Percutaneous Translumbar Vs Transhepatic Permcath

The aim of the study is to emphasize the technique , success rate , efficacy of translumbar and transhepatic approaches and shed light on the complications of both methods and through comparison we can give recommendations to either of these methods.

Inclusion Criteria:- Chronic dialysis patients with failed classic routes of catheterization ( internal jugular, subclavian and femoral veins bilaterally ) as well as non-functioning a-v fistulas.Exclusion Criteria:Patients with uncorrectable coagulopathy.Patients on long term anticoagulantsConcurrent active infection.Sgnificant abdominal ascites. (transhepatic)Cirrhotic liver disease patients. (transhepatic)Morbid obesity. (translumbar)