Transhepatic central venous access for cardiac catheterization and radiologic intervention

Abstract

We describe a technique of direct puncture and catheterization of the hepatic veins for cardiac catheterization and radiologic intervention in children who lack conventional access routes. Four patients underwent eight direct hepatic vein punctures to allow cardiac catheterization (3 patients) and 5-12 F sheath insertions for balloon dilatation of hepatic vein stenoses (1 liver transplant patient). Gelfoam was injected in the sheath tract for hemostasis. All procedures were successful, including five hepatic vein dilatations and right heart access for three cardiac catheterizations. There were no complications. When conventional venous access is precluded, direct percutaneous catheterization of hepatic veins is easy, effective, and probably low risk.