Therapeutic strategy of central vein perforation accompanied by a mediastinal lesion after catheterization

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Nephrology

Background:

• Central vein perforation is a rare but serious complication during central venous catheterization, particularly in patients requiring hemodialysis.
• Chronic kidney disease necessitates long-term hemodialysis, increasing the risk of vascular access procedures and associated complications.

Observation:

• A 50-year-old woman undergoing hemodialysis experienced central vein injury during attempted double-channel catheter placement.
• Imaging revealed catheter perforation of the central vein into the mediastinum.

Findings:

• A multidisciplinary team opted for a minimally invasive approach: percutaneous catheter thrombin injection followed by fluoroscopically guided balloon dilatation.
• This combined technique successfully sealed the central vein perforation.

Implications:

• This case highlights a successful endovascular management strategy for central vein perforation, a potentially life-threatening complication.
• The findings suggest that percutaneous thrombin injection and balloon dilatation can be an effective alternative to surgical repair in select cases.
• Further research into endovascular techniques for managing central venous injuries is warranted.