Clinical Presentation

A 60-year-old man with end-stage renal disease requires placement of a permanent catheter for hemodialysis.

(A) Translumbar placement of a permanent hemodialysis catheter. With the patient prone, punctures are made to the right of the spine at L3 (arrow) from the level of the right iliac crest. (B) Contrast injection verifies direct inferior vena cava (IVC: arrow) puncture for permanent catheter placement. (C) Permanent catheter (arrow) is tunneled from the right side subcutaneously to the puncture site and advanced through a peel-away sheath until the tip is at the junction of the right atrium and IVC.

Differential Diagnosis

• Translumbar hemodialysis catheter