In Reply to: Case 1299_04 -- Placement of a Pulmonary Arterial Hemodialysis Catheter: The Last Resort posted by Editor on November 30, 1999 at 15:56:28:
We have cared for a patient with a similar tale of access woe, but did not take the final step to a pulmonary artery catheter because she underwent a little-known "last surgical resort" procedure. She was given a left axillary artery to right atrial appendage dialysis graft that has been functioning well for several months. Clearly, the thoracotomy risks of this graft outweigh catheter placement (even via middle hepatic vein), but once past that I would think the longer-term risks of a the large dialysis catheter in the pulmonary artery outweigh the surgery.