Central venous catheters in the left-sided superior vena cava: clinical implications

Left-sided superior vena cava (LSVC) is a congenital venous anomaly with an incidence of about 0.3%, and which is sometimes discovered during vascular intervention [Le Cat. Histoire de l'acadroyale des sciences .Paris 1738:62, I Steinberg, W Dubilier, D Lucas. Persistence of left superior vena cava. Dis Chest 1953;24:479-88]. There is little clear guidance on what to do in this event.

Children with LSVC were identified from our prospectively collected database of percutaneous central venous catheter (CVC) insertions between 2004 and 2011. If a LSCV was suspected, usually a venogram was performed. All available documentation was reviewed to identify complications.

Eleven children with LSVC had 12 CVCs during the study period. Mean age at operation was 5.8 years (range 27 days to 15 years). Cardiovascular anomalies were already known in three cases. After CVC insertion, the line tip lay in the LSVC in eight cases and in the RA in 4. In 11 cases there was no immediate problem, but in 1 case there were postoperative bradyarrhythmias, which caused the CVC to be removed on day 1. This case was later found to have abdominal sepsis. The mean duration the CVCs were retained was 331days (range 1 day to 4 years). Other reasons for CVC removal were infection (n=1), damaged line (n=2), no longer required (n=2), and death unrelated to CVC (n=2).

Our experience suggests that a LSVC (i) is often first discovered during CVC insertion, (ii) can be safely used for parenteral nutrition or chemotherapy, and (iii) the best practice would be to leave the CVC tip high in the LSVC or in the RA via another route.