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Navigating the Challenges of Persistent Left Superior Vena Cava in the Catheterization of Peripherally Inserted
Takeshi Nakayama1, Shinichiro Kobayashi1, Shunsuke Murakami1
1Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan.
Insights
Persistent left superior vena cava (PLSVC) is a rare anomaly that requires careful planning for central venous port insertion. Preoperative imaging is crucial for safe placement and to avoid complications in patients with PLSVC.
Area of Science:
- Cardiology
- Vascular Anatomy
- Medical Imaging
Background:
- Persistent left superior vena cava (PLSVC) is an uncommon congenital anomaly affecting 0.3%-0.5% of the population.
- Often asymptomatic, PLSVC can complicate cardiac procedures and alter cardiac anatomy due to an aberrant venous return pathway.
Observation:
- A 75-year-old male with esophageal cancer required a central venous port for treatment.
- Preoperative CT revealed PLSVC, with the catheter tip placed in the left SVC due to inability to access right arm vessels.
Findings:
- PLSVC necessitates meticulous preprocedural evaluation, including advanced imaging like 3D reconstructions.
- Radiographic guidance and echocardiography are vital for accurate placement and complication avoidance.
Implications:
- Early detection and detailed imaging are essential for safe peripherally inserted central catheter (PICC) port insertion in patients with PLSVC.
- Understanding PLSVC anatomy is critical for interventional cardiologists and radiologists performing central venous access procedures.
Introduction:
Persistent left superior vena cava (PLSVC), which is asymptomatic and occurs in 0.3%-0.5% of the general population, is typically detected incidentally but can complicate cardiac procedures owing to its potential to cause arrhythmias. This condition involves an additional venous return pathway to the right atrium, which can alter the cardiac anatomy and is associated with other cardiac aortic anomalies.
Case Presentation:
A 75-year-old male patient required a central venous port for chemotherapy and radiation therapy for mid-thoracic esophageal cancer. Preoperative computed tomography images revealed that the PLSVC ran ventrally to the aortic and left pulmonary arteries, directly communicating with the right atrium. A peripherally inserted central catheter (PICC) port was planned. The catheter tip of the PICC port was placed within the left superior vena cava instead of the more common right superior vena cava, because the appropriate vessels could not be identified in the right upper arm. This anomaly necessitated a review of findings on the preoperative imaging and underscored the importance of early detection through echocardiography and radiographic guidance to prevent procedural complications. Reconstructed three-dimensional images and radiography-guided catheterization support the navigation of PICC port insertion.
Conclusions:
PLSVC, which is often asymptomatic, requires careful preprocedural planning and imaging to ensure safe PICC port insertion.
