Knowledge of the Anomalies of the Big Central Veins Reduces the Morbidity during the Cannulation for Hemodialysis: Description of a Case of Persistent Left Superior Vena Cava and Revision of Literature

Abstract

The persistence of a left superior vena cava is the result of a lack of an embryological involution of the left anterior cardinal vein. This anomaly is very rare: about 0.3% of the general population. Its incidence increases remarkably from 3-10% in those patients affected with congenital heart disease. Described herein is a case of persistent left superior vena cava, discovered by chance, following the placement of a central venous catheter for hemodialysis. A chest X-ray in projection back-forward showed the central venous catheter along the left sternal margin simulating a placement in the aorta artery. This clinical picture, as described in the literature, is often accompanied by other anatomical anomalies, in our case, by the congenital agenesis of a solitary pelvic kidney. In agreement with the literature and in contrast with what has been reported recently, we sustain that a central venous catheter placed, for any reason, in the persistent left superior vena cava must be removed immediately because it can induce hyperkinetic arrhythmia and cardiac arrest as in our case. Our case report should be a warning that lack of awareness of the anomalies of the big central veins can cause a rise in morbidity.

Persistent left superior vena cava: Two case reports and a review from nephrologists’ perspective

“…6 There were not any vascular or perivascular traumatic complications associated with the procedure of catheter insertions, and only one catheter related complication, which was arrhythmia, was reported. 7 Catheters provided good blood flow in all patients after successful catheter placement throughout the course of case presentations. The durations of catheter use for hemodialysis were not provided in all, but ranged from 4 weeks to 15 months where available.…”

“…Nontunneled and/or tunneled hemodialysis catheters were able to be inserted either through the right or left IJVs without any significant difficulties or complications, except for one patient with an absent right SVC who had right subclavian catheter insertion following failed multiple attempts of right IJV catheterization . There were not any vascular or perivascular traumatic complications associated with the procedure of catheter insertions, and only one catheter related complication, which was arrhythmia, was reported . Catheters provided good blood flow in all patients after successful catheter placement throughout the course of case presentations.…”

“…Dionisio et al reported a case with PLSVC who developed clinically significant arrhythmia following catheter placement; hence they suggested that catheters should be removed immediately once PLSVC has been recognized. 7 However, arrhythmia can also occasionally occur in patients with normal venous anatomy of the thorax and it may be due to an inappropriate extension of the catheter tip into the right atrium. 9 In such cases, we attempt a slight withdrawal of the catheter, which has terminated arrhythmia almost in all patients.…”

“…Coronary sinus thrombosis is a rare and potentially fatal entity that has been associated with endovascular procedures in most cases according to a review by Yeo et al PLSVC catheterization has not been reported as a cause of coronary sinus thrombosis, but keeping the catheter tip above the coronary sinus could be an important precaution. Dionisio et al reported a case with PLSVC who developed clinically significant arrhythmia following catheter placement; hence they suggested that catheters should be removed immediately once PLSVC has been recognized . However, arrhythmia can also occasionally occur in patients with normal venous anatomy of the thorax and it may be due to an inappropriate extension of the catheter tip into the right atrium .…”

<p>Persistent Left Superior Vena Cava Identified After Hemodialysis Catheter Insertion: A Case Report</p>

“…7 Use of PLSVC as hemodialysis access was also associated with some complications, including arrhythmia, pericardial effusion, thrombus formation, and reduced blood flow to the heart. 7 , 15 - 17 However, literature reviews of the same case show the possibility of PLSVC being used as hemodialysis access in short- and long-term hemodialysis patients, certainly with tighter monitoring. 7 , 14 …”