Venobronchial Fistula: An Unusual Complication of Long-Term Central Venous Access

Abstract

A venobronchial fistula developed between the azygous vein and the upper aspect of the right main bronchus 12 months after completion of the treatment of a stage IIIB non-small-cell lung cancer in a 54-year-old man. The fistula contained the tip of the catheter placed for chemotherapy perfusion. The reported case presented risk factors previously identified for such a complication. In addition, some clinical particularities were present, suggesting new potent risk factors and some preventive means for safe long-term central venous catheterization.

Leaking stent leading to a venous-bronchial fistula

“…Venous-bronchial fistula is an extremely rare finding and often caused by long-term central venous catheters (CVCs). [ 1 ] The possible mechanism is friction between the catheter tip and vessel wall by withdrawing blood or by vessel wall irritation with chemotherapy or hyperalimentation agents. [ 2 3 4 ] Malposition of CVC in the azygos vein is another reportable cause of fistula.…”

Central Venous Line Placement in the Superior Vena Cava and the Azygos Vein: Differentiation on Posteroanterior Chest Radiographs

“…Optimal placement of the tip is in the SVC or upper right atrium [4]. Complications associated with central venous lines can include mechanical and chemical injury to the vessel wall with thrombus formation [4,5], development of a fibrin sheath around the central venous line tip [5], venobronchial fistula [6], infection [7], and misplacement or migration into other vessels, including the azygos vein. In one study, investigators found azygos malposition in 0.7% of central venous lines [8]; in another study, the rate was 1.2% [9].…”

Uncommon Complications of Long‐Term Hemodialysis Catheters: Adhesion, Migration, and Perforation by the Catheter Tip

“…Management demands a group (pulmonologist, cardiothoracic surgeon, interventional radiology/nephrology) consensus to be taken. The perforating catheter segment if situated proximally can be removed by bronchoscopy (endoluminal section of the tip) with subsequent placement of a stent (6) or removed during thoracotomy. Keeping in mind the possibility of hemoptysis, the catheter maybe removed (nonsurgically) in an operating room with the patient lying on the ipsilateral side to prevent blood entering the contralateral lung (7) or using a Fogarty bronchial occlusion catheter to cordon off the bleeding (4).…”

“…Clinical features with regard to catheter tip embolization have ranged from being asymptomatic to development of various complications (discussed later). Venobronchial perforations have occurred predominantly with left‐sided central venous catheters (CVCs) (4–8). Clinical features include cough, chest pain, dyspnea, hypoxemia, pneumonitis, and a peculiarly unpleasant odor if medication is given at the time of symptoms through the catheter (4,5).…”

“…The management of venobronchial perforation (as in our case) is complicated not only by the fact that two structures have been perforated (vein and bronchus) but also by potential complications that arise with removal of the catheter, namely uncontrolled hemoptysis, air embolism, and pneumo‐ or hemothorax (4,5,7). Usually the perforation involves the proximal portion of the SVC (just below the confluence of R and L BC veins) and therefore misses the pericardium (6). While there are cases caused by CVCs, we are unaware of such a perforation caused by dialysis catheters.…”