experience. Med Sci Monit. 2020;26. doi:10.12659/MSM.927723. PMID: 33318464 DOI: https://doi.org/10.12659/MSM.927723
Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4 Suppl 2). doi:10.1053/j.ajkd.2019.12.001. PMID: 32778223 DOI: https://doi.org/10.1053/j.ajkd.2019.12.001
Inston N, Khawaja A, Mistry H, Jones R, Valenti D. Options for end stage vascular access: translumbar catheter, arterial-arterial access or right atrial graft? J Vasc Access. 2020;21(1):7-18. doi:10.1177/1129729819841153. PMID: 30977412 DOI: https://doi.org/10.1177/1129729819841153
Sood S, Gamanagatti S, Navneet, Sharma K. Translumbar and transhepatic tunnelled cuffed dialysis access: the routes less traversed. Egypt J Radiol Nucl Med. 2025;56:111. doi:10.1186/s43055-025-01531-z. PMID: not available DOI: https://doi.org/10.1186/s43055-025-01531-z
Melo Tavares RJ, Póvoa-Corrêa M, de Souza Mateus Tarricone I, Collopy S, Gonçalves RL, da Silva Magliano CA, et al. Translumbar and transhepatic catheters for hemodialysis in chronic kidney disease: a systematic review and meta-analysis. Kidney Med. 2026;8(2):101216. doi:10.1016/j.xkme.2025.101216. PMID: 41630995 DOI: https://doi.org/10.1016/j.xkme.2025.101216
Partovi S, Kirksey L. Endovascular and surgical interventions in the end-stage renal disease population. Cardiovasc Diagn Ther. 2023;13(1):112-114. doi:10.21037/cdt-23-25. PMID: 36864961 DOI: https://doi.org/10.21037/cdt-23-25
Hajji M, Neji M, Agrebi S, Ben Nessira S, Ben Hamida F, Barbouch S, et al. Incidence and challenges in management of hemodialysis catheter-related infections. Sci Rep. 2022;12(1):20536. doi:10.1038/s41598-022-23787-5. PMID: 36446808 DOI: https://doi.org/10.1038/s41598-022-23787-5
Shahar S, Mustafar R, Kamaruzaman L, Periyasamy P, Pau KB, Ramli R. Catheter-related bloodstream infections and catheter colonisation among haemodialysis patients: prevalence, risk factors, and outcomes. Int J Nephrol. 2021;2021:5562690. doi:10.1155/2021/5562690. PMID: 34249377 DOI: https://doi.org/10.1155/2021/5562690
Vanegas JM, Salazar-Ospina L, Roncancio GE, Jiménez JN. Staphylococcus aureus colonisation increases the risk of bacteremia in hemodialysis patients: a molecular epidemiology approach with time-dependent analysis. Am J Infect Control. 2021;49(2):215-223. doi:10.1016/j.ajic.2020.05.031. PMID: 32485274 DOI: https://doi.org/10.1016/j.ajic.2020.05.031
Fujimoto K, Iida E, Kumano S, Fujii A, Adachi H, Furuichi K, et al. Effect of sutureless securement on hemodialysis catheter-related bloodstream infection. Sci Rep. 2021;11(1):21771. doi:10.1038/s41598-021-01372-6. PMID: 34741127 DOI: https://doi.org/10.1038/s41598-021-01372-6
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Copyright (c) 2026 Shuah Ullah, Ammar Hussain, Nabila Khan, Shariq Bin Yousuf, Abdul Khalique, Ziad Sophie
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