Videothoracoscopic-guided management of a central vein perforation during hemodialysis catheter placement

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Vascular Access

Background:

• Iatrogenic injuries to central veins can occur during vascular access procedures.
• Central vein lesions pose risks of significant hemorrhage and complications.
• Traditional repair methods may involve open surgery, increasing patient morbidity.

Observation:

• A perforation occurred at the confluence of the right innominate vein and superior vena cava during dialysis catheter placement.
• The catheter tip was found misplaced in the right pleural space.
• Prompt identification of the misplacement was crucial.

Findings:

• Successful repair of the central vein perforation was achieved using a videothoracoscopic approach.
• Catheter removal under direct vision with mediastinal tamponade prevented massive bleeding.
• The minimally invasive technique effectively managed the iatrogenic injury.

Implications:

• Videothoracoscopy offers a viable, less invasive alternative for managing central vein perforations.
• This approach can reduce operative time and patient recovery periods.
• Highlights the importance of vigilant monitoring during central venous catheterization.