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Kidney Week

Abstract: PO1360

Unusual Dialysis Catheter Location in a Transplant Patient

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Report

  • 704 Dialysis: Vascular Access

Authors

  • Via Reque Cortes, Daniela del Pilar, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Vale, Pablo Andrade, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
  • Lins, Paulo Ricardo Gessolo, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, São Paulo, Brazil
Introduction

Persistent left superior vena cava (PLSVC) is the most common thoracic venous malformation, despite its low incidence. PLSVC is generally discovered fortuitously without clinical signs. Serious hemodynamic complications may occur during the implantation and the permanency of a hemodialysis vascular access on this vessel.

Case Description

A 56-year-old woman, kidney transplant recipient 8 years ago, was admitted to the Intensive Care Unit with septic shock secondary to disseminated shingles after immunosuppressive therapy for acute cellular rejection. The patient developed acute kidney injury requiring renal replacement therapy. Due to history of right internal jugular vein thrombosis, the left internal jugular vein was catheterized with a non-tunneled double lumen hemodialysis catheter (12 French, 20 cm) without any complications. Routine post-procedure chest radiograph showed that the catheter was descending straight into the left border of the mediastinum (Image 1A). CT angiography (CTA) of the neck and thorax revealed the catheter localized on the PLSVC (Image 1B). The patient was placed on hemodialysis through this access uneventfully throughout the hospitalization period.

Discussion

PLSVC is a congenital malformation reported in 0.4-0.5% of the general population. Patients are mostly asymptomatic and the anomaly is frequently underdiagnosed or only noticed incidentally during imaging studies. Some patients can present with arrhythmias and sudden death. Screening diagnostic studies include chest radiograph and echocardiography, confirmed by CTA, magnetic resonance and cardiac catheterization. The possibility of catheterization of PLSVC is uncertain. Some authors argue that this vessel is too thin to keep a long-term catheter, but others suggest that if an accurate assessment of inner diameter of the vein can be performed before catheterization, it could be used as a site for conventional vascular access. However, there are reports of serious complications during catheterization such as pneumothorax, hemothorax, arrhythmias and cardiac arrest.

Image 1A/1B.