Translumbar and Transhepatic tunnelled cuffed dialysis access: the routes less traversed

Abstract Background Chronic kidney disease (CKD) is a major public health problem with more than 850 million people affected worldwide and will become fifth biggest cause of Years of life lost (YLL) by the year 2040. Deaths due to CKD in India increased from 0.59 million in 1990 to 1.18 million in 2016. Due to the expected increase in life expectancy of the dialysis patient and the limited kidney donors available, the need for vascular access is critical, though challenging. The traditional routes of access such as arteriovenous fistulae and central tunnelled catheter insertions are not devoid of complications and drawbacks, such as infections, thrombosis and stenosis, and when these routes get exhausted, the unconventional routes come into the picture. In this article, we will discuss two unconventional routes i.e. Translumbar and Transhepatic tunnelled cuffed dialysis access. Methods Numerous conventional access for haemodialysis is created in our institution on a regular basis; however, two unconventional procedures were also done in our institution, one each of translumbar and translumbar central tunnelled catheter insertions in DSA suit following proper instructions and guidelines. Results Both the central tunnelled catheter insertions were successful with no peri-procedural complications. Patient with translumbar and transhepatic central tunnelled catheter insertion received 15 and 21 cycles of haemodialysis, respectively, with subsequent successful renal transplant in both the patients. Conclusion The lack of donors for renal transplant is a major roadblock for CKD patients, and so, renal replacement therapy is much needed by conventional routes of dialysis. The role of unconventional routes like transhepatic and translumbar tunnelled catheters comes into play for renal replacement therapy and as a bridging gap for renal transplant.