Severe hemorrhage because of delayed iliac vein rupture after dialysis catheter placement: Is it preventable?

Abstract

Mechanical complications of femoral catheterization for hemodialysis include pseudoaneurysm, arteriovenous fistulae, neurological injury, and vessel perforation. With regard to the latter, severe hemorrhage is a rare but devastating and potentially fatal complication. We report the case of a 76-year-old female who underwent femoral catheterization for hemodialysis using ultrasound guidance. The first hemodialysis session was conducted without incident. Unfortunately, inadvertent injury and delayed perforation of the iliac vein resulted in severe hemorrhage and retroperitoneal hematoma. Surgical repair was performed. The patient was asymptomatic after the procedure and was discharged 15 days later. Based on this case and a review of the literature, we present mechanisms and ways to prevent this complication.

Temporary hemodialysis catheters: recent advances

“…Nonetheless, serious and even fatal complications related to femoral hemodialysis catheter insertion have been reported with the incidence of severe hemorrhage (usually retroperitoneal) estimated at 0.5%. 10 One study by Prabhu et al 11 randomized 110 patients to real-time ultrasound-guided anatomic landmark-guided insertion of a femoral NTHC. The use of real-time ultrasound resulted in significantly better ‘first attempt' and overall success rates compared with the use of anatomic landmarks alone: 85.5% vs. 54.5% ( P <0.001) and 98.2% vs. 80% ( P =0.002), respectively.…”

Intraperitoneally Located Tip of Femoral Vein Catheter; Clinical Suspicion for Avoidance of Unnecessary Laparotomy

“…This kind of fluid extravasation could lead to raised intraabdominal pressure, which is called abdominal compartment syndrome (ACS) ( 2 ). Severe hemorrhage and retroperitoneal hematoma occurred as a late onset complication in a case presented by Sirvent et al This kind of late onset complication is very rare and in case reports, it is more prevalent in jugular or subclavian veincatheterization territories, especially on the left side and with larger catheters ( 7 ). In another case report, the same complication occurred in an elderly patient after 3 successful consecutive hemodialysis.…”

Patency durability of non-tunneled hemodialysis' catheter in adult patients with chronic kidney disease stadium 5 with diabetes mellitus and non-diabetes mellitus

“…severe bleeding, typically retroperitoneal, occurs in approximately 0.5% of femoral insertions. 20 Infection in the vascular access is an infection that occurs as a primary infection that occurs in the vascular access as evidenced by clinical signs of fever >38.0 °c, chills or, hypotension accompanied by evidence of infection in the blood that is not associated with infection elsewhere. Infection can occur due to various factors whose relationship has not been explained, but it is known that dM is also a factor that influences the occurrence of infection in temporary catheters.…”