Migration of jugular or subclavian venous catheters into inferior tributaries of the brachiocephalic veins or into the azygos vein, with possible complications

Currarino, Guido

doi:10.1007/bf01377198

Cited by 57 publications

(30 citation statements)

References 46 publications

(38 reference statements)

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“…The misplacement might lead to severe bleeding. [13] The knowledge of variation of the azygos system is also important during the surgery to repair the esophageal atresia. [14] It is possible to identify the gross anomalies like azygos continuation of inferior vena cava[15] and absence of superior vena cava.…”

Section: Discussionmentioning

confidence: 99%

A unique variation of azygos system of veins

Badagabettu

Shetty

D’Souza

2016

J Cardiovasc Echography

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Knowledge of variations of azygos and hemiazygos veins is of importance to cardiothoracic surgeons and radiologists during various surgical, radiological, and echography techniques. We report some unique variations of azygos system of veins observed during dissection classes for undergraduate medical students. The azygos vein was formed as usual by the union of right subcostal and ascending lumbar veins. The vein ascended upward and to the left to reach the midline at the level of the 9th thoracic vertebra. After ascending till 5th thoracic vertebra, it gradually inclined to the right of midline and terminated by opening into the superior vena cava at the level of the 3rd thoracic vertebra. There was no major variation in the tributaries of the azygos vein on the right side, except that the right superior intercostal vein crossed behind the azygos vein from right to left and opened into the left side of the azygos vein. Further, two anastomotic veins connected the 10th, 11th and 12th posterior intercostal veins with each other to form two anastomotic circles on the right side of 10th to 12th thoracic vertebrae. The hemiazygos vein bifurcated on the left side of the 10th thoracic vertebra and the two ends opened into the azygos vein at the level of 9th and 10th thoracic vertebrae forming a venous circle in front of the 10th thoracic vertebra. The course of accessory hemiazygos vein was noteworthy. Instead of its classic descending course, the vein ascended upward from the left side of the 8th thoracic vertebra till the 6th thoracic vertebra before opening into the azygos vein.

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Section: Discussionmentioning

confidence: 99%

A unique variation of azygos system of veins

Badagabettu

Shetty

D’Souza

2016

J Cardiovasc Echography

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“…Misposition of CVC may lead to complications including perforation [10], venous thrombosis and occlusion [19,26], extravasation of infusate [27], retrosternal or back pain [19,28], and trachea-azygos fistula formation [29]. Risk factors related to unintended AV misplacement of CVCs include left-sided catheter insertion [10,11], use of catheter with long or separated venous tips [11], catheter placement in a patient with fluid overload (high central venous pressure) [10], and absence of real-time radiological guidance [5].…”

Section: Discussionmentioning

confidence: 99%

Misplacement of Tunneled Hemodialysis Catheter into Azygos Vein: Left or Right Jugular Insertion Has Similar Susceptibility

Zhang

et al. 2019

Blood Purif

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Background: Central venous catheter (CVC) is commonly used to provide access for hemodialysis (HD) when arteriovenous access is not available. The misplacement of CVC into azygos vein (AV) is a rare but a potential serious complication. Previous reports communicated the opinion that left-sided catheterization predisposed to AV misplacement, but these reports concentrated on peripherally inserted CVCs, placed for indications rather than HD. Unintended AV misplacement of HD catheters (HDCs) has not been well studied. We seek to investigate factors associated with inadvertent AV miscannulation during HDC placement. Methods: We are to present a case of unintentional misplacement of a tunneled HD catheter (tHDC) into the azygos arch from right internal jugular vein (RIJV) despite real-time fluoroscopy guidance. Additionally, we have undertaken a systematic literature search in Pubmed to study the anatomical and other factors related to unintended AV misposition in HD setting. Results: From 2005 to August 31, 2018, a total of 11 articles containing 16 cases of misplacement of HDCs into AV were identified. Of the 17 cases of unintentional AV misposition including ours, the majority of the misguided HDCs (94.1%, 16/17) were tHDCs and only 1 case was related to a temporary (non-tunneled) catheter. Most catheter misplacements (88.2%, 15/17) were performed without real-time radiological guidance. The reported incidence of inadvertent AV cannulation from different institutions varied between 0.6% and 3.8%. Among the 16 misplaced tHDCs, the rates of AV misposition that arose from RIJV and left internal jugular vein (LIJV) insertion are even at 50%. Conclusions: Based upon anatomical and case studies, we have found that AV may join posterior aspect of superior vena cava at different directions and levels. Hence, this might explain why AV misplacement might occur whether an HDC is inserted from the LIJV or RIJV approach. By raising the awareness of this potential complication and how we may minimize it, we hope to reduce the future complication of AV misposition.

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“…Azygous cannulation has been associated with intermittent back pain [12]. Although most cases are resolved without complications, perforations of inadvertently cannulated veins, hemothorax, thrombosis, stenosis, and complete occlusion have been noted [9,13]. The exact position of the CVC cannot be determined with only posteroanterior chest radiographs.…”

Section: Discussionmentioning

confidence: 99%

Are we underestimating the frequency of malpositioned central venous catheters inserted via the left internal jugular vein? A case report and short review of literature

et al. 2010

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AbstractCentral venous cannulation is a widely used procedure in clinical medicine. Central venous catheters are inserted most often via the internal jugular and subclavian veins. One of the complications is malpositioning of the catheter, and some insertion sites carry a higher risk for that occurrence. We report a case of a malpositioned central venous catheter inserted via the left internal jugular vein in a patient with a ruptured diaphragm. Our objectives were to review the venous anatomy of the chest and the literature reporting malpositioned central venous catheters and to discuss the approach through the left internal jugular vein. Left internal jugular cannulation could carry a higher rate of malposition than reported, and anatomy gives a possible, simple answer. Contrast enhancement, although central venous catheters are radiopaque, is helpful when an approach through the left internal jugular vein is used and difficulties are encountered during insertion.

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Migration of jugular or subclavian venous catheters into inferior tributaries of the brachiocephalic veins or into the azygos vein, with possible complications

Cited by 57 publications

References 46 publications

A unique variation of azygos system of veins

A unique variation of azygos system of veins

Misplacement of Tunneled Hemodialysis Catheter into Azygos Vein: Left or Right Jugular Insertion Has Similar Susceptibility

Are we underestimating the frequency of malpositioned central venous catheters inserted via the left internal jugular vein? A case report and short review of literature

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