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

Abstract

Introduction Central venous catheter (CVC) insertion is the most commonly performed clinical procedure when a patient initiates hemodialysis. Despite its clinical benefits, CVC insertion has several risks of complications. Thrombosis, venous stenosis, infection, arrhythmia, pneumothorax, and bleeding are among these complications. Malposition of the tip of the CVC can also occur with an incidence of up to 7%. One of several factors that could contribute to malposition is venous anatomy variation. Persistent left superior vena cava (PLSVC) is an extremely rare venous anatomical disorder but might have a significant clinical impact. Case Presentation Here we report a PLSVC case that was identified in chest radiography after the insertion of a CVC catheter in a patient with end-stage renal disease (ESRD). A 40-year-old woman with a history of type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity was presented in the emergency room with dyspnea for 1 week. Acute hemodialysis was required because of the ESRD and pulmonary edema. The PLSVC condition accompanied by various complications that occurred in this patient became a dilemma for the nephrologist in determining the diagnosis and proper CVC management. Discussion PLSVC is the most common congenital abnormality of the vena cava, even though it has a very small incidence. PLSVC occurs in about 0.1–0.5% of the total population and reaches 10% in individuals with congenital heart abnormalities. Most PLSVC presents along with normal superior vena cava and drains into the right atrium, which makes it very difficult to see the clinical signs and symptoms. Almost all PLSVC conditions are found incidentally during or after invasive procedures such as CVC insertion. CVC insertion in the PLSVC condition needs proper management to minimize the risk of complications. Conclusion This case shows the importance of understanding the PLSVC condition, which, although very rare, is expected to increase the awareness of the nephrologist in making the diagnosis, determining appropriate management, and preventing complications, thereby improving patient safety.

Accidental Detection of Persistent Left Superior Vena Cava During Central Venous Port Placement

“…In one of the 21 cases, recurrent cerebral embolism associated with PLSVC drainage into the left atrium was observed [ 12 ]. PLSVC catheterization has been reported to be associated with arrhythmia, venous stenosis, thrombosis, cardiac tamponade, and cardiac arrest [ 10 , 13 ]. Therefore, the feasibility of long-term catheterization in PLSVC should be carefully determined [ 9 , 10 , 12 , 13 ].…”

“…PLSVC catheterization has been reported to be associated with arrhythmia, venous stenosis, thrombosis, cardiac tamponade, and cardiac arrest [ 10 , 13 ]. Therefore, the feasibility of long-term catheterization in PLSVC should be carefully determined [ 9 , 10 , 12 , 13 ].…”

Double Superior Vena Cava Due to Persistent Left Superior Vena Cava Incidentally Identified on Central Venous Catheterization: A Case Report

“…In some cases, the right-sided SVC is absent, and in other cases the left brachiocephalic vein is absent [ 7 – 9 ]. Anatomical SVC variation is typically asymptomatic but may complicate clinical intravascular procedures such as central line placement [ 10 ], hemodialysis catheterization [ 11 ], Swan-Ganz catheterization [ 12 ], and pacemaker implantation [ 13 , 14 ]. This report presents the case of a 40-year-old man with an incidental finding of double SVC due to PLSVC identified on hospital admission following a motor vehicle collision.…”