Long term central venous catheters for haemodialysis causing an extra-cardiac right-to-left shunt

Area of Science:

• Nephrology
• Vascular Surgery
• Cardiology

Background:

• Central venous catheters (CVCs) are crucial for long-term haemodialysis access when arteriovenous fistulas or grafts are not feasible.
• Complications of long-term CVC use include central venous stenosis and potentially life-threatening superior vena cava (SVC) obstruction.

Observation:

• A case study of a patient with over 20 years of haemodialysis via CVCs.
• Chronic SVC obstruction developed, leading to the formation of mediastinal collateral vessels.

Findings:

• Mediastinal collaterals created an abnormal pathway, shunting deoxygenated systemic venous blood into the pulmonary venous system.
• This resulted in a significant acquired, extra-cardiac, right-to-left shunt and subsequent hypoxemia.

Implications:

• Highlights a novel and severe complication of long-term CVC use in haemodialysis.
• Underscores the importance of monitoring for SVC obstruction and its sequelae in patients with long-term CVCs.
• Suggests potential for acquired intracardiac shunts due to vascular complications.