# The Tunnelled Atrial Catheter: A Promising Solution for Vascular Capital Depletion in Dialysis despite Associated Thrombi

## TL;DR

A tunneled atrial catheter is a safe and effective dialysis option for patients with no other vascular access, despite potential complications like blood clots.

## Contribution

The study presents real-world clinical experience with ATDC as a last-resort vascular access for dialysis patients.

## Key findings

- Two patients with exhausted vasculature successfully used ATDC for dialysis with patency lasting up to 29 months.
- One case of post-operative thrombosis was resolved with thrombolysis, showing the treatability of complications.
- ATDC is a viable and life-saving option when traditional vascular access is no longer possible.

## Abstract

Longer survival in dialysis led to a higher incidence of vascular access complications and failure. With the limited access to kidney transplantation programs and peritoneal dialysis, exhaustion of vascular access for hemodialysis is an increasingly common situation. Among the available options, atrial tunneled dialysis catheter (ATDC) has been reported as an effective vascular access in this population. Methodology. We report the experiences of two nephrology centers in Tunis with ATDC as an ultimate vascular access for dialysis. Case Reports. Two patients with exhausted vasculature underwent ATDC insertion in 2020 and 2022, respectively, as a vascular access of last resort. Both patients underwent CRBI, which resolved with favorable outcomes. One case was complicated by post-operative thrombosis and was successfully treated with thrombolysis. Both patients are currently on dialysis via their ATDC with a catheter patency of 29 months.

ATDC is a life-saving and safe vascular access in cases of depleted vasculature. Little more than 50 cases have been reported in the literature during the last 30 years. As the frequency of vasculature exhaustion is expected to increase, preservation of veinous access in patients at risk of chronic kidney disease have never been more crucial.