Anatomy Revisited: Hemodialysis Catheter Malposition in the Left Ascending Lumbar Vein

2017 ◽  
Vol 44 (3) ◽  
pp. 206-209 ◽  
Author(s):  
Stefan Büttner ◽  
Sammy Patyna ◽  
Sarah Rudolf ◽  
Despina Avaniadi ◽  
Moritz Kaup ◽  
...  
Keyword(s):  
Position Control ◽  
Vena Cava ◽  
Iliac Vein ◽  
Chronic Hemodialysis ◽  
Hemodialysis Catheter ◽  
Catheter Malposition ◽  
Lumbar Vein ◽  
The Right ◽  
Tunneled Catheter ◽  
Ascending Lumbar Vein

In selected cases, cuffed tunneled catheters via the iliac vein are implanted as a last resort access for hemodialysis. To monitor the correct position, sonography of the inferior vena cava (IVC) is sufficient in most cases. Position control using an X-ray of the abdomen is not routinely recommended when femoral catheters are implanted. In this report, we describe the case of a 59-year-old patient on chronic hemodialysis due to granulomatosis with polyangiitis and complex shunt history with multiple shunt occlusions and revisions. The implantation of an iliac-cuffed tunneled catheter led to complications because the catheter was malpositioned into the left ascending lumbar vein (ALV). It is important to be aware of potential incorrect positioning of dialysis catheters into the ALV. Due to the anatomical relation to the IVC, this happens more frequently on the left side than on the right side. In case of doubt, the correct placement of large-bore catheters via iliac access route should be verified by means of appropriate imaging before hemodialysis is performed.

Safety and efficacy of placing internal jugular dialysis catheter tip in the inferior vena cava

2017 ◽  
Vol 18 (1) ◽  
pp. 79-81
Author(s):  
Michael A.M. Mayer ◽  
Vinaya Soundararajan ◽  
Ramesh Soundararajan
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Medical Records ◽  
Inferior Vena ◽  
Vena Cava ◽  
Chronic Hemodialysis ◽  
Vascular Intervention ◽  
Hemodialysis Catheter ◽  
Catheter Tip ◽  
The Right

Purpose To assess the efficacy and safety of placing the tip of the internal jugular (IJ) hemodialysis catheter in the inferior vena cava (IVC) in situations where it does not work well when placed in the right atrium. Methods The medical records of chronic hemodialysis patients at an outpatient vascular intervention facility were retrospectively reviewed. Out of the 831 patients who had dialysis catheters exchanged over a 4-year period, 13 patients were identified who underwent catheter exchanges where the tip of the catheter was placed in the IVC via the IJ approach. These were all patients where the catheters had poor flows when placed in the right atrium earlier. Results Adequate flow (>350 mL/min) was achieved in all 13 cases with the catheter placed in the IVC with no significant complications. Conclusions This study suggests that exchanging the catheter and placing the tip in the IVC is effective and safe in certain situations especially when the tip placement in the conventional position (i.e. the right atrium) does not work well.

Placement, Performance and Complications of the Ash Split Cath™ Hemodialysis Catheter

2002 ◽  
Vol 25 (12) ◽  
pp. 1137-1143 ◽  
Author(s):  
M. Gallieni ◽  
P.A. Conz ◽  
E. Rizzioli ◽  
A. Butti ◽  
D. Brancaccio
Keyword(s):  
Vascular Access ◽  
Good Alternative ◽  
Chronic Hemodialysis ◽  
Dialysis Session ◽  
Dialysis Dose ◽  
Hemodialysis Catheter ◽  
Venous Fistula ◽  
Tunneled Catheter ◽  
Urea Reduction Ratio

A tunneled catheter is the alternative vascular access for those patients in need of hemodialysis who cannot undergo dialysis through an arterio-venous fistula or a vascular graft. This study was undertaken to evaluate the performance of the Ash Split Cath™, a 14 French chronic hemodialysis catheter with D-shaped lumens and a Dacron® cuff. After tunneling through a transcutaneous portion the catheter enters the venous system, where it splits into two separate limbs. Data regarding catheter positioning, function and adequacy of dialysis were collected from two hemodialysis facilities. Twenty-eight Ash-split catheters were placed in 28 patients, with no complications, and immediate technical success was 100%. Patients were followed up for a total of 7,286 catheter days. No catheter-related infections were observed. Only one catheter failed after 15 days, with a primary catheter patency of 96% for the whole study length. Mean blood flow was 303 ± 20 ml/min at 1 week after insertion, 306 ± 17 ml/min at 3 months, 299 ± 44 ml/min at 6 months, and 308 ± 16 ml/min at 12 months. With a mean dialysis session duration of 234 ± 25 minutes, adequate dialysis dose was observed for 96% of catheters, as reflected by a mean urea reduction ratio (URR) of 71%±8 or a mean urea kinetic modeling, or Kt/V, value of 1.51±0.3 during follow up. In conclusion, compared with previous studies we report the best permanent catheter performance, confirming that the Ash-split catheter is a good alternative for vascular access in hemodialysis patients who are not candidates for surgical A-V fistula or graft placement.

Iliocaval Compression Syndrome

1987 ◽  
Vol 2 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Syde A. Taheri ◽  
Paul Nowakowski ◽  
David Pendergast ◽  
Julie Cullen ◽  
Steve Pisano ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Common Iliac Artery ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Iliac Vein ◽  
Venous Hypertension ◽  
Common Iliac Vein ◽  
Compression Syndrome ◽  
Extrinsic Compression ◽  
The Right

The iliocaval compression syndrome is a disorder, frequently found in young women, in which extrinsic compression of the left iliocaval junction produces signs and symptoms of lower extremity venous insufficiency. The anatomic variant which gives rise to this syndrome consists of compression of the left common iliac vein by the overlying right common iliac artery, near its junction with the vena cava. Additional reduction of outflow results from intraluminal venous webs and tight adhesions between the iliac artery and vein. Pain, swelling, pigmentation, and venous claudication characterize this syndrome, which affects predominantly the left leg. The syndrome may progress to iliofemoral thrombosis, phlegmasia cerulea dolens, and venous gangrene. Longstanding iliocaval stenosis may produce valvular incompetence. Exercise plethysmography is a non-invasive test useful in screening patients for iliocaval compression. The definitive diagnosis is made by venography, both ascending and descending, to determine the degree of outflow stenosis. Iliocaval patch angioplasty with retrocaval positioning of the right iliac artery, decreases venous hypertension and leads to improvement in the clinical condition. To date, we have performed iliocaval angioplasty, with retrocaval repositioning of the right common iliac artery, on 18 patients. Of these, 83% have had good results as determined by hemodynamic and clinical assessment.

Inferior Vena Caval Bullet Embolism

1996 ◽  
Vol 4 (3) ◽  
pp. 176-177
Author(s):  
Rajendar K Suri ◽  
Neerod K Jha ◽  
Virendar Sarwal ◽  
Arunanshu Behera ◽  
Ashok Attri ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Iliac Vein ◽  
Inferior Vena Caval ◽  
And Migration ◽  
The Right

We report a case of bullet penetration into the left iliac vein, with embolus into the inferior vena cava and migration up to the junction of the inferior vena cava and the right atrium. The bullet was subsequently extracted through laparotomy from the infrarenal segment of the inferior vena cava, just above its bifurcation.

scholarly journals A Case of Intravenous Leiomyomatosis Extending into the Right Ventricle through the Internal Iliac Vein and Inferior Vena Cava.

2001 ◽  
Vol 30 (1) ◽  
pp. 36-39
Author(s):  
Toshiaki Ohto ◽  
Masahisa Masuda ◽  
Naoki Hayashida ◽  
Yoko Pearce ◽  
Mitsuru Nakaya ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Ventricle ◽  
Inferior Vena ◽  
Vena Cava ◽  
Iliac Vein ◽  
Intravenous Leiomyomatosis ◽  
Internal Iliac Vein ◽  
Internal Iliac ◽  
The Right

Anatomy Revisited: Hemodialysis Catheter Malposition into the Chest

2018 ◽  
Vol 47 (1-3) ◽  
pp. 58-61
Author(s):  
Pan Xie ◽  
Kanfu Peng ◽  
Keqin Zhang ◽  
Hongwen Zhao ◽  
Yuxiu Sheng ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Chronic Hemodialysis ◽  
Catheter Position ◽  
Cross Sectional ◽  
Hemodialysis Catheter ◽  
Catheter Tip ◽  
And Migration ◽  
Wall Perforation ◽  
The Right

In most situations, central catheters are implanted in the right jugular vein as initial access for hemodialysis. However, after repeated punctures, the proximal vessels become stenosed and thrombosed and misplacement is likely to occur. Correct catheter position in the vein can be easily ascertained with X-ray or cross-sectional CT imaging. In this report, we describe the case of a 77-year-old patient on chronic hemodialysis via catheter due to arteriovenous fistula dysfunction. We placed a cuffed-tunneled hemodialysis catheter in the left internal jugular vein. Malpositioning of the catheter led to perforation of the great veins and migration of the catheter tip into the chest. It is important to be aware of the risk of potential incorrect positioning of dialysis catheters. Due to the stenosis and fragility of the vessel wall, perforation may occur. In cases of doubt, correct placement of large-bore catheters via the internal jugular vein should be verified by means of appropriate imaging before hemodialysis is performed.

Perforation of the Superior Vena Cava by a Subclavian Hemodialysis Catheter: Early Detection by Angiography

1992 ◽  
Vol 15 (11) ◽  
pp. 666-668 ◽  
Author(s):  
C.J. Kaupke ◽  
J. Ahdout ◽  
N.D. Vaziri ◽  
L.S. Deutsch
Keyword(s):  
Early Detection ◽  
Superior Vena ◽  
Vena Cava ◽  
Rapid Diagnosis ◽  
Clinical Suspicion ◽  
Dialysis Access ◽  
Hemodialysis Catheter ◽  
Catheter Tip ◽  
Catheter Malposition ◽  
Subclavian Catheter

A dual-lumen subclavian catheter was placed for temporary dialysis access in a 36-year-old woman. Clinical suspicion for a possible vena caval perforation by the catheter tip was confirmed by injection of contrast through the catheter. This technique allowed rapid diagnosis and prevented further potential complications related to catheter malposition.

scholarly journals Surgical treatment of intravenous leiomyomatosis involving the right heart: a case series

2019 ◽  
Vol 47 (7) ◽  
pp. 3465-3474
Author(s):  
Guangze Luo ◽  
Hongrui Pan ◽  
Jiaxue Bi ◽  
Yudong Luo ◽  
Jiechang Zhu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Iliac Vein ◽  
Right Atrial ◽  
Intravenous Leiomyomatosis ◽  
Right Heart ◽  
The Right

Objective This study was performed to investigate the surgical treatment of intravenous leiomyomatosis involving the right heart. Methods The clinical data of five patients with intracardiac leiomyomatosis treated from April 2002 to October 2017 at a single center were retrospectively analyzed. Results All five patients underwent successful intravenous and right atrial tumor removal via abdominal and inferior vena cava incisions. In three patients, these incisions were combined with thoracotomy and a right atrial incision, and in two patients, they were combined with uterine and bilateral fallopian tube and ovarian resection. One patient with advanced disease underwent a one-stage procedure and died thereafter. Of the remaining four patients who underwent follow-up for 1.5 to 12.0 years, one developed recurrence at 1 year postoperatively. The recurrent tumor, which was pathologically confirmed to be an intravenous leiomyoma, was removed via inferior vena cava and internal iliac vein incisions without subsequent recurrence. Conclusions The main treatment goal for inferior vena cava leiomyomas involving the right heart is to first address the severe obstruction of cardiac blood flow and then pursue second-stage surgery. Concurrent thoracotomy appears unnecessary because moderately sized right heart tumors can be gently removed via the inferior vena cava.

Sonographic demonstration of the right ascending lumbar vein

1982 ◽  
Vol 138 (2) ◽  
pp. 339-341
Author(s):  
A Manor ◽  
Y Itzchak ◽  
S Strauss ◽  
M Graif
Keyword(s):  
Lumbar Vein ◽  
The Right ◽  
Sonographic Demonstration ◽  
Ascending Lumbar Vein
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