Anatomy Revisited: Hemodialysis Catheter Malposition in the Left Ascending Lumbar Vein

Abstract

In selected cases, cuffed tunneled catheters via the iliac vein are implanted as a last resort access for hemodialysis. To monitor the correct position, sonography of the inferior vena cava (IVC) is sufficient in most cases. Position control using an X-ray of the abdomen is not routinely recommended when femoral catheters are implanted. In this report, we describe the case of a 59-year-old patient on chronic hemodialysis due to granulomatosis with polyangiitis and complex shunt history with multiple shunt occlusions and revisions. The implantation of an iliac-cuffed tunneled catheter led to complications because the catheter was malpositioned into the left ascending lumbar vein (ALV). It is important to be aware of potential incorrect positioning of dialysis catheters into the ALV. Due to the anatomical relation to the IVC, this happens more frequently on the left side than on the right side. In case of doubt, the correct placement of large-bore catheters via iliac access route should be verified by means of appropriate imaging before hemodialysis is performed.

One patient, two malpositioned hemodialysis catheters, (hepatic vein and ascending lumbar vein), no fluoroscopy

“…3,4 However, CTHC inserted into the ALV via FV is a rarer malposition. 5,8 As in our case, the possibility of malposition of the catheter to the ALV is higher in interventions performed through the left FV, due to the wider angle between the left ALV and CIV. 9 Findings such as difficulties in advancing the guide wire or catheter, insufficient blood flow in aspiration, and sudden lower back pain during insertion suggest catheter malposition.…”

“…7 However, complications such as malposition and dysfunction have been reported after catheterization through FV. [3][4][5] In our case as well, malposition developed in both catheter interventions, and late diagnosis could be made since no evaluation was made with fluoroscopy or x-ray immediately after the procedure.…”

“…2,3 The insertion of the hemodialysis catheter tip into the hepatic veins is a very rare condition 4 ; yet, the insertion of the hemodialysis catheter tip into the ascending lumbar vein (ALV) is a rarer condition. 5 Placement of CTHC first in the hepatic vein and then in the left ALV at the next attempt in the same patient is a much rarer situation. We could not find any publication in the literature in which catheter malpositions were reported for the same patient.…”

“…In addition, complications such as infection, thrombosis, arrhythmia, entrapped guide wire and malposition may occur during and/or after the procedure 2,3 . The insertion of the hemodialysis catheter tip into the hepatic veins is a very rare condition 4 ; yet, the insertion of the hemodialysis catheter tip into the ascending lumbar vein (ALV) is a rarer condition 5 . Placement of CTHC first in the hepatic vein and then in the left ALV at the next attempt in the same patient is a much rarer situation.…”

Central venous catheters misplaced in paraspinal veins: A systematic literature review based on case reports

“…[40][41][42] In the present review, only 3 of 36 patients were reported to have received a US and/or undergone fluoroscopy to guide catheterization. 1,4,8 At the practical operational level, the above-mentioned image guidance techniques for LE catheterization have limited option ranges and unsatisfactory degrees of effectiveness. [43][44][45] The absence of real-time image guidance was an important technical cause of misplacement.…”