Catheterisation of a persistent left superior vena cava

Area of Science:

• Cardiology
• Vascular Anatomy
• Nephrology

Background:

• End-stage renal disease (ESRD) necessitates renal replacement therapy, often via hemodialysis.
• Central venous catheterization, frequently through the internal jugular vein (IJV), is a common procedure for hemodialysis access.
• Congenital vascular anomalies can present challenges during medical interventions.

Observation:

• A 62-year-old female patient with ESRD presented with an incidentally detected persistent left superior vena cava (PLSVC).
• The PLSVC was identified during the insertion of a hemodialysis catheter via the left internal jugular vein.
• Diagnostic confirmation involved a left IJV cathetogram, CT thorax, and transthoracic echocardiography.

Findings:

• The persistent left superior vena cava was confirmed as a pre-existing anatomical variation.
• Hemodialysis catheter placement through the left IJV was technically feasible despite the anomaly.
• No immediate complications arose from the catheterization procedure.

Implications:

• Awareness of persistent left superior vena cava is crucial for clinicians performing central venous catheterizations, particularly in patients with ESRD.
• Accurate diagnosis through imaging modalities ensures safe procedural planning and execution.
• This case highlights the importance of recognizing congenital vascular anomalies to prevent potential iatrogenic complications.