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Xiong Y, Zhao Q, Yu Y, Cui T. A 4-year tunneled hemodialysis catheter malpositioned into the azygos vein and how to remedy the hemodialysis circuit. J Vasc Access 2024:11297298231223108. [PMID: 38197201 DOI: 10.1177/11297298231223108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Mispositioning in the azygos vein is a rare but hazardous complication of central venous catheterization. A patient was admitted for a dysfunctional hemodialysis tunneled cuffed catheter (TCC) placed in the azygos vein for 4 years. Computed tomography angiography revealed multiple sites of occlusion, including the superior vena cava (SVC), right and left innominate veins (IVs), and right femoral vein. Percutaneous transluminal angioplasty and a TCC replacement based on a segment-by-segment recanalizing strategy were performed. First, an 8-Fr sheath was inserted through the left femoral vein approach to retrogradely traverse the occlusive SVC followed by a guidewire extending to the occlusive left IV. A left transjugular 15-cm snare was inserted to capture the transfemoral guidewire and achieve recanalization from the left IV to the SVC. Second, a transjugular guidewire was advanced through the dysfunctional TCC yet shunted into the left IV due to the inability to cross the SVC. A left transfemoral 15-cm snare was inserted to capture the guidewire and achieve complete recanalization from the right internal jugular vein to the SVC. Balloons were passed over the guidewires to dilate the obstructive lesions sequentially, and a new TCC was inserted successfully with the tip positioned in the right atrium.
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Affiliation(s)
- Yuqin Xiong
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
- Department of Nephrology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qiuyan Zhao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Yang Yu
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Tianlei Cui
- Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
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2
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Wang M, Xu L, Feng Y, Gong S. Misplacement of a central venous catheter into azygos vein via the right internal jugular vein. J Vasc Access 2020; 22:1004-1007. [PMID: 32787623 DOI: 10.1177/1129729820950996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
For critically ill patients, central venous catheterization may not always be placed in a correct tip position, even when guided by ultrasound. A case of inadvertent catheterization into azygos vein is described.
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Affiliation(s)
- Minjia Wang
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China
| | - Liang Xu
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China
| | - Yue Feng
- Department of Radiology, Zhejiang Hospital, Hangzhou, China
| | - Shijin Gong
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China
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3
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Cao D, Shen Z, Gui Q, He Y. Misplacement of the tunnel hemodialysis catheter through the left jugular vein to the azygos vein: A case report. Medicine (Baltimore) 2020; 99:e19805. [PMID: 32282745 PMCID: PMC7220763 DOI: 10.1097/md.0000000000019805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The percutaneous catheterization of central veins is widely applied in patients with end-stage renal diseases as a permanent vascular access. To our knowledge, inadvertent placement of a hemodialysis catheter into the azygos vein through the left internal jugular vein is not described. PATIENT CONCERNS A 72-year-old female patient was admitted to the hospital for replacement of another new tunneled hemodialysis catheter due to poor flow in the left internal jugular vein tunneled catheter during hemodialysis. DIAGNOSIS The catheter tip was incorrectly positioned into the azygos vein as confirmed by conventional anteroposterior and lateral chest radiographs. INTERVENTIONS The catheter was removed and replaced under Digital Subtraction Angiography. OUTCOMES The catheter tip was finally placed in the proper position. LESSIONS The insertion of central vein catheterization is not always in suitable position especially through left jugular vein in hemodialysis patients. DSA technology should be performed to confirm the correct position of the tip and to ensure good blood flow.
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Kampouroglou G, Noutsos G, Skandalakis P, Mirilas P. Azygos vein cannulation after catheterisation of the left internal jugular vein in a toddler. BMJ Case Rep 2019; 12:12/1/bcr-2018-227930. [PMID: 30659011 DOI: 10.1136/bcr-2018-227930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Central venous catheterisation is routinely performed in paediatric patients to facilitate therapeutic management when long-term vascular access is needed. Misplacement of the catheter tip in thoracic vessels other than the superior vena cava has been described, along with related complications. Hereby, a case of a 15-month-old child is presented with a fully functional Hickman catheter introduced via the left internal jugular vein. The tip of the catheter was misplaced into the azygos vein. Intraoperative spot fluoroscopic images and anatomical explanations for the course of the catheter are presented. An understanding of the aetiology of the radiological appearance may help to increase recognition of such cases and avoid complications.
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Affiliation(s)
- Georgios Kampouroglou
- Department of Pediatric Surgery, Geniko Nosokomeio Paidon Agia Sofia, Athens, Greece
| | - Georgios Noutsos
- Department of Anesthesiology, Geniko Nosokomeio Paidon Agia Sofia, Athens, Greece
| | - Panagiotis Skandalakis
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Mirilas
- Department of Surgery, Emory University, Atlanta, Georgia, USA
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Zhu LN, Mou LJ, Ying-Hu, Wei GN, Sun JF. Failure to place a tunneled hemodialysis catheter due to malformation of right internal jugular vein draining to subclavian vein. J Int Med Res 2018; 46:2481-2485. [PMID: 29690817 PMCID: PMC6023040 DOI: 10.1177/0300060518766649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/01/2018] [Indexed: 11/15/2022] Open
Abstract
The right internal jugular vein (IJV) is an important access site for hemodialysis catheterization. Venous cannulation failure is usually caused by central venous stenosis and is rarely related to vessel malformation. We herein present a case of failure to place a tunneled hemodialysis catheter into the right IJV. The patient had an arteriovenous fistula in the right arm with inadequate flow and a history of multiple central venous catheterizations. The guidewire was repeatedly misplaced into the right subclavian vein (SV) regardless of the technique used. Computed tomography venography revealed that the inferior segment of the right IJV drained into the ipsilateral SV. To the best of our knowledge, this is the first report of catheterization failure due to abnormal drainage of the right IJV into the ipsilateral SV.
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Affiliation(s)
- Li-na Zhu
- Department of Nephrology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li-jun Mou
- Department of Nephrology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying-Hu
- Department of Nephrology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gui-na Wei
- Department of Nephrology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun-feng Sun
- Department of Anesthesiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Mou LJ, Wang SH, Li QH, Zhang RS, Pan NZ, Wang JF. Malpositioning of a Tunneled Hemodialysis Catheter into the Azygos Vein: A Case Report and Literature Review. Blood Purif 2017; 44:108-109. [DOI: 10.1159/000475593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/06/2017] [Indexed: 11/19/2022]
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Sampathkumar K, Prabhakar A, Saravanan R, Nayak MA. Misplaced tunneled catheter into azygos vein. Indian J Nephrol 2015; 25:384-5. [PMID: 26664219 PMCID: PMC4663781 DOI: 10.4103/0971-4065.147767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- K Sampathkumar
- Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
| | - A Prabhakar
- Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
| | - R Saravanan
- Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
| | - M A Nayak
- Department of Nephrology, Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu, India
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Aoyama K, Takenaka I. In reply: Ultrasound-guided internal jugular vein cannulation: a novel technique for confirming that the guidewire is directed towards the right atrium. Can J Anaesth 2015; 63:364. [PMID: 26511283 DOI: 10.1007/s12630-015-0519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Kazuyoshi Aoyama
- Department of Anesthesia, Kitakyushu General Hospital, Kitakyushu, Japan.
| | - Ichiro Takenaka
- Department of Anesthesia, Kyushu Rosai Hospital, Kitakyushu, Japan
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9
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Ultrasound-guided internal jugular vein cannulation: a novel technique for confirming that the guidewire is directed towards the right atrium. Can J Anaesth 2015; 63:362-3. [PMID: 26507534 DOI: 10.1007/s12630-015-0518-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 09/24/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022] Open
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Weber E, Liberek T, Wołyniec W, Rutkowski B. Catheter tip malposition after percutaneous placement of tunneled hemodialysis catheters. Hemodial Int 2015; 19:509-13. [DOI: 10.1111/hdi.12303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ewa Weber
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
| | - Tomasz Liberek
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
| | - Wojciech Wołyniec
- Department of Occupational and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
| | - Bolesław Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
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Weber E, Wołyniec W, Liberek T. Please, take X-ray! Hemodial Int 2014; 18:563-4. [PMID: 24698094 DOI: 10.1111/hdi.12146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Ewa Weber
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Poland
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