At the Viewbox: Transhepatic Port Placement

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Transhepatic Port Placement

A 15-year-old child with cerebral palsy, ventriculoperitoneal shunt infection, and bowel obstruction required central venous access. Peripherally inserted central catheter placement was unsuccessful. An internal jugular catheter was requested; however, ultrasound (not shown) revealed absence of the internal jugular veins with extensive collateral veins, one of which was accessed for a subsequent venogram. The venogram showed a lack of opacification of the internal jugular, subclavian, and brachiocephalic veins, as well as the superior vena cava; multiple collateral were present (A). MR angiogram confirmed the lack of central venous patency in the chest (B).

When traditional methods of venous access have been exhausted, there are a few non-traditional options for central catheters. The first is the inferior vena cava (IVC) via translumbar approach.1 A small caliber IVC and severe scoliosis in this case made the translumbar approach implausible. Another option is to utilize a collateral vessel to gain access to the central venous system. This patient had no patent central veins in the chest; therefore, the decision was made to place a transhepatic catheter. Using image guidance, the middle hepatic vein was accessed. A wire and catheter were advanced into the right atrium, a surgical port pocket was created, and the tip of the catheter was positioned in the right atrium (C). Transhepatic central venous access is a feasible option in pediatric patients when the usual venous access sites are not available.2

References

  1. Azizkhan RG, Taylor LA, Jaques PF, et al. Percutaneous translumbar and transhepatic inferior vena caval catheters for prolonged vascular access in children. J Pediatr Surg 1992;27(2):165-169.
  2. Mortell A, Said H, Doodnath R, et al. Transhepatic central venous catheter for long-term access in paediatric patients. J Pediatr Surg 2008;43(2):344-347.
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McDaniel JD, Pittinger TP.  At the Viewbox: Transhepatic Port Placement.  J Am Osteopath Coll Radiol.  2016;5(1):29.

About the Author

Janice D. McDaniel, M.D., Timothy P. Pittinger, M.D.

Janice D. McDaniel, M.D., Timothy P. Pittinger, M.D.

Dr. McDaniel works with the Division of Pediatric Interventional Radiology and Dr. Pittinger works with the Division of Pediatric Surgery, Akron Children’s Hospital, Akron, OH.


 

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