Catheterization of a persistent left superior vena cava

Area of Science:

• Cardiovascular Medicine
• Medical Imaging
• Vascular Surgery

Background:

• Persistent left superior vena cava (PLSVC) is the most common anomaly of thoracic vessels, occurring in 0.3-0.5% of the population.
• PLSVC arises from the incomplete involution of an embryological vein during fetal development.
• Understanding PLSVC is crucial for interventional procedures involving central veins.

Observation:

• A 50-year-old hemodialysis patient presented with a revealed PLSVC during left internal jugular vein catheterization.
• The anomaly was identified during the process of placing a catheter for hemodialysis treatment.
• Initial catheterization confirmed the presence of PLSVC, necessitating further evaluation.

Findings:

• Catheterization of PLSVC is considered safe when there is adequate drainage into the right atrium.
• In this case, successful hemodialysis was achieved after confirming sufficient venous return to the right atrium.
• A cuffed tunneled hemodialysis catheter was safely placed and utilized post-confirmation of drainage.

Implications:

• This case highlights the feasibility and safety of using PLSVC for central venous access in hemodialysis patients.
• It underscores the importance of pre-procedural imaging and assessment of venous drainage in patients with suspected or confirmed PLSVC.
• Successful management strategies can be developed for hemodialysis patients with this vascular anomaly.