Tunnelled translumbar catheterization of IVC Nik Rizal NY et al. 65 CT-Guidance Combined with Fluoroscopy for Tunnelled Translumbar Catheterization of Inferior Vena Cava: A Technical Case Report Nik Rizal NY 1 , Shahrina MH 1 , Abdullah M 2 , Rozman Z 2 , Sobri M 2 () 1 Department of Diagnostic Imaging, Hospital Selayang, Selayang, Selangor 2 Abstract Patients with end-stage renal disease typically require catheter hemodialysis during the time required for fistula or graft maturation or after other methods of hemodialysis are exhausted. When patients requiring indwelling catheters develop central venous occlusions, unconventional routes to the central veins are used. Translumbar catheterization of inferior vena cava is considered as one of the options for central venous access. We highlight a case of Translumbar central venous tunelled catheterization performed under Computed Tomography (CT) guidance combined with fluroscopy in a 40-year-old lady with end-stage renal failure. Keywords: CT-Guidance, translumbar, central venous catheter, hemodialysis Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia Fax: +60391737824. Tel: +603-9145 6172 Email: sobri_muda@yahoo.com Date of submission: 24 Jan 2011 Date of acceptance: 17 Mac 2011 Date of publication: 6 Apr 2011 Correspondence: Dr. A. Sobri Muda, Associate Professor, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak 56000 Cheras, Kuala Lumpur, Malaysia. Introduction The traditional access for a central venous catheter is through the subclavian or internal jugular vein. However, in patients with central vein obstruction, alternative routes are needed such as the inferior vena cava (IVC), for placement of the catheters. Translumbar placement of IVC catheters is performed only in patients considered to have few or no other options and is not intended as the primary central venous access. There are different routes to gain access to the IVC, routinely transfemoral and rarely translumbar or transhepatic. The translumbar catheterization of IVC been used for chemotherapy, antibiotics, plasmaphoresis, hemodialysis, parenteral nutrition or others (1). The translumbar catheterization of IVC is generally performed under fluoroscopic guidance rather than Computed Tomography (CT) combined with fluroscopy guidance. CT guidance combined with fluroscopy is able to clearly define the anatomy of the IVC and its relationship to the surrounding structures, making the puncture more accurate. We describe translumbar placement of the central venous catheter using CT guidance combined with fluroscopy. Case report and technical note. A 40-year-old lady with Systemic Lupus Erythematosus (SLE)-related end stage renal failure has been on regular haemodialysis for more than 10 years. After all arteriovenous fistulas became non- functional, she relied on central venous dialysis via femoral, jugular, subclavian veins, and peritoneal dialysis. She presented with thrombosed both jugular and femoral veins with peritonitis secondary to peritoneal dialysis. Prior to the procedure, consent was taken from the patient. Plain baseline CT scan was performed to identify the IVC and to plan the puncture. The access Technical report