Figure 523

Translumbar catheter placement. Patients receiving chronic hemodialysis may exhaust potential sites for permanent vascular access. Additionally, after long-term use of central vein catheters, these sites also develop irreversible occlusion. In most cases, these patients are trained for peritoneal dialysis; however, some patients cannot tolerate this modality. This patient failed all attempts at arteriovenous and central vein access placement, including those involving the vessels of the lower extremity. Peritoneal dialysis was not possible owing to recurrent disabling pleural effusions. Translumbar placement of tunneled catheters (arrow) into the inferior vena cava can provide a long-term solution for the patient with no apparent remaining access sites.

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