nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2025-29-4-112-117QUMNNUnefr-2503Research ArticleНАБЛЮДЕНИЯ ИЗ ПРАКТИКИPRACTICAL NOTESКлинический случай транспеченочной реканализации брахиоцефальной вены с одномоментной имплантацией туннельного центрального венозного катетера для гемодиализаClinical case of transhepatic recanalization of the brachiocephalic vein with simultaneous implantation of a tunneled central venous catheter for hemodialysishttps://orcid.org/0009-0005-6702-2292ВетровК. П.VetrovK. P.

Ветров Кирилл Павлович

620102, Свердловская обл., г. Екатеринбург, ул. Волгоградская, д. 185

Тел.: (343) 351-15-19

Kirill P. Vetrov, MD

620102, Russia, Yekaterinburg, Volgogradskaya St., 185

Phone: +7 (343) 351-15-19

mr.vetrov.kv@gmail.comhttps://orcid.org/0009-0006-4219-3383БорецкаяЕ. И.BoretskayaE. I.

Борецкая Елена Ильинична, канд. мед. наук

620102, Россия, Свердловская обл., г. Екатеринбург, ул. Волгоградская, д. 185

Тел.: (343) 351-15-83

Elena I. Boretskaya, MD, PhD

620102, Yekaterinburg, Volgogradskaya St., 185

bei22@mail.ruhttps://orcid.org/0009-0008-2891-154XКардапольцевЛ. В.KardapoltsevL. V.

Кардапольцев Лев Владимирович

620102, Свердловская обл., г. Екатеринбург, ул. Волгоградская, д. 185

Тел.: (343) 351-15-19

Lev V. Kardapoltsev

620102, Russia, Yekaterinburg, Volgogradskaya St., 185

Phone: +7 (343) 351-15-19

lvkard@mail.ruhttps://orcid.org/0009-0009-5204-9934КолокольцеваД. А.KolokoltsevaD. A.

Колокольцева Дарья Аркадьевна

620102, Свердловская обл., г. Екатеринбург, ул. Волгоградская, д. 185

Тел.: (343) 351-15

Darya A. Kolokoltseva

620102, Yekaterinburg, Volgogradskaya St., 185

Phone: +7 (343) 351-15-83

dashik19922008@icloud.comhttps://orcid.org/0000-0002-4208-4658КовинА. Е.KovinE. A.

Ковин Егор Андреевич

620102, Свердловская обл., г. Екатеринбург, ул. Волгоградская, д. 185

Тел.: (343) 351-15-83

Egor A. Kovin

620102, Yekaterinburg, Volgogradskaya St., 185

Phone: +7 (343) 351-15-83

eakovin@inbox.ruhttps://orcid.org/0009-0007-5509-1906СветловГ. С.SvetlovG. S.

Светлов Георгий Станиславович

620102, Свердловская обл., г. Екатеринбург, ул. Волгоградская, д. 185

Тел.: (343) 351-15-19

Georgiy S. Svetlov

620102, Yekaterinburg, Volgogradskaya St., 185

Phone: +7 (343) 351-15-19

gs_svetlov@mail.ruСвердловская областная клиническая больница №1РоссияState Autonomous Healthcare Institution of Sverdlovsk Region "Sverdlovsk Regional Clinical Hospital No. 1"Russian Federation202526012026294112117Copyright © Ветров К.П., Борецкая Е.И., Кардапольцев Л.В., Колокольцева Д.А., Ковин А.Е., Светлов Г.С., 20262026Ветров К.П., Борецкая Е.И., Кардапольцев Л.В., Колокольцева Д.А., Ковин А.Е., Светлов Г.С.Vetrov K.P., Boretskaya E.I., Kardapoltsev L.V., Kolokoltseva D.A., Kovin E.A., Svetlov G.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/2503

На фоне длительной заместительной почечной терапии гемодиализом постепенно может произойти утрата всех возможных сосудистых доступов, в том числе, и в связи с предыдущими катетеризациями. Кроме того, перитонеальный диализ у этих пациентов, как правило, уже неэффективен. В подобных клинических случаях в качестве спасательной процедуры по жизненным показаниям остается только попытка имплантации туннельного центрального венозного катетера (ЦВК) для гемодиализа в качестве единственного возможного адекватного доступа. Подобные ситуации, возможно, являются нечастыми, но в тоже время возникают достаточно регулярно. Использование транспеченочного доступа в качестве дополнительного метода для реканализации центральных вен оправдано, но при отсутствии других, менее опасных вариантов. В случае полной утраты классических сосудистых доступов при неудачной попытке транспеченочной реканализации центральных вен через созданный доступ может быть установлен туннельный ЦВК в правое предсердие.

With long-term renal replacement therapy with hemodialysis, all possible vascular accesses may gradually be lost, including those associated with previous catheterizations. Furthermore, peritoneal dialysis is typically no longer effective in these patients. In such clinical cases, the only viable option is to attempt a tunneled central venous catheter (CVC) for hemodialysis as a life-saving procedure, based on life-saving indications. Such situations may be uncommon, but they do occur quite regularly. The use of transhepatic access as an additional method for central vein recanalization is justified, but only in the absence of other, less risky options. In cases of complete loss of classic vascular accesses following an unsuccessful attempt at transhepatic recanalization of the central veins, a tunneled CVC can be inserted into the right atrium through the created access.

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The authors declare that there are no conflicts of interest present.