Transhepatički venski pristup za hemodijalizu – iskustvo jednog centra

  • Momir Šarac Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Goran Sjeničić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Dragan Sekulić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Saša Micković Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Sanja Šarac University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Goran Rondović Military Medical Academy, Clinic for Anesthesiology and Intensive Care, Belgrade, Serbia
  • Mihajlo Bezmarević University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP200922002S
Ključne reči: kateteri, trajni, kateterizacija, centralna, venska, hemodijaliza, jetra, cirkulacija, radiologija, interventna

Sažetak


Uvod. Za postavljanje tuneliziranih katetera za hemodijalizu u donju šuplju venu koristi se perkutani transhepatični pristup. Ovaj pristup preko suprahepatičnog dela donje šuplje vene mogao bi da se  koristi za postavljanje tuneliziranog katetera za trajnu hemodijalizu, sa minimalnim rizikom od pojave komplikacija i sa odličnom funkcionalnošću. Prikaz bolesnika. U periodu od 2011. do 2020. godine, u Vojnomedicinskoj akademiji u Beogradu kod 4 bolesnika bio je postavljen transhepatični kateter za hemodijalizu. Svi bolesnici su imali iscrpljene vaskularne pristupe tokom dugogodišnjeg perioda hemodijalize. Kao posledica dugotrajnih hemodijaliza preko femoralnih katetera kod njih su bile prisutne trombozirane arteriovenske fistule na gornjim ekstremitetima, bilteralna tromboza supklavijske vene, tromboza gornje i donje šuplje vene, kao i bilateralna tromboza ilijačne i femoralne vene. Peritoneumska dijaliza nije bila moguća. Kod jednog bolesnika je bilo potrebno uraditi repoziciju katetera, a kod drugog smo uradili trombolizu katetera zbog malfunkcije. Druga dva bolesnika imala su uspešne hemodijalize bez pojave komplikacija u trajanju od 300, odnosno 1 650 dijaliznih dana. Zaključak. Perkutani transhepatični venski pristup vođen ultrazvukom i radioskopskom kontrolom je sigurna metoda i prihvatljiva je alternativa za plasiranje tuneliziranih hemodijaliznih katetera ukoliko su iscrpljeni drugi dijalizni pristupi i kada ih izvodi dobro obučen tim.

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Objavljeno
2022/07/13
Broj časopisa
Vol. 79 Br. 5 (2022): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika