Central Venous Access through a Persistent left Superior Vena Cava: A Case Series

Abstract

A persistent left superior vena cava (PLSVC) is a rare, under-recognized congenital anomaly. The PLSVC is incidentally discovered during central venous access procedures when access is obtained from the left internal jugular vein. The vast majority of PLSVCs drain into the right atrium; however, it is critical to recognize a PLSVC that drains into the left atrium as it can predispose to systemic dispersion of emboli through bypassing the lungs. Additionally, PLSVC catheterization has also been previously reported to be associated with cardiac dysrhythmias, venous stenosis, coronary sinus thrombosis, cardiac tamponade, and cardiac arrest. This case review presents three cases which illustrate the viability and safety of a PLSVC for long-term central venous access in the setting of chemotherapy and hemodialysis. Ascertaining the drainage pattern of a PLSVC with venogram, echocardiography, computed tomography is paramount prior to long-term catheterization.

Persistence of left superior vena cava: a rare cause of hemodialysis tunneled catheter malposition

“…The persistent left SVC is a common congenital variation with no clinical significance, which is seen in 0.3% of healthy patients and 4.3% of patients with congenital heart disease 6,7 . The most common subtype of persistent left SVC results in the presence of both left and right SVCs 8,9 . More rarely, abnormalities of the embryological development lead to an absent right SVC with persistent left SVC, as previously described in both pediatric and adult patients [10][11][12][13][14][15][16] .…”

Persistent left superior vena cava identified by transesophageal echocardiography

“…PLSVC is the most common thoracic venous anomaly (Sarodia and Stoller, 2000). A predominant associated concern for the clinician is mechanical vascular damage by forceful manipulation, thrombosis, or cardiac arrest secondary to coronary sinus irritation (Zhou et al, 2016). Because PLSVC is largely asymptomatic, it is usually diagnosed incidentally.…”

Vascular access via translumbar Hemodialysis Reliable Outflow dialysis catheter in a case of severe central venous occlusion

“…The Journal of Vascular Access 19 (4) echocardiography and angiographic investigations prior to catheterization. 4 Kute VB et al 5 have also successfully demonstrated safe use of HD catheter into the PLSVC for 2 months.…”